School readiness in children born preterm

Abstract

Approximately 7-9% of children worldwide are born preterm [<37 weeks gestational age (GA)], and ~15% of these preterm births occur at <32 weeks GA (very preterm). Advances in modern medicine have dramatically improved the survival of preterm children. However, preterm birth influences a vulnerable period of brain growth in which there is rapid gain in volume, maturation, and connectivity. Several aspects of neonatal intensive care, including altered sensory exposures and acute illness, compounded by social risk factors affect the developing brain. School readiness, understood as the state of child developmental health at school entry, is an outcome of genetic predisposition and the experiences and environment children are exposed to since birth and is a predictor of future academic trajectory. Children born preterm face a range of challenges, especially at times of transition, such as school entry. Academic underachievement in preterm children is common as evidenced by higher needs for grade repetition and remedial assistance. Educational concerns may be prevented most efficiently before school entry with supportive services that promote school readiness. This narrative review will allow readers to gain a comprehensive understanding of school readiness in children born preterm, associated risk factors, potential interventions, and implications for practice. IMPACT: Children born preterm, particularly those born very preterm, remain vulnerable to delays in school readiness, even in the context of having standardized assessments showing performance within the typical range at earlier stages in childhood (i.e. in toddlerhood). Routine neurodevelopmental assessment of preterm children at entry to school is not performed, although there is increasing recognition of issues impacting academic performance and adjustment into school. This review summarizes the available literature around school readiness in preterm children, which will allow for early recognition of school readiness difficulties and opportunities for targeted interventions to improve longer term outcomes.