Associations between Apgar scores and children's educational outcomes at eight years of age
2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: Low Apgar scores are associated with neonatal morbidity and mortality, but effects of Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) on longer-term neurodevelopmental outcomes are less clear. Aim: To examine the associations between Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) and children's educational outcomes as measured by the Australian National Assessment Program-Literacy and Numeracy (NAPLAN) tests at age eight. Materials and Methods: We merged perinatal data including all children born in South Australia from 1999 to 2008 with school assessment data (NAPLAN). School assessments included five learning areas (domains)-reading, writing, spelling, grammar and numeracy. Each domain was categorised according to performing at or below National Minimum Standards (≤NMS). Effects were estimated using Augmented Inverse Probability Weighting (AIPW) accounting for a range of maternal, perinatal and sociodemographic characteristics. Results: Risk differences comparing five-minute Apgar scores of 0-5 with Apgar scores of 10 for children performing ≤NMS for each domain were: reading (0.07 (95% CI −0.16 to 0.29)), writing (0.27 (95% CI −0.14 to 0.68)), spelling (0.15 (95% CI −0.10 to 0.40)), grammar (0.04 (95% CI −0.21 to 0.29)) and numeracy (0.21 (95% CI −0.04 to 0.45)). Risk differences for children performing ≤NMS were also evident when Apgar score of 6 was compared with Apgar score of 10. Conclusions: Children with five-minute Apgar scores of 0-5 and 6, compared with Apgar score of 10, are at higher risk of scoring at/below the NMS on the NAPLAN assessments at eight years.