Children born very prematurely have difficulty in school
12 March 2009
More than half of children born extremely prematurely need extra support in school and have particular difficulty with maths, a study funded by the Medical Research Council has found.
Scientists from the EPICure study group compared the intelligence and academic attainment of 219 11-year-old children who were born before 26 weeks (of pregnancy) with 153 classmates who were born after a normal length of pregnancy. The research is published in the Fetal and Neonatal Edition of Archives of Disease in Childhood.
EPICure was established in 1995 to determine the health and chances of survival of babies born extremely early in the United Kingdom and Ireland. This latest research recorded results for children at 11 years of age and follows previous studies when they were two-and-a-half and six years old.
The latest study results show:
• Children born extremely prematurely scored significantly lower on IQ and had trouble with reading and maths.
• Boys scored significantly fewer points than the girls, except for maths. There were no such sex differences among their classmates.
• One in three children born extremely prematurely found reading difficult, while 44% battled with maths.
• These children also found simultaneous processing of complex information especially difficult.
Dr Samantha Johnson, a research Psychologist at The University of Nottingham and co-author of the paper, said: “These latest findings from the EPICure Study highlight the kinds of difficulties extremely preterm children are likely to face at school and what kind of help they may need in order to realise their potential. These children have poorer performance than their classmates across all national curriculum subjects, with the most prominent difficulties in maths, and around two thirds had some degree of special educational needs. As survival rates for extremely preterm babies continue to increase, studies such as these are crucial for educational planning and to aid in the development of programmes to optimise outcomes for these children.”
The assessments were based on standard tests of IQ and academic achievement combined with teachers’ reports of school performance and any special educational needs.
Only 29 of the children attended special schools. The rest attended mainstream schools, where over half (57%) had special educational needs, most of which required additional learning support.
In all, two thirds had academic and behavioural special educational needs compared with 11% of their classmates and 24% of schoolchildren across England.
They were also more likely than their classmates to require multiple support services, and services provided by external agencies.
Teachers rated the academic performance of half of their charges who had been born very early as below the average range expected for their age, compared with just 5% of children born after a normal length pregnancy.
Researchers compared the academic performance of children born extremely prematurely, who started school a year earlier than if they were born on their expected delivery date, with those who would have started school the same year regardless of whether they were born extremely prematurely or on their expected birth date. They found the academic performance of these two groups of children the same however the children who started school a year earlier than if they were born at normal length pregnancy needed more special needs support.
Dr Samantha Johnson said: “Our results also suggest that delaying school entry may be beneficial for children who start full time school in an earlier academic year because of their extremely preterm birth.”
The researchers say although delaying school entry may be beneficial for extremely preterm children further studies are needed to investigate this issue.
Since 1995, the care given to very premature babies has improved markedly. In view of this, the MRC has funded a repeat study to determine whether this has had any effect on survival rates and later health status: this second study of outcome following extremely premature birth was started in 2006 and is called EPICure-2. These children are currently being followed-up at two and a half years of age, in the same way as the 1995 cohort, to determine whether outcomes have improved. The initial results from the EPICure-2 studies are expected to be published in full later this year.
Neil Marlow, Professor of Neonatal Medicine at University College London Institute for Women's Health, is senior author of the paper and chief investigator of the EPICure studies. He said: “It is important that the funding of long-term studies such as EPICure continue. Outcome-based research such as the EPICure studies is extremely important in finding the ‘real’ impact of premature birth on children and their education.”
Notes:
Original research paper: Academic attainment and special educational needs in extremely preterm children at 11 years of age: the EPICure study, published in Archives of Disease in Childhood Fetal and Neonatal Edition 2009; doi 10.1136/adc.2008.152793
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