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Academic achievement in children born extremely preterm: a cohort study
Ylva F Kaul1,2, Martin Johansson1, Anu Haavisto3,4
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Insights
Children born extremely preterm (EPT) face higher risks of academic challenges and special education needs compared to full-term peers. Factors like cognitive impairment and ADHD/ASD diagnosis significantly influence academic outcomes in EPT children.
Area of Science:
- Pediatrics
- Developmental Psychology
- Educational Psychology
Background:
- Extremely preterm (EPT) birth is associated with a wide spectrum of academic outcomes.
- Understanding subgroups within the EPT population is crucial for targeted interventions.
- Previous research highlights variability in academic achievement among EPT children.
Purpose of the Study:
- To compare academic outcomes between children born extremely preterm (EPT) and full-term controls.
- To investigate the influence of maternal education, child sex, maternal origin, cognitive ability, and diagnoses of attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) on EPT children's academic performance.
Main Methods:
- A national cohort study in Sweden followed EPT children (n=449) and full-term controls (n=365) for 12 years.
- Academic data, including school grades and special education attendance, were collected from national registers.
- Subgroup analyses were conducted within the EPT group to identify risk factors for poor academic achievement.
Main Results:
- EPT children were significantly more likely to attend special education schools (13.6% vs 0.5%) and receive failing grades in mainstream education (32.3% vs 5.2%) compared to controls.
- Lower gestational age (GA ≤23 weeks) was associated with poorer outcomes in mainstream school.
- Within the EPT group in mainstream education, low GA, low maternal education, cognitive impairment, and ADHD/ASD diagnoses increased the risk of poor academic achievement.
Conclusions:
- Extremely preterm birth is a significant risk factor for poor academic achievement, with substantial variability within the EPT population.
- Cognitive impairment, ADHD/ASD diagnosis, and maternal education are key factors influencing academic outcomes in EPT children.
- The elevated risk of academic difficulties among EPT children persists even after accounting for confounding and mediating factors.
Objective:
Children born extremely preterm (EPT) vary greatly regarding academic outcomes, underscoring the need to investigate subgroups in large representative samples. This study aimed to (1) examine academic outcomes in EPT children versus full-term controls and (2) examine the role of maternal education, child sex, maternal origin, cognitive ability and the presence of attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) diagnosis.
Design:
National cohort study.
Setting:
Sweden.
Patients:
12-year follow-up of a cohort study, the Extremely Preterm Infants in Sweden Study, including children born EPT (n=449) and full-term controls (n=365).
Outcome Measures:
Data on school grades (mathematics, Swedish and English) and special education school attendance were obtained from registers.
Exposure:
EPT group versus controls and subgroup analyses within the EPT group.
Results:
Compared with full-term controls, children born EPT more often attended special education schools (13.6% vs 0.5%; OR 28.5 (95% CI 6.9 to 117.5)) and those attending mainstream school more often received at least one failing grade (32.3% vs 5.2%; OR 8.7 (95% CI 5.2 to 14.5)). Of children with gestational age (GA) ≤23 weeks, 39% attended mainstream school and passed all three core subjects, compared with 65% of those born at 26 weeks (OR 0.34 (95% CI 0.17 to 0.62)). Among EPT children attending mainstream education, low GA, low maternal education, cognitive impairment and ADHD/ASD diagnosis increased the risk of poor academic achievement.
Conclusions:
EPT birth was associated with poor academic achievement, but the risk varies substantially within the EPT group, primarily based on cognitive impairment, ADHD/ASD diagnosis and maternal education. However, the risk of poor academic achievement among children born EPT remained after adjusting for confounders and mediators.
