Abstract
ObjectivesTo investigate school difficulties, special care and behavioral problems in 8 year-old very preterm (VPT) children.Patient and MethodsLongitudinal population-based cohort in nine regions of France of VPT children and a reference group born at 39–40 weeks of gestation (WG). The main outcome measures were information about school, special care and behavioral problems using Strengths and Difficulties Questionnaire from a questionnaire to parents.ResultsAmong the 1439 VPT children, 5% (75/1439) were in a specialised school or class, 18% (259/1439) had repeated a grade in a mainstream class and 77% (1105/1439) were in the appropriate grade-level in mainstream class; these figures were 1% (3/327) , 5% (16/327) and 94% (308/327) , respectively, for the reference group. Also, 15% (221/1435) of VPT children in a mainstream class received support at school versus 5% (16/326) of reference group. More VPT children between the ages of five and eight years received special care (55% (794/1436)) than children born at term (38% (124/325)); more VPT children (21% (292/1387)) had behavioral difficulties than the reference group (11% (35/319)). School difficulties, support at school, special care and behavioral difficulties in VPT children without neuromotor or sensory deficits varied with gestational age, socioeconomic status, and cognitive score at the age of five.ConclusionsMost 8-year-old VPT children are in mainstream schools. However, they have a high risk of difficulty in school, with more than half requiring additional support at school and/or special care. Referral to special services has increased between the ages of 5 and 8 years, but remained insufficient for those with borderline cognitive scores.
Highlights
Most very preterm children (VPT) are discharged from the hospital alive, due to recent progress in obstetrics and neonatal care [1]
Parents of 1444 VPT (64% of the 2249 VPT children included in follow-up who survived) and 327 ‘born at term’ eight-year-old children (59% of the reference group included in follow-up who survived) answered to the 8 year questionnaire
The main reason for non-response (911 VPT children) was a change of address (462 address unknown at 8 years).VPT responders and nonresponders did not differ for gestational age, but non responders had more cerebral lesions in the neonatal period
Summary
Most very preterm children (VPT) are discharged from the hospital alive, due to recent progress in obstetrics and neonatal care [1]. Clinicians and parents are highly concerned by the long-term consequences of preterm delivery, such as disabilities, health problems and school difficulties for these children. Preterm birth is associated with abnormalities in brain development, leading to high rates of severe long-term neurodisability (cerebral palsy, sensory impairments, mental retardation) [1]. For these children, little is known about educational achievement by mid childhood (5–8 years old), support at school or special care outside school. We first aimed to assess the prevalence of difficulties in school, special health care, and behavioral difficulties, and investigated how school difficulties and special care are associated with social levels of the family, grade of immaturity and cognitive deficits assessed at the age of five
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