Educational Performance of Children Born Prematurely

Abstract

Survivors of preterm birth often present with medical morbidities; however, variation in their long-term educational performance has not been well described.OBJECTIVE To estimate the association between gestational age and 4 outcomes in school-aged children: readiness to enter kindergarten, scores on standardized tests in elementary and middle school, gifted status, and low performance. DESIGN, SETTING, AND PARTICIPANTSIn a retrospective cohort study, children born in Florida between 1992 and 2002 at 23 to 41 weeks' gestation who entered Florida's public schools between 1995 and 2012 were assessed for kindergarten readiness and tested in mathematics and reading in grades 3 through 8. Data analysis was performed from January 12, 2016, to March 1, 2017.EXPOSURES Gestational age at birth. MAIN OUTCOMES AND MEASURES Kindergarten readiness, scores on the FloridaComprehensive Achievement Test (FCAT), classified as gifted, and classified as low performance.RESULTS A total of 1 527 113 singleton infants with gestational ages of 23 to 41 weeks born between 1992 and 2002 were matched to Florida public school records. Of these, 1 301 497 children were included in the analysis; 641 479 (49.3%) were girls. A total of 301 (65.0%) Florida children born at 23 to 24 weeks' gestation were designated as ready to start kindergarten. When the FCAT test scores were adjusted for potentially confounding maternal and infant variables, children born at 23 to 24 weeks' gestation performed 0.66 SD (95% CI, −0.73 to −0.59) lower compared with those born at full term. A total of 123 554 (9.5%) of all Florida-born public school students were considered gifted, including 17 (1.8%) of those born at 23 to 24 weeks' gestation. In comparison, 75 458 (5.8%) of all Florida-born public school students were low performing; 310 (33.5%) of these children had been born at 23 to 24 weeks' gestation. Kindergarten readiness, FCAT scores, and gifted status were positively related to gestational age, whereas low performance was inversely related to gestational age. CONCLUSIONS AND RELEVANCEAlthough gestational age has long been associated with poor educational performance, a sufficient proportion of children born near the limits of viability performed within expected school norms, warranting further investigation into how and why certain children are able to overcome the educational burdens that may follow preterm birth.

Association of Socioeconomic Status and Brain Injury With Neurodevelopmental Outcomes of Very Preterm Children

“…While prior studies of preterm children demonstrated that intelligence is negatively associated with GA, 3 , 49 , 78 in our cohort, GA is only an important factor associated with outcome in those without brain injury. In the presence of brain injury and CLD, GA was not independently associated with cognitive outcomes.…”

Extremely preterm children exhibit increased interhemispheric connectivity for language: findings from fMRI‐constrained MEG analysis

“…Future studies are needed—including prospective longitudinal studies and those incorporating a group with known language impairment or structural damage—to further elucidate more beneficial from less beneficial phenotypes, with the aim of developing biomarkers for language network development in EPT. In light of recent evidence that extreme prematurity is not universally devastating for neurological functioning and scholastic performance, investigation into possible markers of resiliency is especially interesting (Garfield et al., ). The reported results comparing high‐functioning TC and EPT with no known brain injury are valuable as a step toward that aim.…”

School Starting Age and Cognitive Development

“…Birth weight and its subsequent effect on childhood height and weight may make it difficult to disentangle maturity from ability as larger children may appear to be more mature due to their physical stature. Likewise, gestational age is another avenue one might suspect could affect the age gap (Figlio et al., ; Garfield et al., ). These interactions between initial birth endowments and school starting age have never been studied in the extant literature.…”