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Community-based screening to detect school readiness problems in very preterm children
Nitin Rajput1, Chris McKinlay2,3,4, Gordon Purdie5
1Department of Paediatrics, Tamworth Base Hospital, Tamworth, New South Wales, Australia.
Insights
Very preterm children show higher rates of school readiness difficulties. Community screening can identify these issues, but low referral rates may hinder program effectiveness.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Public health screening
Background:
- Very preterm (VPT) children (born ≤32 weeks) often experience school readiness challenges.
- Routine follow-up for VPT children's developmental progress is frequently insufficient.
Purpose of the Study:
- To evaluate the performance of VPT children in the Before School Check (B4SC) screening program.
- To assess school readiness at four years of age in VPT children using a community-based approach.
Main Methods:
- A cohort of VPT children (2005-2009) from neonatal intensive care units was compared to a national control group.
- Outcomes included Parental Evaluation of Developmental Status (PEDS), Strengths and Difficulties Questionnaire (SDQ-P and SDQ-T), and vision/hearing screenings.
- Perinatal and demographic data were sourced from the Australia and New Zealand Neonatal Network database.
Main Results:
- VPT children were significantly more likely than controls to have abnormal outcomes in PEDS, SDQ-P, SDQ-T, vision, and hearing screenings.
- Abnormal screening results in VPT children were associated with factors including low birthweight z-score, cranial ultrasound abnormalities, and younger maternal age.
- Referral rates for further assessment following abnormal screens were suboptimal, particularly for PEDS and SDQ outcomes.
Conclusions:
- Community-based screening programs like B4SC can identify VPT children with school readiness difficulties.
- The effectiveness of these screening programs may be limited by low rates of appropriate referrals for VPT children requiring further evaluation.
Aim:
Very preterm (VPT) children (≤32 weeks) have school readiness difficulties across multiple domains, but routine follow-up is often limited. We assessed the performance of VPT children on the Before School Check (B4SC), a community-based screening programme of school readiness at 4 years of age.
Methods:
VPT children discharged from Wellington and Auckland Neonatal Intensive Care Units (2005-2009) were compared to a national control cohort born during the same period. Outcome measures included Parental Evaluation of Developmental Status (PEDS), parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ-P and SDQ-T) and vision and hearing screening, and were related to perinatal and demographic characteristics obtained from the Australia and New Zealand Neonatal Network database.
Results:
Of 1105 VPT children, 920 were matched to the B4SC database, of whom 814 (88%) had one or more B4SC screening outcomes recorded. Compared with controls, VPT children were more likely to have abnormal PEDS (odds ratio (OR) = 1.79, 1.53-2.10), SDQ-P (OR = 1.82, 1.49-2.23), SDQ-T (OR = 1.51, 1.10-2.06), vision (OR = 2.00, 1.54-2.60) and hearing (OR = 1.95, 1.65-2.31) screen outcomes. While VPT children with an abnormal screen were more likely to be referred for further assessment, only 34%, 22%, 94% and 51% with abnormal PEDS, SDQ or vision and hearing screen, respectively, had evidence of appropriate referral. School readiness difficulties were significantly associated with birthweight z-score ≤ -1, vaginal delivery, significant cranial ultrasound abnormalities, younger maternal age, higher deprivation neighbourhood and ventilation ≥72 h.
Conclusion:
Community-based screening may be useful for identifying VPT children with school readiness difficulties, but low referral rates may limit the effectiveness of such programmes.
