Validated predictive risk analyses for Apgar scores at 5 and 10 minutes before birth as part of the smartphone application ‘BrainProtect’

Reduced Apgar scores at 5 and 10 minutes after birth reflect signs of circulatory centralisation in newborns and are associated with poorer neurocognition in childhood and adolescence. Therefore, predictive risk analyses conducted prior to birth may enhance risk stratification and obstetrical management to improve clinical outcome and hence psychomotor development of the newborn child. To form a basis for preventive strategies, we developed a smartphone application BrainProtect by first calculating a weighted pregnancy risk score based on odds ratios to quantify the adverse effects of risk factors on overall predicted psychomotor development at 4 years of age. Secondly, we used a large prospective cranial ultrasound screening database (n = 5,301) and a validation cohort (n = 508,926) to relate the weighted pregnancy risk score to predicted Apgar scores at 5 and 10 minutes. The results confirmed that weighted pregnancy risk scores provide predictive capacity for expected Apgar scores at 5 and 10 minutes in newborn infants before birth which is clinically important to improve risk stratification and develop preventive strategies for a safe delivery with unimpaired vitality.