{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T09:39:24Z","timestamp":1790501964024,"version":"4.1.0"},"reference-count":29,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,12,1]]},"abstract":"<jats:p>OBJECTIVE: The objective of this study was to determine whether Apgar scores at 10 minutes are associated with death or disability in early childhood after perinatal hypoxic-ischemic encephalopathy.<\/jats:p><jats:p>METHODS: This was a secondary analysis of infants who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network hypothermia trial. Infants who were born at \u226536 weeks\u2019 gestation and had clinical and\/or biochemical abnormalities at birth and encephalopathy at &amp;lt;6 hours were studied. Logistic regression and classification and regression-tree analysis were used to determine associations between Apgar scores at 10 minutes and neurodevelopmental outcome, adjusting for covariates. Death or disability (moderate or severe) at 18 to 22 months of age was the measured outcome.<\/jats:p><jats:p>RESULTS: Twenty of 208 infants were excluded (missing data). More than 90% of the infants had Apgar scores of 0 to 2 at 1 minute, and Apgar scores at 5 and 10 minutes shifted to progressively higher values; at 10 minutes, 27% of infants had Apgar scores of 0 to 2. After adjustment, each point decrease in Apgar score at 10 minutes was associated with a 45% increase in the odds of death or disability. Death or disability occurred in 76%, 82%, and 80% of infants with 10-minute Apgar scores of 0, 1, and 2, respectively. Classification and regression-tree analysis indicated that Apgar scores at 10 minutes were discriminators of outcome.<\/jats:p><jats:p>CONCLUSIONS: Apgar scores at 10 minutes provide useful prognostic data before other evaluations are available for infants with hypoxic-ischemic encephalopathy. Death or moderate\/severe disability is common but not uniform with Apgar scores of &amp;lt;3; caution is needed before adopting a specific time interval to guide duration of resuscitation.<\/jats:p>","DOI":"10.1542\/peds.2009-0934","type":"journal-article","created":{"date-parts":[[2009,11,30]],"date-time":"2009-11-30T12:27:49Z","timestamp":1259584069000},"page":"1619-1626","source":"Crossref","is-referenced-by-count":142,"title":["Outcome of Term Infants Using Apgar Scores at 10 Minutes Following Hypoxic-Ischemic Encephalopathy"],"prefix":"10.1542","volume":"124","author":[{"given":"Abbot R.","family":"Laptook","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Women & Infants\u2019 Hospital of Rhode Island, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seetha","family":"Shankaran","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wayne State University, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namasivayam","family":"Ambalavanan","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Alabama, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waldemar A.","family":"Carlo","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Alabama, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary D.","family":"Higgins","sequence":"additional","affiliation":[{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhik","family":"Das","sequence":"additional","affiliation":[{"name":"Statistics and Epidemiology Unit, RTI International, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Hypothermia Subcommittee of the NICHD Neonatal Research Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2009,12,1]]},"reference":[{"key":"2021120905221464600_R1","doi-asserted-by":"crossref","unstructured":"Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg.\u20081953;32(4):260\u2013267","DOI":"10.1213\/00000539-195301000-00041"},{"key":"2021120905221464600_R2","doi-asserted-by":"crossref","unstructured":"Apgar V, Holaday DA, James LS, Weisbrot IM, Berrien C. Evaluation of the newborn infant: second report. J Am Med Assoc.\u20081958;168(15):1985\u20131988","DOI":"10.1001\/jama.1958.03000150027007"},{"key":"2021120905221464600_R3","unstructured":"Drage JS, Kennedy C, Schwarz BK. The Apgar score as an index of neonatal mortality: a report from the Collaborative Study of Cerebral Palsy. Obstet Gynecol.\u20081964;24:222\u2013230"},{"key":"2021120905221464600_R4","doi-asserted-by":"crossref","unstructured":"Bharti B, Bharti S. A review of the Apgar score indicated that contextualization was required within the contemporary perinatal and neonatal care framework in different settings. J Clin Epidemiol.\u20082005;58(2):121\u2013129","DOI":"10.1016\/j.jclinepi.2004.04.012"},{"key":"2021120905221464600_R5","doi-asserted-by":"crossref","unstructured":"O'Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ. Interobserver variability of the 5-minute Apgar score. J Pediatr.\u20082006;149(4):486\u2013489","DOI":"10.1016\/j.jpeds.2006.05.040"},{"key":"2021120905221464600_R6","doi-asserted-by":"crossref","unstructured":"Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med.\u20082001;344(7):467\u2013471","DOI":"10.1056\/NEJM200102153440701"},{"key":"2021120905221464600_R7","unstructured":"American Academy of Pediatrics; American Heart Association. Neonatal Resuscitation Textbook. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006"},{"key":"2021120905221464600_R8","doi-asserted-by":"crossref","unstructured":"Nelson KB, Ellenberg JH. Apgar scores as predictors of chronic neurologic disability. Pediatrics.\u20081981;68(1):36\u201344","DOI":"10.1542\/peds.68.1.36"},{"key":"2021120905221464600_R9","doi-asserted-by":"crossref","unstructured":"The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: neonatal resuscitation. Pediatrics.\u20082006;117(5). Available at: www.pediatrics.org\/cgi\/content\/full\/117\/5\/e978","DOI":"10.1542\/peds.2006-0350"},{"key":"2021120905221464600_R10","doi-asserted-by":"crossref","unstructured":"Harrington DJ, Redman CW, Moulden M, Greenwood CE. The long-term outcome in surviving infants with Apgar zero at 10 minutes: a systematic review of the literature and hospital-based cohort. Am J Obstet Gynecol.\u20082007;196(5):463.e1\u2013463.e5","DOI":"10.1016\/j.ajog.2006.10.877"},{"key":"2021120905221464600_R11","doi-asserted-by":"crossref","unstructured":"Shankaran S, Laptook AR, Ehrenkranz RA, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med.\u20082005;353(15):1574\u20131584","DOI":"10.1056\/NEJMcps050929"},{"key":"2021120905221464600_R12","doi-asserted-by":"crossref","unstructured":"Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol.\u20081976;33(10):696\u2013705","DOI":"10.1001\/archneur.1976.00500100030012"},{"key":"2021120905221464600_R13","unstructured":"Breiman L, Friedman JH, Olshen RA. Classification and Regression Trees. Belmont, CA: Wadsworth; 1984"},{"key":"2021120905221464600_R14","unstructured":"Steinberg D, Colla P. Classification and Regression Tree: Supplementary Manual for Windows. San Diego, CA: Salford Systems; 1997"},{"key":"2021120905221464600_R15","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics, Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists and Committee on Obstetric Practice. The Apgar score. Pediatrics.\u20082006;117(4):1444\u20131447","DOI":"10.1542\/peds.2006-0325"},{"key":"2021120905221464600_R16","doi-asserted-by":"crossref","unstructured":"Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T. The association of Apgar score with subsequent death and cerebral palsy: a population-based study in term infants. J Pediatr.\u20082001;138(6):798\u2013803","DOI":"10.1067\/mpd.2001.114694"},{"key":"2021120905221464600_R17","doi-asserted-by":"crossref","unstructured":"Thorngren-Jerneck K, Herbst A. Low 5-minute Apgar score: a population-based register study of 1 million term births. Obstet Gynecol.\u20082001;98(1):65\u201370","DOI":"10.1016\/S0029-7844(01)01370-9"},{"key":"2021120905221464600_R18","doi-asserted-by":"crossref","unstructured":"Thorngren-Jerneck K, Herbst A. Perinatal factors associated with cerebral palsy in children born in Sweden. Obstet Gynecol.\u20082006;108(6):1499\u20131505","DOI":"10.1097\/01.AOG.0000247174.27979.6b"},{"key":"2021120905221464600_R19","doi-asserted-by":"crossref","unstructured":"Moster D, Lie RT, Markestad T. Joint association of Apgar scores and early neonatal symptoms with minor disabilities at school age. Arch Dis Child Fetal Neonatal Ed.\u20082002;86(1):F16\u2013F21","DOI":"10.1136\/fn.86.1.F16"},{"key":"2021120905221464600_R20","doi-asserted-by":"crossref","unstructured":"Nelson KB, Ellenberg JH. Obstetric complications as risk factors for cerebral palsy or seizure disorders. JAMA.\u20081984;251(14):1843\u20131848","DOI":"10.1001\/jama.251.14.1843"},{"key":"2021120905221464600_R21","doi-asserted-by":"crossref","unstructured":"Freeman JM, Nelson KB. Intrapartum asphyxia and cerebral palsy. Pediatrics.\u20081988;82(2):240\u2013249","DOI":"10.1542\/peds.82.2.240"},{"key":"2021120905221464600_R22","doi-asserted-by":"crossref","unstructured":"Koppe JG, Kleiverda G. Severe asphyxia and outcome of survivors. Resuscitation.\u20081984;12(3):193\u2013206","DOI":"10.1016\/0300-9572(84)90006-6"},{"key":"2021120905221464600_R23","doi-asserted-by":"crossref","unstructured":"Jain L, Ferre C, Vidyasagar D, Nath S, Sheftel D. Cardiopulmonary resuscitation of apparently stillborn infants: survival and long-term outcome. J Pediatr.\u20081991;118(5):778\u2013782","DOI":"10.1016\/S0022-3476(05)80046-0"},{"key":"2021120905221464600_R24","doi-asserted-by":"crossref","unstructured":"Socol ML, Garcia PM, Riter S. Depressed Apgar scores, acid-base status, and neurologic outcome. Am J Obstet Gynecol.\u20081994;170(4):991\u2013998; discussion 998\u2013999","DOI":"10.1016\/S0002-9378(94)70092-3"},{"key":"2021120905221464600_R25","doi-asserted-by":"crossref","unstructured":"Thornberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia: incidence, clinical course and outcome in a Swedish population. Acta Paediatr.\u20081995;84(8):927\u2013932","DOI":"10.1111\/j.1651-2227.1995.tb13794.x"},{"key":"2021120905221464600_R26","doi-asserted-by":"crossref","unstructured":"Casalaz DM, Marlow N, Speidel BD. Outcome of resuscitation following unexpected apparent stillbirth. Arch Dis Child Fetal Neonatal Ed.\u20081998;78(2):F112\u2013F115","DOI":"10.1136\/fn.78.2.F112"},{"key":"2021120905221464600_R27","doi-asserted-by":"crossref","unstructured":"Haddad B, Mercer BM, Livingston JC, Talati A, Sibai BM. Outcome after successful resuscitation of babies born with Apgar scores of 0 at both 1 and 5 minutes. Am J Obstet Gynecol.\u20082000;182(5):1210\u20131214","DOI":"10.1067\/mob.2000.104951"},{"key":"2021120905221464600_R28","doi-asserted-by":"crossref","unstructured":"Patel H, Beeby PJ. Resuscitation beyond 10 minutes of term babies born without signs of life. J Paediatr Child Health.\u20082004;40(3):136\u2013138","DOI":"10.1111\/j.1440-1754.2004.00314.x"},{"key":"2021120905221464600_R29","doi-asserted-by":"crossref","unstructured":"Nelson KB, Ellenberg JH. Children who \u201coutgrew\u201d cerebral palsy. Pediatrics.\u20081982;69(5):529\u2013536","DOI":"10.1542\/peds.69.5.529"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/6\/1619\/1022175\/zpe01209001619.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/6\/1619\/1022175\/zpe01209001619.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T18:29:07Z","timestamp":1685212147000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/124\/6\/1619\/72213\/Outcome-of-Term-Infants-Using-Apgar-Scores-at-10"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,12,1]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2009,12,1]]},"published-print":{"date-parts":[[2009,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2009-0934","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,12,1]]}}}