Academic trajectories of very preterm born children at school age

Title: The first longitudinal study showing academic difficulties in very preterm born infants persist during primary school

Very preterm birth is associated with academic difficulties, which is known to subsequently impact health and life chances. Close monitoring of academic development is key to identify those with difficulties and prevent academic failure, however knowledge of academic trajectories of very preterm infants is scarce. Whether very preterm infants academic development is characterised by persisting deficits, delay with catch up at a later age, or deficits that become more apparent with time is not yet understood. Whilst cross-sectional studies provide valuable insights on functioning at a specific time during development they do not provide information on development trajectories. Longitudinal studies however, have the capability to study individual change over time providing information on the expected developmental trajectory of very preterm children and potentially identifying time points where issues may become apparent or worsen.

Academic performance of a Dutch cohort of 52 very preterm children and 58 full-term controls was assessed in grade 1-6 of primary school with 11 measurements of arithmetic and spelling performance and 7 measurements of reading comprehension.

The study demonstrated that very preterm infants scored on average 0.53 SD lower on arithmetic (p<.001), 0.31 SD on reading comprehension (p<.001), and 0.21 SD on spelling (p=.01) compared to full-term peers through the course of primary school. This relationship was stable over time, implying intact learning abilities, but also that deficits apparent in the first grade of primary school do not improve or worsen with progression through later grades. Academic difficulties in very preterm children were indicated by increased educational assistance and grade repetition, and lower secondary education levels. With the present education, including special assistance and grade repetition, very preterm infants in general were not able to reach similar academic performance levels as full-term peers.

This longitudinal study demonstrated for the first the academic development trajectory of very preterm children. Very preterm children showed difficulties in arithmetic, reading and spelling that persisted throughout primary school. However, they showed a similar progression to full-term children suggesting intact learning abilities providing potential opportunities for intervention. More research is needed to identify risk factors that may be target of preventive strategies for poor academic outcomes, clarify which skills and neurocognitive functions can be trained in what way, at which time in development, and in which children to minimise this academic performance gap.

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