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Eight-year school performance and growth of preterm, small for gestational age infants: a comparative study with
C M Robertson1, P C Etches, J M Kyle
1Department of Pediatrics, University of Alberta, Edmonton, Canada.
Insights
Preterm infants, including those small for gestational age (SGA), showed poorer school performance and growth compared to term peers. However, intrauterine growth retardation itself did not appear to disadvantage preterm children.
Area of Science:
- Developmental Pediatrics
- Neonatology
- Child Psychology
Background:
- Preterm birth is associated with potential long-term neurodevelopmental challenges.
- Infants small for gestational age (SGA) may face unique developmental trajectories.
- Understanding the long-term outcomes of preterm infants is crucial for early intervention.
Purpose of the Study:
- To compare the 8-year school performance and growth of preterm infants, including those who were small for gestational age (SGA), with matched controls and term infants.
- To identify factors influencing academic achievement in preterm SGA children.
- To determine if intrauterine growth retardation poses an additional disadvantage.
Main Methods:
- Longitudinal study comparing three groups of preterm infants (SGA, appropriate for gestational age matched for birth weight, appropriate for gestational age matched for gestational age) with a peer group of term infants.
- Assessment of school performance (reading, arithmetic, spelling), cognitive function (intellectual, visual-motor integration, receptive vocabulary), physical growth (head circumference), and behavior at 8 years of age.
- Multivariate analyses to identify predictors of academic performance.
Main Results:
- Preterm infants, regardless of SGA status, demonstrated significantly lower intellectual scores, visual-motor integration, reading and arithmetic levels, and higher behavior ratings compared to term peers.
- SGA preterm infants had smaller head circumferences than other preterm groups.
- Mother's education was a key predictor of academic achievement in preterm SGA children, especially when excluding those with disabilities.
- Preterm SGA children without disabilities achieved similar academic scores to term peers but exhibited more hyperactivity.
Conclusions:
- Preterm birth, not specifically intrauterine growth retardation, is associated with poorer academic and developmental outcomes at 8 years.
- Early environmental factors, such as maternal education, play a significant role in the academic success of preterm SGA children.
- While preterm SGA children without disabilities can achieve comparable academic results to term peers, behavioral differences like hyperactivity warrant attention.
Abstract:
Eight-year school performance and growth outcome are reported for three groups of preterm infants: one group that was small for gestational age (SGA; 36 infants) and two comparison groups that were appropriate in size for gestational age, one matched for birth weight and the other for gestational age. The subjects all had white parents whose mother tongue was English and were matched for gender, mother's height, mother's education, and father's socioeconomic status (Blishen Scale). A comparison peer group of term infants was also studied. The three preterm groups did not differ in school performance or physical growth, with the exception of head circumference, which was smaller in the SGA children. All preterm groups had growth measures, intellectual and visual-motor integration scores, reading and arithmetic grade levels, and behavior rating levels significantly inferior to those of the peer group. Receptive vocabulary scores and spelling grade levels did not differ between the preterm groups and the peer group. On multivariate analyses, mother's education was the primary predictor of academic grade levels for the preterm SGA group, and the only predictor when the disabled children were excluded from analyses. Preterm SGA children without disabilities had academic scores similar to those of their term peers, but their scores indicated more hyperactivity. Intrauterine growth retardation did not appear to impose a disadvantage on the preterm children in this study.