Abstract
ObjectiveTo investigate if the lack of gestational age correction may explain some of the school failure seen in ex-preterm infants.DesignA cohort study based on the Avon Longitudinal Study of Parents and Children (ALSPAC). The primary outcome was a low Key Stage 1 score (KS1) score at age 7 or having special educational needs (SEN). Exposure groups were defined as preterm (<37 weeks gestation, n = 722) or term (37–42 weeks, n = 11,268). Conditional regression models were derived, matching preterm to term infants on date of birth (DOB), expected date of delivery (EDD) or expected date of delivery and year of school entry. Multiple imputation was used to account for missing covariate data.ResultsWhen matching for DOB, infants born preterm had an increased odds of a low KS1 score (OR 1.73 (1.45–2.06)) and this association persisted after adjusting for potential confounders (OR 1.57 (1.25–1.97)). The association persisted in the analysis matching for EDD (fully adjusted OR 1.53 (1.21–1.94)) but attenuated substantially after additionally restricting to those infants who entered school at the same time as the control infants (fully adjusted OR 1.25 (0.98–1.60)). A compatible reduction in the population attributable risk fraction was seen from 4.60% to 2.12%, and year of school entry appeared to modify the association between gestational age and the risk of a poor KS1 score (p = 0.029).ConclusionsThis study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their EDD) may increase their risk of learning difficulties with corresponding school failure.
Highlights
It is well recognised that infants born preterm, both at extreme gestations and at more modest gestations (e.g. 32–36 weeks), have worse outcomes at school age, including cognitive abilities [1,2] and educational performance [3,4]
When matching for date of birth (DOB), infants born preterm had an increased odds of a low Key Stage 1 score (KS1) score (OR 1.73 (1.45–2.06)) and this association persisted after adjusting for potential confounders (OR 1.57 (1.25–1.97))
The association persisted in the analysis matching for expected date of delivery (EDD) (fully adjusted odds ratio (OR) 1.53 (1.21–1.94)) but attenuated substantially after restricting to those infants who entered school at the same time as the control infants (fully adjusted OR 1.25 (0.98–1.60))
Summary
It is well recognised that infants born preterm, both at extreme gestations (e.g. less than 32 weeks) and at more modest gestations (e.g. 32–36 weeks), have worse outcomes at school age, including cognitive abilities [1,2] and educational performance [3,4]. There is some evidence that impact on educational outcomes is out of proportion to the cognitive deficits seen [1] and other consequences of the preterm birth may have a role to play. Preterm infants may well be enrolled in school a year earlier than would be expected if this decision had been based on their expected data of birth (i.e. corrected for their prematurity). Nearly 30% of the most extreme preterm infants could be enrolled in school a year earlier than predicted by the expected due date
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