Association between being born preterm (<37 weeks) and school performance.

*<p>Adjusted for ethnicity, housing, crowding, and maternal education, socio-economic group, car ownership and age.</p><p>†Further adjusted for gender, parity, weight, length and head circumference at birth.</p><p>‡Further adjusted for mode of delivery, maternal hypertension and pyrexia.</p><p>Measures are OR (95% CI) for preterm infants vs. term infants.</p

Association between being born preterm (<37 weeks) and school performance.

<p>Association between being born preterm (<37 weeks) and school performance.</p

Characteristics of study population (n = 11,990).

<p>Standard deviations are given for means of normally distributed continuous variables and percentages for proportions.</p>*<p>CSE = Certificate in Secondary Education (commonly taken at 16 years of age); Vocational = City & Guilds (intermediate level), technical, shorthand or typing, or other qualification; O level = Ordinary level (commonly taken at 16 years of age); A level = Advanced level (commonly taken at 18 years of age), state enrolled nurse, state registered nurse, City & Guilds (final or full level) or teaching qualification; Degree = University degree.</p

Educational Measures, and Special Educational Needs, split by gestation.

<p>Educational Measures, and Special Educational Needs, split by gestation.</p

Preterm Birth, Age at School Entry and Educational Performance

<div><p>Objective</p><p>To investigate if the lack of gestational age correction may explain some of the school failure seen in ex-preterm infants.</p><p>Design</p><p>A cohort study based on the Avon Longitudinal Study of Parents and Children (ALSPAC). The primary outcome was a low Key Stage 1 score (KS1) score at age 7 or having special educational needs (SEN). Exposure groups were defined as preterm (<37 weeks gestation, n = 722) or term (37–42 weeks, n = 11,268). Conditional regression models were derived, matching preterm to term infants on date of birth (DOB), expected date of delivery (EDD) or expected date of delivery and year of school entry. Multiple imputation was used to account for missing covariate data.</p><p>Results</p><p>When matching for DOB, infants born preterm had an increased odds of a low KS1 score (OR 1.73 (1.45–2.06)) and this association persisted after adjusting for potential confounders (OR 1.57 (1.25–1.97)). The association persisted in the analysis matching for EDD (fully adjusted OR 1.53 (1.21–1.94)) but attenuated substantially after additionally restricting to those infants who entered school at the same time as the control infants (fully adjusted OR 1.25 (0.98–1.60)). A compatible reduction in the population attributable risk fraction was seen from 4.60% to 2.12%, and year of school entry appeared to modify the association between gestational age and the risk of a poor KS1 score (p = 0.029).</p><p>Conclusions</p><p>This study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their EDD) may increase their risk of learning difficulties with corresponding school failure.</p></div

Association between being born moderate preterm (32–36 weeks) and school performance.

*<p>Adjusted for ethnicity, housing, crowding, and maternal education, socio-economic group, car ownership and age.</p><p>†Further adjusted for gender, parity, weight, length and head circumference at birth.</p><p>‡Further adjusted for mode of delivery, maternal hypertension and pyrexia.</p><p>Measures are OR (95% CI) for preterm infants vs. term infants.</p

Characteristics of study population.

<p>Characteristics of study population.</p

Mean Key Stage 1 scores by gestation and month of birth.

<p>Mean Key Stage 1 scores by gestation and month of birth.</p

Association between being born very or moderate preterm and school performance.

<p>Association between being born very or moderate preterm and school performance.</p

Association between being born very preterm (<32 weeks) and school performance.

*<p>Adjusted for ethnicity, housing, crowding, and maternal education, socio-economic group, car ownership and age.</p><p>†Further adjusted for gender, parity, weight, length and head circumference at birth.</p><p>‡Further adjusted for mode of delivery, maternal hypertension and pyrexia.</p><p>Measures are OR (95% CI) for preterm infants vs. term infants.</p