Children Born Prematurely Remain at Risk for Educational Underachievement at Age 10

BUFFALO, N.Y. -- Children born extremely prematurely are 3 to 4 times more likely to be educational underachievers than children born at or near full term, a study by University at Buffalo researchers has shown.

The study, which appears in the October issue of Paediatric and Perinatal Epidemiology, found a significant increase in risk of grade repetition, placement in special education and use of additional school-based services for children born at less than 28 weeks gestation compared to full-term children.

The results held after controlling for age, race, maternal education and foster-care placement.

"These findings suggest that despite improved survival, children born at the extremes of gestation remain at risk for educational underachievement," said Germaine M. Buck, Ph.D., branch chief of epidemiology at the National Institute of Child Health and Human Development, who conducted the study while at UB.

"These children may benefit from targeted educational intervention programs aimed at maximizing their academic potential."

Much information is available on handicapping conditions (such as cerebral palsy and mental retardation) among children who survive extreme prematurity due to the use of lung surfactant and other biomedical advances. But less data exist on cognitive, behavioral or school-related difficulties, particularly among children in recent cohorts of extremely premature births.

The purpose of this study was to assess the impact of extreme prematurity on three general outcome measures of school performance: grade repetition, special education placement and use of school-based services. The children -- 108 born prematurely and 219 born full term at The Children's Hospital of Buffalo -- were between the ages of 9 and 10 at the time of the study.

Parents completed a survey on the health and development of their children, including the questions on school performance. Repeating one or more grades for any reason counted as grade repetition. Special education was defined as placement in a classroom having one teacher for 12 or fewer children and a modified curriculum.

Use of school-based services referred to a child's need for teacher assistance in reading, spelling, math, handwriting, speech and language problems, or for occupational or physical therapy.

Results showed that children with pre-term birth were in lower grades than the full-term children, with 33 percent of the former group having repeated one or more grades compared to 18 percent of the latter group. Twenty percent of pre-term children received special education resources compared to 5 percent of full-term children. The figures for use of school-based resources by pre-term and full-term children were 16 percent and 6 percent, respectively, and for rehabilitation therapies, 47 percent and 18 percent.

In addition, Buck and colleagues found that having Medicaid or no health insurance put children at twice the risk for grade repetition compared to children with private health insurance, and that boys were more likely to repeat grades than girls.

"These findings suggest that social factors, in addition to biomedical factors such as pre-term delivery, also are important in predicting children's academic success," Buck said. "These factors need to be considered when devising intervention programs for at-risk children."

Additional researchers on the study were Michael E. Msall, M.D., formerly of UB's Department of Pediatrics, now at Brown University School of Medicine; Enrique Schisterman, Ph.D., formerly of UB's Department of Social and Preventive Medicine, now at Cedars Sinai Medical Center; and Nancy Lyons, pediatric nurse practitioner and Brian Rodgers, M.D., of UB's Department of Pediatrics and the Robert Warner Rehabilitation Center of Children's Hospital.