School Outcomes of Late Preterm Infants: Special Needs and Challenges for Infants Born at 32- to 36-Week Gestation

Abstract

Most neonatal outcome studies have focused on extremely premature or very-low-birth-weight infants. Limited long-term outcome data are available for infants born at 32- to 36-week gestation. This study compared test scores, teacher evaluations, individualized education programs (IEPs), and special educational services from kindergarten (K) to fifth grade in 970 preterm infants, including moderate preterm (MP) infants born at 32- to 33-week gestation and late preterm (LP) infants born at 34 to 36 weeks, and 13,671 full-term (FT) control infants. None of those studied had had neonatal compromise that would have qualified them for developmental follow-up. In direct child assessment tests, LP infants scored lower than FT infants in reading but not in math in K and first grade. For teacher academic rating scale scores, LP infants in multiple grades scored lower than FT infants for both reading and math. LP infants also had a greater need than those in the FT group for individualized education programs and special education services. MP infants scored lower for reading in K and grades 1 and 5 and lower for math at all grade levels. For teacher academic rating scale scores, MP infants in all post-K grades had worse reading and math skills than LP or FT infants. Compared with FT infants, twice as many MP infants required special education at all grade levels. After adjusting for gender, race, and maternal educational level, LP infants in the first grade were substantially likelier to have below-average scores in both reading and math than FT infants. MP infants had a similar adjusted risk for below average reading and math test scores compared to FT infants. The risk of poor school outcomes remained significant when only singleton LP infants were analyzed. These findings demonstrate that infants born at 32- to 36-week gestation are more likely than full-term infants to have poor school outcomes when evaluated from kindergarten to grade 5. All preterm infants are at risk and would benefit from follow-up, anticipatory guidance, and appropriate intervention.