Villamor, EduardoBeer, Rachael J.Seeley, Allison L.López-Arana, SandraMarín, ConstanzaMora-Plazas, Mercedes2025-08-272025-08-272024-11-14Acta Paediatrica: Nurturing the child, Vol. 114, N° 5 (2025) p. 954–963.0803-5253https://hdl.handle.net/20.500.12254/4282Aim: Infections can impair cognitive development, but their role on adverse childhoodeducational outcomes is unknown. We examined the associations of infectious mor-bidity and inflammatory biomarkers with grade repetition and school absenteeism.Methods: We followed 2762 Colombian children aged 5–12 years for a school year.We quantified inflammatory biomarkers at enrolment and prospectively recorded in-cidence of gastrointestinal and respiratory infections, doctor visits and absent daysfrom school using pictorial diaries. We estimated adjusted relative risks (ARR) with95% confidence intervals (CI) for grade repetition and absenteeism by infectious mor-bidity burden and inflammatory biomarker categories, and percentages of the asso-ciations mediated through absenteeism.Results: Morbidity was associated with increased risk of grade repetition. ARR (95%CI) of grade repetition comparing high versus no incidence of gastrointestinal, res-piratory and ear infections were, respectively, 2.17 (1.00, 4.72), 2.31 (1.28, 4.16) and2.57 (1.13, 5.86). Infections also predicted school absenteeism, which mediated 35%,31% and 38% of the corresponding morbidity-grade repetition associations. Elevatedwhite blood cells (WBC), especially granulocytes, were related to increased grade rep-etition and school absenteeism risks.Conclusion: Childhood infections and elevated WBC are associated with grade repeti-tion and school absenteeism. Absenteeism does not fully explain the morbidity-graderepetition associations.enAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)Childhood infectionsGastrointestinal morbidityGrade repetitionGrade retentionGranulocytesRespiratory infectionSchool absenteeismWhite blood cellsInfectious morbidity and white blood cell count associated withgrade repetition and school absenteeismArticlehttp://orcid.org/0000-0002-4312-1318https://doi.org/10.1111/apa.175131651-2227