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Background <p>Neonatology has made significant advances in identifying factors that influence long-term neurodevelopmental outcomes in newborns. Among these, APGAR scores and the neonatal microbiome have emerged as important determinants of neurological development.</p> Objective <p>To review the current evidence regarding the relationship between APGAR scores, neonatal microbiome composition, and neurodevelopmental outcomes and to explore their combined influence on neurodevelopmental pathways.</p> Results <p>The APGAR score remains an important clinical tool for assessing neonatal health immediately after birth, with low scores often indicating potential central nervous system compromise. However, its ability to predict long-term neurodevelopmental outcomes remains variable. Emerging evidence highlights the critical role of the gut-brain axis and neonatal microbiome in shaping neurodevelopment. Alterations in microbial colonization may contribute to inflammatory processes and increase the risk of neurodevelopmental disorders, including cerebral palsy and autism spectrum disorder. Current findings suggest that APGAR scores and microbiome composition may act synergistically in influencing neurodevelopmental trajectories.</p> Conclusion <p>Understanding the interplay between APGAR scoring, neonatal microbiome composition, and central nervous system development may enhance early risk assessment and facilitate the development of personalized microbiome-targeted interventions. Further research is warranted to clarify these relationships and improve strategies for preventing long-term neurological complications.</p> Graphical abstract <p>Low APGAR scores (≤5) indicate perinatal hypoxia and systemic stress, leading to neuroinflammation. Perinatal stress disrupts gut microbial colonization, elevating pro-inflammatory cytokines (IL-6, TNF-α, ROS) through the gut-brain axis. These alterations impair brain signaling, resulting in abnormal neurodevelopment and increased risk of disorders such as autism spectrum disorder (ASD), cerebral palsy (CP), and attention-deficit hyperactivity disorder (ADHD).</p> <p></p>

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Neonatal predictors of neurodevelopment: the interplay between APGAR score and neonatal microbiome

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • R. Parthiban,
  • E. Bhavya,
  • S. Murshidha Shireen,
  • J. Aswin John Solomon

摘要

Background

Neonatology has made significant advances in identifying factors that influence long-term neurodevelopmental outcomes in newborns. Among these, APGAR scores and the neonatal microbiome have emerged as important determinants of neurological development.

Objective

To review the current evidence regarding the relationship between APGAR scores, neonatal microbiome composition, and neurodevelopmental outcomes and to explore their combined influence on neurodevelopmental pathways.

Results

The APGAR score remains an important clinical tool for assessing neonatal health immediately after birth, with low scores often indicating potential central nervous system compromise. However, its ability to predict long-term neurodevelopmental outcomes remains variable. Emerging evidence highlights the critical role of the gut-brain axis and neonatal microbiome in shaping neurodevelopment. Alterations in microbial colonization may contribute to inflammatory processes and increase the risk of neurodevelopmental disorders, including cerebral palsy and autism spectrum disorder. Current findings suggest that APGAR scores and microbiome composition may act synergistically in influencing neurodevelopmental trajectories.

Conclusion

Understanding the interplay between APGAR scoring, neonatal microbiome composition, and central nervous system development may enhance early risk assessment and facilitate the development of personalized microbiome-targeted interventions. Further research is warranted to clarify these relationships and improve strategies for preventing long-term neurological complications.

Graphical abstract

Low APGAR scores (≤5) indicate perinatal hypoxia and systemic stress, leading to neuroinflammation. Perinatal stress disrupts gut microbial colonization, elevating pro-inflammatory cytokines (IL-6, TNF-α, ROS) through the gut-brain axis. These alterations impair brain signaling, resulting in abnormal neurodevelopment and increased risk of disorders such as autism spectrum disorder (ASD), cerebral palsy (CP), and attention-deficit hyperactivity disorder (ADHD).