The 5-min Apgar score and primary school performance: a Dutch nationwide cohort study

The purpose of this study is to investigate the association between the 5-min Apgar score and primary school performance. The national cohort study involves singletons born between 35+ 0-42 + 6 weeks of gestation from 2000 to 2009. The Dutch Perinatal Registry was linked with Statistics Netherland's database to study educational outcomes at primary school, focusing on special education use and a high track recommendation for secondary school at age 12. Multivariate (adjusted) logistic regression assessed the association between Apgar score (grouped as 0-3, 4-6, 7, 8, 9, and 10) and these outcomes. Of the 1,618,087 children available, a total of 6.4% attended special education at primary school. The highest rate of 14.3% was observed in the group with the lowest Apgar scores (0-3), gradually decreasing to the lowest rate of 6.0% in the group with the highest Apgar score. Compared with a score of 10, the lowest scores had the highest odds ratio for use of special education (adjusted OR 2.4; 95% CI 2.1-2.8). Similarly, lower Apgar scores were associated with a reduced likelihood of receiving a high track recommendation for secondary school. The lowest rate of a high track recommendation (40.7%) was found in children with Apgar score of 0-3, increasing to 45.0% in those with score of 10. Even Apgar scores of 7, 8 and 9 showed significantly lower odds for, compared with a score of 10. Conclusion: There is an association between the Apgar score and primary school performance, with lower Apgar scores linked to poorer educational outcomes.