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Education Outcomes of Children Born Late Preterm: A Retrospective Whole-Population Cohort Study
L K Crockett1, C A Ruth2,3, M I Heaman4
1Department of Community Health Sciences, Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 374(1) - 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada. umcrocke@myumanitoba.ca.
Insights
Children born late preterm (34-36 weeks gestational age) face higher risks for developmental and educational setbacks, including ADHD and kindergarten repetition. These findings highlight the need to address the vulnerabilities of late preterm infants for better population health outcomes.
Area of Science:
- Pediatric Health
- Developmental Pediatrics
- Public Health
Background:
- Early life exposures significantly influence child development.
- Late preterm birth (34-36 weeks gestational age) is linked to later childhood health and developmental challenges.
Purpose of the Study:
- To investigate the association between late preterm birth and developmental/educational outcomes in early childhood.
- To control for health and social factors in the analysis.
Main Methods:
- Retrospective cohort study using administrative health databases.
- Included children born late preterm and full-term (39-41 weeks GA) between 2000-2005.
- Logistic regression analysis adjusted for covariates.
Main Results:
- Late preterm birth was associated with increased prevalence of ADHD.
- Children born late preterm showed higher vulnerability in language, cognitive, communication, and physical health domains.
- Increased likelihood of kindergarten or grade 1 repetition observed in late preterm infants.
Conclusions:
- Late preterm infants represent a significant portion of preterm births and experience poorer outcomes.
- Recognizing and addressing the developmental vulnerabilities of late preterm children is crucial.
- Accounting for social differences is important when comparing late preterm and term-born children.
Background:
Early life exposures can have an impact on a child's developmental trajectory and children born late preterm (34-36 weeks gestational age) are increasingly recognized to have health and developmental setbacks that extend into childhood.
Objectives:
The purpose of this study was to assess whether late preterm birth was associated with poorer developmental and educational outcomes in the early childhood period, after controlling for health and social factors.
Methods:
We conducted a retrospective cohort study using administrative databases housed at the Manitoba Centre for Health Policy, including all children born late preterm (34-36 weeks gestational age (GA)) and at full-term (39-41 weeks GA) between 2000 and 2005 in urban Manitoba (N = 28,100). Logistic regression was used to examine the association between gestational age (GA) and outcomes, after adjusting for covariates.
Results:
Adjusted analyses demonstrated that children born late preterm had a higher prevalence of attention deficit hyperactivity disorder (ADHD) (aOR = 1.25, 95% CI [1.03, 1.51]), were more likely to be vulnerable in the language and cognitive (aOR = 1.29, 95% CI [1.06, 1.57]), communication and general knowledge (aOR = 1.24, 95% CI [1.01, 1.53]), and physical health and well-being (aOR = 1.27, 95% CI [1.04, 1.53]) domains of development at kindergarten, and were more likely to repeat kindergarten or grade 1 (aOR = 1.52, 95% CI [1.03, 2.25]) compared to children born at term. They did not differ in receipt of special education funding, in social maturity or emotional development at kindergarten, and in reading and numeracy assessments in the third grade.
Conclusions:
Given that the late preterm population makes up 75% of the preterm population, their poorer outcomes have implications at the population level. This study underscores the importance of recognizing the developmental vulnerability of this population and adequately accounting for the social differences between children born late preterm and at term.
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