Preemies can be just as kindergarten ready as their peers

For pediatricians working with children born prematurely, it can be difficult to offer guidance to parents on how those children will perform academically given a high probability of medical and neurodevelopmental morbidities.

A new report, however, offers hope for long-term success in school, revealing that children born prematurely aren’t as far behind children born at full term as previously thought.

The study, published in JAMA Pediatrics, followed more than 1 million children as they progressed through their school years, tracking their kindergarten readiness and standardized test scores.

Craig F Garfield, MD, MAPP, associate professor of Pediatrics and Medical Social Sciences at Northwestern University Feinberg School of Medicine, Chicago, Illinois, director of research in the division of hospital-based medicine and co-director of Pediatric Hospital Medicine Fellowship at the Anne and Robert H. Lurie Children’s Hospital of Chicago, and lead author of the report, says the findings are a bright spot for parents of premature infants.

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“For some families with really premature babies, these babies still do well in school and even can go on to be gifted. This is true for the youngest, most premature babies (23 to 24 weeks) and is even better for babies born at later ages, like 25 weeks and up,” Garfield says. “By the time a baby reaches 28 weeks, the difference between their Florida Comprehensive Assessment Test (FCAT) scores in third to eighth grade and those of the full-term babies is negligible.”

Preterm births are often associated with a number of risks, from medical morbidities and mortality to neurodevelopmental deficits. It can be difficult for pediatricians, however, to offer parents specific answers as to how their children will perform scholastically as they grow. In this study, researchers aimed to track educational performance based on gestational age at birth, and what they found may offer parents of preterm infants new hope about their long-term development.

The study investigated Florida infants born between 23 and 41 weeks’ gestation. The cohort was tracked from 1992 to 2002 as they progressed through Florida public schools. Researchers evaluated more than 1 million infants and found that 65% of children who were born at 23 to 24 weeks’ gestation were designated as kindergarten ready at the time school started, compared with 85.3% of children born at full term.

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On standardized testing, researchers found that both adjusted and unadjusted scores were higher for children born prematurely but with longer gestational ages than full-term children. Additionally, 9.5% of Florida-born public school students were deemed gifted-and 1.8% of them were born at 23 to 24 weeks’ gestation. In terms of low performance, 5.8% of all Florida students were considered low performers, with 33.5% of that cohort born at 23 to 24 weeks’ gestation. The proportion of children considered low performers decreased with gestational age, just as gifted status increased with gestational age, researchers note.

Overall, the study found that although children born at lower gestational ages were less likely to be kindergarten ready or achieve gifted status and performed lower on standardized testing, the deficits were less than expected and children were generally able to perform well within school norms.

“These results contribute to the growing body of knowledge that, although preterm birth-even near the traditional limits of viability-confers risks of long-term developmental impairments, the outcomes may not be uniformly deleterious,” the report states. “Our results suggest that, by 5 to 6 years, the negative effects of preterm birth on kindergarten readiness or later achieving competence in mathematics and reading tests might be less than expected when compared with full-term infants.”

The study did not weigh whether specific interventions were used to achieve these outcomes or whether early educational interventions had an effect on educational success.

Garfield says the study was unique in that it is one of the few to have looked at a large number of children and follow them so far into their education.

“We were able to follow 1.3 million babies born in Florida as they entered the public school system through eighth grade and look at their educational outcomes. What we found was reassuring. Two-thirds of babies born at only 23 or 24 weeks were ready for kindergarten on time,” Garfield says. “Unexpectedly, nearly 2% of them even achieved gifted status in school. While these extremely premature babies often scored low on standardized tests, preterm infants born 25 weeks or later performed only slightly lower than full-term infants. In fact, as the length of pregnancy increased after 28 weeks, the differences in test scores were negligible.”

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Garfield says as a physician in the neonatal intensive care unit (NICU), it can be challenging to advise parents on what their premature child’s educational outcome will be. This study, however, gives new reason for hope.

“Doctors working with premature infants and families in the NICU have reason to remain optimistic as the glass is half-full, [and] premature babies born even at the edge of viability who survive to 1 year are generally prepared for kindergarten and even can achieve gifted status in school,” Garfield says. “If babies are born even a little later, 25 weeks and above, the differences on FCAT scores in third through eighth grade are very small compared to full term babies. I hope clinicians can share this perspective with worried families.”