Editor’s Note: Dr. Elizabeth Zeichner (she/her) is a former high school teacher. She is a pediatrics resident at the Children’s Hospital of Philadelphia. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Extremely preterm (EPT) infants are those who are born at <28 weeks gestation. With medical advancements, more infants born EPT are surviving and thriving, prompting questions surrounding outcomes for these children later in life.
This week, Pediatrics is early releasing the article, “Educational Performance of Extremely Preterm Infants in Primary School” by Dr. Nele Legge and colleagues at University of Sydney and the Children’s Hospital at Westmead in Australia (10.1542/peds.2024-069425).
The authors included infants born at 23–27 weeks gestation between August 2001 and July 2010 in New South Wales, Australia. They reviewed educational data for these children from the National Assessment Program – Literacy and Numeracy (NAPLAN) assessment, a standardized assessment taken between ages 7 and 9 years. They compared results for children born at 23–25 weeks gestational age and 26–27 weeks gestational age with children born at full term. They included sociodemographic factors (such as maternal education and socio-economic index for area of residence) and maternal health factors (such as smoking during pregnancy) as variables.
The authors analyzed scores in numeracy and reading from 1409 children; of this group, 443 (31%) were born 23–25 weeks' gestation and 966 (69%) were born 26-27 weeks' gestation. They found small differences between the gestational age groups, but overall, most infants born EPT scored above the national minimum standard (NMS):
- For numeracy:
- 63% of infants born at 23–25 weeks scored above NMS
- 4% of infants born 26–27 weeks scored above NMS
- 9% of infants born at term scored above NMS
- For reading:
- 4% of infants born at 23–25 weeks scored above NMS
- 4% of infants born 26–27 weeks scored above NMS
- 7% of infants born at term scored above NMS
Sociodemographic factors were found to be more important in predicting academic performance. Some interesting findings include:
- Lowest rates of reduced numeracy and literacy were seen in those born at 26–27 weeks, without morbidity or congenital abnormalities, and who had highly educated parents.
- Highest rates of reduced numeracy and literacy were seen in those born at 23–25 weeks, who had morbidity and/or congenital abnormalities, and who had parents with low levels of education.
- Infants with parent(s) with a low education level were twice as likely to have poor numeracy results, regardless of their gestational age.
- For literacy, there was no statistically significant difference between those born at 23–25 weeks and those born at 26–27 weeks, though there were significant differences based on an infant parent(s)’ education level.
- Other factors found to be associated with reduced numeracy and reading included maternal age <25 years, low socioeconomic index for area (SEIFA), and maternal smoking.
Overall, many children who were born EPT perform well on school standardized testing. However, sociodemographic factors, such as parental education levels and socio-economic status, and maternal health factors, such as smoking during pregnancy, strongly influence these scores and are also closely intertwined. This provides more context when we consider which of our patients may be more vulnerable and require additional support to succeed.
