The Impact of Delayed School Entry on Developmental Outcomes in Very Preterm Children: A Prospective Cohort Study

To investigate whether delayed school entry (DSE) is associated with everyday functioning and participation in children born very preterm to inform the evidence-based guideline of follow-up of preterm born children.

We conducted a systematic review of the literature and analysed outcome data at 10 years of age of a prospective cohort study of 1620 children born in 2009-2016 at < 32 gestational weeks. Children with DSE were compared to those with age-appropriate school entry (ASE) regarding everyday functioning and participation, using standardized parent- and self-report questionnaires.

In the cohort, DSE was associated with less favourable outcomes (mean [standard deviation]): participation (ASE 95.8 [8.5]; DSE 90.3 [14.0]; p < 0.001), attention (3.6 [1.2]; 4.1 [1.3]; p < 0.001), internalizing problems (4.5 [3.3]; 5.7 [4.0]; p = 0.01), executive function (52 [11]; 58 [13]; p < 0.001). The proportion of children with special educational needs was higher in the DSE group (9.8% vs. 34%; p < 0.001). After adjustment for confounders, no differences remained at 10 years. ASE based on chronological age was associated with delayed transition to secondary school.

After adjustment, DSE did not affect everyday functioning and participation at 10 years or the timely transition to secondary school. School entry should consider corrected age for prematurity. Further research should examine long-term academic outcomes.