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Prediction of school outcome after preterm birth: a cohort study
  1. David Odd1,2,
  2. David Evans1,
  3. Alan M Emond2
  1. 1 Neonatal Unit, North Bristol NHS Trust, Bristol, UK
  2. 2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  1. Correspondence to Dr David Odd, Neonatal Unit, Southmead Hospital, Bristol BS10 5NB, UK; david.odd{at}


Objective To identify if the educational trajectories of preterm infants differ from those of their term peers.

Design This work is based on the Avon Longitudinal Study of Parents and Children (ALSPAC). Educational measures were categorised into 10 deciles to allow comparison of measures across time periods. Gestational age was categorised as preterm (23–36 weeks) or term (37–42 weeks). Multilevel mixed-effects linear regression models were derived to examine the trajectories of decile scores across the study period. Gestational group was added as an interaction term to assess if the trajectory between educational measures varied between preterm and term infants. Adjustment for possible confounders was performed.

Subjects The final dataset contained information on 12 586 infants born alive at between 23 weeks and 42 weeks of gestation.

Main outcome measures UK mandatory educational assessments (SATs) scores throughout educational journal (including final GCSE results at 16 years of age).

Results Preterm infants had on average lower Key Stage (KS) scores than term children (−0.46 (−0.84 to −0.07)). However, on average, they gained on their term peers in each progressive measure (0.10 (0.01 to 0.19)), suggesting ‘catch up’ during the first few years at school. Preterm infants appeared to exhibit the increase in decile scores mostly between KS1 and KS2 (p=0.005) and little between KS2 and KS3 (p=0.182) or KS3 and KS4 (p=0.149).

Conclusions This work further emphasises the importance of early schooling and environment in these infants and suggests that support, long after the premature birth, may have additional benefits.

  • premature birth
  • preterm
  • cohort studies
  • education

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  • Contributors DO, AME and DE conceived the idea and developed the methodology. DO performed the statistical analysis and wrote the first draft of the paper. DO, AME and DE developed and approved the final manuscript. This publication is the work of the authors and DO will serve as guarantor for the contents of this paper.

  • Funding This research was specifically funded by North Bristol NHS Trust Springboard Fund (Round 10, R&I ref: 3883). The UK Medical Research Council and the Wellcome Trust (Grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website. The Project to Enhance ALSPAC through Record Linkage (PEARL) is funded by the Wellcome Trust (WT086118/Z/08/Z), John Macleod is the principal investigator (PI). Measures would include all record linkage to Primary Care records, Hospital Episode Statistics Records, Education Records, Child Looked After (CLA) and Child in Need (CIN) records, Geographical Records. ‘Developing the ALSPAC longitudinal survey of children as a resource for education’ was funded by the UK Department for Education and Skills (EOR/SBU/2002/121), Jean Golding was the PI. Measures would include all record linkage to National Pupil Database school-age educational records.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data were obtained from ALSPAC ( and access is not available from the authors.

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