title: Five-minute Apgar score and educational outcomes: retrospective cohort study of 751,369 children.
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.
authors: Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors: Emily J
authors: EJ
authors: Tweed
authors: Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors: Daniel F
authors: DF
authors: Mackay
authors: School of Medicine, University of Glasgow, Glasgow, UK.
authors: Scott M
authors: SM
authors: Nelson
authors: Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors: Sally-Ann
authors: SA
authors: Cooper
authors: Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors: Jill P
authors: JP
authors: Pell
mesh_terms: D000328:Adult; D001034:Apgar Score; D002648:Child; D015331:Cohort Studies; D016208:Databases, Factual; D004522:Educational Status; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D065886:Neurodevelopmental Disorders / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology
keywords: Apgar score; Educational status; Neurodevelopment; Neurodisability; Special education