Gestational age at birth, chronic conditions and school outcomes: a population-based data linkage study of children born in England

Abstract

Introduction We aimed to generate evidence about child development measured through school attainment and provision of special educational needs (SEN) across the spectrum of gestational age, including for children born early term and >41 weeks of gestation, with and without chronic health conditions. Methods We used a national linked dataset of hospital and education records of children born in England between 1 September 2004 and 31 August 2005. We evaluated school attainment at Key Stage 1 (KS1; age 7) and Key Stage 2 (KS2; age 11) and any SEN by age 11. We stratified analyses by chronic health conditions up to age 2, and size-for-gestation, and calculated population attributable fractions (PAF). Results Of 306 717 children, 5.8% were born <37 weeks gestation and 7.0% had a chronic condition. The percentage of children not achieving the expected level at KS1 increased from 7.6% at 41 weeks, to 50.0% at 24 weeks of gestation. A similar pattern was seen at KS2. SEN ranged from 29.0% at 41 weeks to 82.6% at 24 weeks. Children born early term (37–38 weeks of gestation) had poorer outcomes than those born at 40 weeks; 3.2% of children with SEN were attributable to having a chronic condition compared with 2.0% attributable to preterm birth. Conclusions Children born with early identified chronic conditions contribute more to the burden of poor school outcomes than preterm birth. Evaluation is needed of how early health characteristics can be used to improve preparation for education, before and at entry to school.

Trends in survival of children with severe congenital heart defects by gestational age at birth: A population‐based study using administrative hospital data for England

“…In a study using linked administrative health and education data from England, children with cardiovascular conditions including CHD had a greater cumulative incidence of special education needs provision by age 11 than children without a chronic health condition, both for those born at 40 weeks (50.1% versus 28.8%) and preterm (68.0% versus 48.0% at 24-32 weeks). 12 Survival of children born with CHD into childhood and adulthood increased dramatically in the 20th century. 13,14 Improvements in surgical and clinical management of CHD (e.g.…”

“…CHD is also associated with more complex educational needs. In a study using linked administrative health and education data from England, children with cardiovascular conditions including CHD had a greater cumulative incidence of special education needs provision by age 11 than children without a chronic health condition, both for those born at 40 weeks (50.1% versus 28.8%) and preterm (68.0% versus 48.0% at 24–32 weeks) 12 …”

Whose entry to primary school is deferred or delayed? Evidence from the English National Pupil Database

“…(Participant i10, Hunter, 2022, p66) Such indications of social inequity are at odds with the impact presumably intended by the Department for Education's retention of discretionary deferred entry-which assumedly is not that only the informed and privileged should benefit, but that children who would feasibly be better served by education with the cohort below should access this placement when appropriate (Department for Education, 2021b). Bliss, a campaign group for babies born prematurely (who are gestationally younger and who are more likely to have disabilities and 'special educational needs' [Alterman et al, 2021;Libuy et al, 2022;Mackay et al, 2010]) emphasise the desirability of the option. They have 'argued for many years for greater flexibility, particularly for children who are born premature in the summer months and have fallen into a different school year group as a result' (Bliss, online, nd).…”

“…In England, 7.4% of babies were reported as being born premature (pre‐37 weeks gestation) in 2020 (calculated using data from ONS, 2022). The NPD contains no information on due date or prematurity, but there is an overlap between groups of children born premature and those reported with SEND (Alterman et al, 2021; Libuy et al, 2022; Mackay et al, 2010)—so some premature children should be captured within the SEND variable.…”

Evaluation of variation in special educational needs provision and its impact on health and education using administrative records for England: umbrella protocol for a mixed-methods research programme

“…Compared with their peers, children with recorded SEN provision experience higher rates of chronic physical and mental health conditions and hospitalisations, and have lower self-reported well-being 10–12. Recent evidence reviews found that classroom-based SEN interventions improved children’s social, emotional well-being and reduced challenging behaviour, and contributed to better mental health outcomes 13 14.…”