A newborn’s Apgar score may predict future school success

Dominika Osmolska Psy.D.'s picture
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A new study suggests that a newborn’s Apgar score – a short test given at 1 and five minutes after the baby’s birth – may indicate future academic challenges for some of those whose scores are lower. The researchers found that there is a relationship between having an Apgar score below 7 and having cognitive deficits later in life. They say better understanding the relationship may provide insights into what early problems might cause those deficits.

Apgar tests are given at 1 and 5 minutes after birth, and they evaluate an infant's heart rate, breathing, muscle tone, skin color and reflex irritability (sneezing or coughing in response to the bulb used to drain mucus from the nose), each on a two-point scale. Scores of 8 and above are considered to be signs of good health.

The Apgar score itself does not lead to later cognitive problems; it is the conditions which lead to the lower score. Since the Apgar essentially measures the newborn’s physical vitality, a lower Apgar score reflects a compromised vitality. Several perinatal factors can impact an infant’s health and physical robustness: for example, pre-term delivery, low birth weight, asphyxiation, maternal drug use and infections. These can all lead to a compromised physical state, which can then have consequences for the baby’s cognitive development.

The Swedish study found that children with Apgar scores below 7 had roughly double the odds of attending a special school because of cognitive deficits or other difficulties. The researchers are quick to point out, however, that mothers of babies with those scores need not hit the panic button. The truth is only 1 in 44 of those babies end up needing special education.

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"Most babies who have Apgar scores of 7 or less do perfectly fine," said Dr. Richard Polin, director of neonatology at Columbia University Medical Center and a member of the American Academy of Pediatrics Committee on Fetus and Newborn.

"It is important that the children born with a low Apgar score are not stigmatized or treated differently than their peers due to the low Apgar score per se," said study author Dr. Andrea Stuart, an obstetrician at Central Hospital in Helsingborg, Sweden. While tests might indicate how many teens in a large group would be expected to have deficits, the Apgar score would not help predict whether an individual child might have a learning disability.

The Apgar score was devised in 1952 by Dr. Virginia Apgar as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after birth. Apgar was an anesthesiologist who developed the score in order to ascertain the effects of obstetric anesthesia on babies.

The test is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low. Scores of 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally normal.

A low score on the one-minute test may show that the newborn requires medical attention but is not necessarily an indication that there will be long-term problems, particularly if there is an improvement by the stage of the five-minute test. If the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer-term neurological damage.

A score of 10 is uncommon due to the prevalence of transient cyanosis, or bluish discoloration of the skin due to tissues near the skin surface being low on oxygen. A score of 9 is therefore not substantially different from a score of 10.

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