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Extreme prematurity and school outcomes
G M Buck1, M E Msall, E F Schisterman
1Department of Social and Preventive Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, NY 14214, USA. gbuck@buffalo.edu
Insights
Infants born extremely prematurely face higher risks of grade repetition, special education, and school services. These educational challenges persist even after accounting for various background factors, indicating long-term impacts.
Area of Science:
- Pediatrics
- Developmental Psychology
- Educational Psychology
Background:
- Extreme prematurity (< or = 28 weeks gestation) poses significant risks to child development.
- Long-term educational outcomes for extremely premature infants require further investigation.
Purpose of the Study:
- To assess the impact of extreme prematurity on school outcomes.
- To evaluate risks for grade repetition, special education placement, and school-based services.
Main Methods:
- Matched cohort study comparing extremely premature infants (n=132) with full-term infants.
- Data collected via standardized telephone interviews on school performance.
- Unconditional logistic regression used to analyze adjusted odds ratios (OR) and confidence intervals (CI).
Main Results:
- Extreme prematurity significantly increased the risk of grade repetition (OR=3.22, 95% CI=1.63-6.34).
- Increased risk observed for special education placement (OR=3.16, 95% CI=1.14-8.76) and school services (OR=4.56, 95% CI=1.82-11.42).
- Associations remained significant after controlling for confounders like maternal education and race.
Conclusions:
- Survivors of extreme prematurity are at a substantially higher risk of educational underachievement.
- Early birth complications have lasting effects on academic trajectories.
- Intervention and support services are crucial for this vulnerable population.
Abstract:
The purpose of this study was to assess the impact of extreme prematurity on three global measures of school outcomes. Using a matched cohort design, exposed infants comprised all surviving singleton infants < or = 28 weeks gestation born at one regional neonatal intensive care hospital between 1983 and 1986 (n = 132). Unexposed infants comprised randomly selected full-term infants (> or = 37 weeks gestation) frequency matched on date of birth, zip code and health insurance. All children were selected from a regional tertiary children's centre serving western New York population. Standardised telephone interviews elicited information on grade repetition, special education placement and use of school-based services. Unconditional logistic regression was used to estimate odds ratios (OR) and corresponding 95% confidence intervals (CI) adjusted for potential confounders for children without major handicaps. Extreme prematurity was associated with a significant increase in risk of grade repetition (OR = 3.22; 95% CI = 1.63, 6.34), special education placement (OR = 3.16; 95% CI = 1.14, 8.76) and use of school-based services (OR = 4.56; 95% CI = 1.82, 11.42) in comparison with children born at term, even after controlling for age, race, maternal education, foster care placement and the matching factors. These findings suggest that survivors of extreme prematurity remain at risk of educational underachievement.