Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

Tweed, E. J. , Mackay, D. F. , Nelson, S. M. , Cooper, S.-A. and Pell, J. P. (2016) Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children. Archives of Disease in Childhood: Fetal and Neonatal Edition, 101(2), F121-F126. (doi: 10.1136/archdischild-2015-308483) (PMID:26297221)

Abstract

Background: The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. Methods: Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. Results: Of the 751 369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49 962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0–3, 10.1% had ASN, compared with 9.1% of those scoring 4–7 and 6.6% of those scoring 7–10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. Conclusions: Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cooper, Professor Sally-Ann and Pell, Professor Jill and Nelson, Professor Scott and Mackay, Professor Daniel and Tweed, Dr Emily
• Authors: Tweed, E. J., Mackay, D. F., Nelson, S. M., Cooper, S.-A., and Pell, J. P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Archives of Disease in Childhood: Fetal and Neonatal Edition
• Publisher: BMJ Publishing Group
• ISSN: 1359-2998
• ISSN (Online): 1359-2998
• Copyright Holders: Copyright © 2015 BMJ Publishing Group
• First Published: First published in Archives of Disease in Childhood: Fetal and Neonatal Edition 101(2):F121-F126
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher.