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.
The study also found that children born in the most deprived areas had up to two times the risk of under attainment compared with those born in the least deprived areas.
Strategies to reduce social inequalities, promote brain health and increase support for preterm children during the transition to school are vital to improve outcomes, experts say.
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.
Scientists, led by the University of Edinburgh and Imperial College London, studied 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.
The study, funded by the Medical Research Council and National Institute for Health and Care Research, is published in the journal JAMA Network Open: http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2026.23068?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=071426 [URL will become active after embargo lifts].
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."
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".
