Three findings advance the scientific knowledge about the prognostic value of the 5-min Apgar score in this high-risk population. First, the proportion of VPT infants with 5-min Apgar scores <7 varies largely between European countries. Second, there is a clinically relevant association of low 5-min Apgar scores with most adverse neonatal outcomes. While mortality was not impacted by country variations in 5-min Apgar scores, this was present for severe IVH. Study results indicate that low 5-min Apgar scores <7 are associated with an unfavourable short-term outcome in VPT infants.