Original article
School Outcomes of Late Preterm Infants: Special Needs and Challenges for Infants Born at 32 to 36 Weeks Gestation

https://doi.org/10.1016/j.jpeds.2008.01.027Get rights and content

Objective

Because limited long-term outcome data exist for infants born at 32 to 36 weeks gestation, we compared school outcomes between 32- to 33-week moderate preterm (MP), 34-36 week late preterm (LP) and full-term (FT) infants.

Study design

A total of 970 preterm infants and 13 671 FT control subjects were identified from the Early Childhood Longitudinal Study-Kindergarten Cohort. Test scores, teacher evaluations, and special education enrollment from kindergarten (K) to grade 5 were compared.

Results

LP infants had lower reading scores than FT infants in K to first grade (P < .05). Adjusted risk for poor reading and math scores remained elevated in first grade (P < .05). Teacher evaluations of math skills from K to first grade and reading skills from K to fifth grade were worse for LP infants (P < .05). Adjusted odds for below average skills remained higher for math in K and for reading at all grades (P < .05). Special education participation was higher for LP infants at early grades (odds ratio, 1.4-2.1). MP infants had lower test and teacher evaluation scores than FT infants and twice the risk for special education at all grade levels.

Conclusions

Persistent teacher concerns through grade 5 and greater special education needs among MP and LP infants suggest a need to start follow-up, anticipatory guidance, and interventions for infants born at 32 to 36 weeks gestation.

Section snippets

Data Source

The data source was the publicly available ECLS-K dataset from the United States Department of Education. The ECLS-K is a longitudinal study providing national data to analyze how family, school, community, and individual variables contribute to school performance.14, 15, 16 The ECLS-K includes a nationally representative sample of 17 565 children from public and private schools with diverse socioeconomic and racial/ethnic backgrounds. Children were observed from enrollment (1998-1999 K class)

Demographics

Baseline characteristics of the infants in the LP, MP, and FT study groups are shown in Table I. Compared with FT infants, LP infants weighed less at birth (P < .0001) and were more likely to be multiple (P < .0001) and male (P = .05). Racial distribution varied in the 2 groups (P = .02). Parental demographics were similar, with the exception of higher maternal education in LP infants. MP infants also differed from FT infants in lower birth weight (P < .0001) and increased multiple birth status

Discussion

Infants born at 32 to 36 weeks gestation are at increased risk for poor school outcome compared with FT infants. Despite similar test scores in later grades, teachers still recognize less advanced reading ability in 34- to 36-week LP infants through grade 5.

The resolution in test score differences by third and fifth grade may reflect a number of factors. LP infants may have “caught up” in their cognitive development by later grades. Another possibility is that LP infants have improved scores

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