Early development and school readiness in very preterm children

Children born very preterm often experience difficulties in academic performance at school entry, which may persist and affect long-term outcomes. Few studies have examined school readiness among children born very preterm, and routine follow-up to school age is uncommon. This study aims to describe school readiness in very preterm children and assess associations between neurodevelopmental outcomes at 18-24 months corrected age and later school readiness.

This study included 112 children born <29 weeks' gestation in Ontario, Canada (birth years 2009 and 2012), who completed the assessments of the Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III) at 18-24 months corrected age. Deterministic linkage connected BSID-III results with the Early Development Instrument (EDI), a kindergarten teacher-completed measure of school readiness. Vulnerability-defined as scores below the 10th percentile-was compared between the very preterm cohort and their Ontario peers and between children with and without neurodevelopmental impairment at 18-24 months.

Children born very preterm were more than twice as likely to be vulnerable in two or more EDI domains compared with their Ontario peers (34% vs. 14%). Those with neurodevelopmental impairment at 18-24 months showed higher vulnerability across all domains. Notably, 35% of children without neurodevelopmental impairment still demonstrated vulnerability at school entry. Lower BSID-III language scores were associated with vulnerability in physical health and wellbeing, language and cognitive development, and communication skills and general knowledge.

Very preterm children, especially those with early neurodevelopmental impairment, were at increased risk for vulnerability across all areas of school readiness. Attention to early language development may help improve later school readiness outcomes.