Educational Performance of Children Born Prematurely

Abstract

Importance: Survivors of preterm birth often present with medical morbidities; however, variation in their long-term educational performance has not been well described.

Objective: To estimate the association between gestational age and 4 outcomes in school-aged children: readiness to enter kindergarten, scores on standardized tests in elementary and middle school, gifted status, and low performance.

Design, setting, and participants: In a retrospective cohort study, children born in Florida between 1992 and 2002 at 23 to 41 weeks' gestation who entered Florida's public schools between 1995 and 2012 were assessed for kindergarten readiness and tested in mathematics and reading in grades 3 through 8. Data analysis was performed from January 12, 2016, to March 1, 2017.

Exposures: Gestational age at birth.

Main outcomes and measures: Kindergarten readiness, scores on the Florida Comprehensive Achievement Test (FCAT), classified as gifted, and classified as low performance.

Results: A total of 1 527 113 singleton infants with gestational ages of 23 to 41 weeks born between 1992 and 2002 were matched to Florida public school records. Of these, 1 301 497 children were included in the analysis; 641 479 (49.3%) were girls. A total of 301 (65.0%) Florida children born at 23 to 24 weeks' gestation were designated as ready to start kindergarten. When the FCAT test scores were adjusted for potentially confounding maternal and infant variables, children born at 23 to 24 weeks' gestation performed 0.66 SD (95% CI, -0.73 to -0.59) lower compared with those born at full term. A total of 123 554 (9.5%) of all Florida-born public school students were considered gifted, including 17 (1.8%) of those born at 23 to 24 weeks' gestation. In comparison, 75 458 (5.8%) of all Florida-born public school students were low performing; 310 (33.5%) of these children had been born at 23 to 24 weeks' gestation. Kindergarten readiness, FCAT scores, and gifted status were positively related to gestational age, whereas low performance was inversely related to gestational age.

Conclusions and relevance: Although gestational age has long been associated with poor educational performance, a sufficient proportion of children born near the limits of viability performed within expected school norms, warranting further investigation into how and why certain children are able to overcome the educational burdens that may follow preterm birth.

Figure.. Adjusted and Unadjusted Associations for 4 Educational Outcomes

A, Kindergarten readiness odds ratios (ORs); error bars indicate 95% CI. There is a mean (SD) value of 0.853 (0.354) for the reference group (39-41 weeks’ gestation). B, Linear regression of mean Florida Comprehensive Achievement Test (FCAT) scores. Error bars indicate 95% CI. There is a mean (SD) value of 0.028 (0.992) for the reference group. C, Gifted status ORs; error bars indicate 95% CI. There is a mean (SD) value of 0.099 (0.298) for the reference group. D, Low performance ORs; error bars indicate 95% CI. There is a mean (SD) value of 0.054 (0.255) for the reference group. All coefficients are relative to full-term gestation. Sample was based on 1992-2002 birth cohorts, but birth cohorts 1997-1999 were excluded in the kindergarten readiness analysis because readiness was not assessed in these 3 years. Standard errors corrected for heteroscedasticity were used to calculate 95% CI. The unadjusted analysis did not include controls. The adjusted analysis controlled for the following maternal characteristics: race, ethnicity, nativity status, marital status, educational level, age at the time of the child’s birth, number of previous births, prenatal care started in first trimester, maternal health problems, and language spoken at home. It also controlled for the following child characteristics: sex, month and year of birth indicators, congenital anomalies, abnormal conditions at birth, and age in third grade for test scores.