Why Children Born as Late-Preterm Infants Should Be on Our Radar
Why Children Born as Late-Preterm Infants Should Be on Our Radar
In a new study, such children had more difficulties in school.
For years, babies born between 32 and 36 weeks’ gestation have been thought to have developmental and neurological outcomes similar to those of full-term infants. Although studies have shown that these infants are at greater risk for short-term morbidities, such as respiratory distress, hyperbilirubinemia, hypoglycemia, and feeding problems,1 little research had been done regarding school outcomes for moderatepreterm (32 to 33 weeks) and late-preterm (34 to 36 weeks) infants. Now a study in The Journal of Pediatrics by Chyi and colleagues2 has shown that these infants may also be at greater risk for difficulties in school later in life.
Using the kindergarten cohort data of the US Department of Education Early Childhood Longitudinal Study, the authors identified children who had been born moderate-preterm or late-preterm; they excluded those who had a history of anoxia or respiratory distress at birth. At kindergarten, first grade, third grade, and fifth grade, the authors examined direct assessment test scores, teacher rating scales, and the need for Individualized Education Programs (IEPs) and special education in both the study children and a control group of children born as full-term infants.
The Chyi study found that the children born as latepreterm infants scored lower on the direct child assessment tests for reading in kindergarten and in first grade, with teacher ratings showing lower abilities in fifth grade as well. The assessment tests did not find a difference in math abilities between those born late-preterm and those born at full term; however, teachers rated the children born late-preterm as having lower math abilities in kindergarten and first grade.
The children born as moderate-preterm infants were found to have lower math test scores than those born at full term in all grades and to have lower scores on reading tests in all grades but third. In addition, those born as moderate-preterm infants were rated by teachers as having lower reading levels than the children born at full term in all grades, and lower math aptitude in all grades except kindergarten.
In kindergarten and first grade, the children born as late-preterm infants were more likely than those born at full term to require IEPs and to need special education. Of the 3 groups of children, those born as moderate-preterm infants required the most services at all grade levels.
As Chyi and colleagues state—and as Jain3 discusses in an editorial published with the article—this study has significant limitations, including demographic discrepancies between the groups, participant attrition, and limited data availability secondary to use of a preexisting dataset. More than 30% of the children in each group were lost to follow-up (although the authors feel that the children born preterm who were lost to follow-up had lower test scores and more difficulties early on than did the children born at full term who were lost). Also, only parental reports were available to assess gestational age and medical complications at birth: no medical records were accessible.
Despite these limitations, this study is an important early step in understanding the differences between the brains of preterm and full-term infants. Rather than assuming that infants born without complication between 32 and 36 weeks’ gestation will develop similarly to fullterm infants, we must be aware of potential struggles they may face. Moderate- reterm and late-preterm infants may be at risk for difficulties in school and should be on our radar for careful observation and evaluation.