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Five-minute Apgar score and educational outcomes: retrospective cohort study of 751,369 children
Emily J Tweed1, Daniel F Mackay1, Scott M Nelson2
1Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK.
Insights
The Apgar score, used for newborn assessment, is linked to long-term educational outcomes and additional support needs. Lower scores indicate a higher likelihood of needing educational support, impacting prognosis beyond the short term.
Area of Science:
- Neonatal Health
- Pediatric Education
- Public Health
Background:
- The Apgar score is a standard for assessing newborns' immediate health.
- Previous research on Apgar scores and long-term educational outcomes is inconsistent.
- This study examines the Apgar score's association with educational needs and attainment.
Purpose of the Study:
- To investigate the relationship between the 5-minute Apgar score and additional support needs (ASN).
- To assess the association between Apgar score and educational attainment.
- To determine if Apgar scores predict long-term educational outcomes.
Main Methods:
- Linked Scottish national data on maternity and education (2006-2011).
- Analyzed Apgar scores in relation to overall and type-specific ASN.
- Used logistic regression models to assess educational attainment, with data imputation for missing covariates.
Main Results:
- Low Apgar scores were independently linked to overall ASN (OR 1.52 for Apgar ≤3).
- Associations were found with cognitive, sensory, and motor impairments.
- A dose-response relationship existed between Apgar score and ASN; lower scores correlated with higher ASN rates.
- Low Apgar scores showed a non-robust association with lower educational attainment after confounder adjustment.
Conclusions:
- Apgar scores predict not only short-term clinical status but also long-term prognoses.
- The findings highlight the Apgar score's relevance to educational outcomes at a population level.
- Apgar scores serve as an indicator for potential long-term support needs.
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.