ORIGINAL ARTICLE Low Apgar score in term newborns and long-term infectious morbidity: a population-based cohort study with up to 18 years of follow-up Yuval Gutbir 1,2 & Tamar Wainstock 3 & Eyal Sheiner 4 & Idit Segal 5 & Ruslan Sergienko 3 & Daniella Landau 6 & Asnat Walfisch 4 Received: 10 June 2019 /Revised: 15 January 2020 /Accepted: 22 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Since introduced, the Apgar score has remained the most widespread predictor for neonatal morbidity and mortality. We aimed to investigate the association between low 5-min Apgar score and long-term infectious pediatric morbidity. A population-based cohort analysis was performed comparing total and specific subtypes of infectious morbidity leading to hospitalization among term newborns with normal ( ≥ 7) and low (< 7) 5-min Apgar scores, born between 1999 and 2014 at a single tertiary regional hospital. Infectious morbidity included hospitalizations involving a pre-defined set of infection-related ICD-9 codes. A Kaplan-Meier survival curve was constructed to compare cumulative infectious morbidity incidence and a Cox proportional hazards model to adjust for confounders. The long-term analysis of 223,335 children (excluding perinatal death cases) yielded 585 (0.3%) infants with low 5-min Apgar scores. The rate of infection-related hospitalizations was 9.8% and 12.4% among newborns with normal and low 5-min Apgar scores, respectively (p = 0.06). Adjusting for maternal age, gestational age, hypertension, diabetes, cesarean delivery, and fertility treatments, the association proved to be statistically significant (adjusted HR = 1.28; 95% CI 1.01–1.61). Conclusion: Term infants with low 5-min Apgar scores may be at an increased risk for long-term pediatric infectious morbidity. What is Known: • Though not meant to be a prognostic tool for long-term morbidity, studies assessing the correlation between low Apgar score and long-term outcomes were and are being performed, reporting significant associations with many outcomes—such as cerebral palsy (CP), ophthalmic disorders, GI disorders, and several types of malignancies. • Yet, an association between low Apgar scores and future health remains a matter of controversy. What is New: • Our work shows that a low 5-min Apgar score is independently associated with long-term pediatric infection-related hospitalizations among term singleton newborns. Keywords Newborn . Child . Infection . Hospitalization . Long-term outcome Dr. Wainstock equally contributed to this manuscript and is considered a second first author Communicated by Nicole Ritz * Yuval Gutbir gutbir@gmail.com Tamar Wainstock wainstoc@bgu.ac.il Eyal Sheiner sheiner@bgu.ac.il Idit Segal Isegal@MOH.gov.il Ruslan Sergienko sergienk@bgu.ac.il Daniella Landau Landaud@bgu.ac.il Asnat Walfisch asnatwalfisch@yahoo.com Extended author information available on the last page of the article European Journal of Pediatrics https://doi.org/10.1007/s00431-020-03593-9