Babies with low Apgar scores at birth have a higher risk of having special education needs during adolescence, Swedish researchers reported in Obstetrics & Gynecology.

Apgar is a way of evaluating the health of a newborn shortly after birth. The Apgar score is a number which is added up by scoring respiratory effort, heart rate, skin color, response to a catheter in the nostril, and muscle tone. Each objective sign can receive a score from 0 to 2 points. The highest total Apgar score is ten – a baby with a score between 0 and 3 needs to be resuscitated immediately.

Dr. Andrea Stuart of Central Hospital in Helsingborg, Sweden, and team set out to estimate what the link might be between low Apgar score and long-term cognitive function. The scores are taken within five minutes of the baby being born. They were specifically looking at scores below 7.

The researchers gathered Apgar score data from the Swedish Medical Birth Registry and academic performance from the Swedish School Grade Registry. They were specifically trying to link low Apgar scores with the likelihood of a child having to go to a special-education school. The database included information on 877,618 babies from 1973 to 1986. 23,000 kids were attending a special-education school.

The vast majority of the newborns had Apgar scores of 9 or ten, and 1% had a score below 7. Of those with a score below 7, one third had a score below 4.

The team calculated that a newborn with an Apgar score below 7 within five minutes of being born had twice the risk of subsequently going to a special school, compared to those with high scores. The risk was three times greater for those whose Apgar scores were 2 or 3.

Those with an Apgar score of less than seven had a much higher chance of never receiving graduation grades.

Dr. Andrea Stuart said:

“It is not the Apgar score in itself that leads to lower cognitive abilities. It is the reasons leading to a low Apgar score (including asphyxiation, preterm delivery, maternal drug use, infections) that might have an impact on future brain function.”

Even though the risk is higher, the authors stressed that it is still low. A newborn with a score below seven has only a 2.27% chance of needing to go to a special-education school as a teenager.

The authors concluded:

“An Apgar score of less than 7 at 5 minutes after birth is associated with subtle cognitive impairment, as measured by academic achievement at 16 years of age.”

“Apgar Scores at 5 Minutes After Birth in Relation to School Performance at 16 Years of Age”
Stuart, Andrea MD; Otterblad Olausson, Petra PhD; Källen, Karin PhD
Obstetrics & Gynecology: August 2011 – Volume 118 – Issue 2, Part 1 – pp 201-208 doi: 10.1097/AOG.0b013e31822200eb

Written by Christian Nordqvist