Children born prematurely are more likely to underachieve in the first years of school than those born at full term, particularly among those born or living in the most deprived areas.
These are the findings of a new analysis, led by researchers at Imperial College London and the University of Edinburgh, and published today in the journal JAMA Network Open.
In an analysis of data from nearly 16,000 children, researchers found that more than half of children (57 per cent) born before 32 weeks were not ready for school at five years of age, including in areas such as communication and language, and physical and emotional development.
Those born earlier, at 23–24 weeks, were up to three times more likely to miss expected development milestones compared with those born at 31 weeks. Children born in the most deprived areas had up to twice the risk of under attainment compared with those born in the least deprived areas.
The researchers say that strategies to reduce social inequalities, promote brain health and increase support for preterm children during the transition to school are vital to improve outcomes.
Dr Cheryl Battersby, co-lead author from Imperial College London, said: "One of the most striking findings was that social disadvantage had an impact on attainment comparable to severe brain injury.
"We need to better understand which aspects of social disadvantage are driving these differences and identify the interventions that can have the greatest impact. Improving outcomes will require a combination of medical advances and targeted social policies that address the wider determinants of child development."
Educational impact
In recent decades, developments in neonatal intensive care have led to better survival rates for preterm babies. Although preterm birth is a leading cause of atypical brain development and cognitive impairment, little is known about its impact on early educational outcomes.
In the latest study, researchers looked at data from nearly 16,000 children born before 32 weeks gestation in England between 2008 and 2012. They used deidentified data from the National Neonatal Research Database and the National Pupil Database to link neonatal clinical data with educational outcomes.
The team looked at factors influencing school readiness at age 5 and attainment in reading, writing, maths and science at ages 6–7.
They found half of preterm children did not meet expected attainment at ages 6-7 in writing (51 per cent) and maths (48 per cent). A slightly lower number of preterm children missed attainment levels in reading (42 per cent) and science (36 per cent).
The study identified several potentially modifiable risk factors linked to differences in attainment, including maternal smoking during pregnancy, nutrition and certain medications during neonatal intensive care, medical difficulties sometimes experienced by preterm babies, and social deprivation.
There was an increased risk of lower attainment among boys than girls, and those born in the summer months, who enter school a year earlier than those born in the autumn. Deferred school entry or targeted academic support may benefit the very preterm depending on when they were born, experts say.
Dr Sadia Haider, from Imperial's School of Public Health and study author, said: "This is the first study in England to link national neonatal and education records, allowing us to follow the journeys of almost 16,000 children born very preterm from birth into the classroom. By bringing together health and education data, we were able to understand how these vulnerable children's early health and social circumstances combine to shape their educational outcomes. It demonstrates the power of linking data across sectors to answer questions that neither system could answer alone, generating evidence to improve care and policy for future generations of children."
Professor James Boardman, co-lead author from the University of Edinburgh's Centre for Reproductive Health, said: "The data revealed a very high burden of low attainment at primary school among children who were born preterm. Improving the life chances of this vulnerable group of children is going to require focus on social inequalities in childhood as well as discovering new ways to reduce medical problems linked to preterm birth."
The research was supported by the Medical Research Council and National Institute for Health and Care Research.
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'Health and socioeconomic factors associated with education in preterm children: a cohort study ' by Sadia Haider, Athanasios Tsanas, G. David Batty, et al. is published in JAMA Network Open. DOI:
This article is based on materials produced by the University of Edinburgh.
