The first large study of Apgar score at birth and the risk of cerebral palsy was the US National Collaborative Perinatal Project. It found that most cases of cerebral palsy occurred in children with normal Apgar scores; that the risk of cerebral palsy was strongly related to an Apgar score lower than 4 in normal weight infants, especially when the low score was prolonged; and that low Apgar scores were less predictive of cerebral palsy in low birthweight infants⇓.1

In the linked study (doi:10.1136/bmj.c4990), Lie and colleagues confirm—in a Norwegian dataset 10 times larger (540 000 children)—all of these findings but add the new observation that the risk of cerebral palsy by Apgar score depends on the type of cerebral palsy. Hemiplegia was 10 times more common in babies with Apgar score less than 4, diplegia 22 times more common, but quadriplegia 137 times more common.2

Although the nature of the insult or insults in cerebral palsy is still unclear, …