Very preterm born children at early school age: Healthcare therapies and educational provisions

The early educational environment at five years of age in a European cohort of children born very preterm: challenges and opportunities for research

BACKGROUND

Early childhood education offers opportunities for stimulation in multiple developmental domains and its positive impact on long-term outcomes and wellbeing for children is well documented. Few studies have explored early education in children born very preterm (VPT; <32 weeks of gestation) who are at higher risk of neurodevelopmental disorders and poor educational outcomes than their term-born peers. The purpose of the study is to describe and compare the educational environment of children born VPT in European countries at 5 years of age according to the degree of perinatal risk.

METHODS

Data originated from the population-based Screening to Improve Health In very Preterm infants (SHIPS) cohort of children born VPT in 2011/2012 in 19 regions from 11 European countries. Perinatal data were collected from medical records and the 5-year follow-up was conducted using parental questionnaires. Outcomes at 5 years were participation in early education (any, type, intensity of participation) and receipt of special educational support, which were harmonized across countries.

RESULTS

Out of 6,759 eligible children, 3,687 (54.6%) were followed up at 5 years (mean gestational age 29.3 weeks). At 5 years, almost all children (98.6%) were in an educational program, but type (preschool/primary), attendance (full-time/part-time) and use and type of school support/services differed by country. In some countries, children with high perinatal risk were more likely to be in full-time education than those with low risk (e.g. Estonia: 97.9% vs. 87.1%), while the inverse pattern was observed elsewhere (e.g. Poland: 78.5% vs. 92.8%). Overall, 22.8% of children received special educational support (country range: 12.4-34.4%) with more support received by children with higher perinatal risk. Large variations between countries remained after adjustment for socio-demographic characteristics.

CONCLUSIONS

There are marked variations in approaches to early education for children born VPT in Europe, raising opportunities to explore its impact on their neurodevelopment and well-being.

Predicting neurodevelopmental outcomes in preterm infants: A comprehensive evaluation of neonatal and maternal risk factors

OBJECTIVE

This retrospective cohort study aimed to evaluate neurodevelopmental outcomes of preterm infants (≤ 34 weeks gestational age) in the NICU.

METHODS

This retrospective cohort study included 89 preterm infants admitted to the NICU of Ghaem hospital, Mashhad, between 2016 and 2020. Data on neonatal and maternal factors were collected. By recalling the mentioned infants in 2021, the neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development. Data analysis included descriptive statistics, non-parametric tests, and binary logistic regression conducted with SPSS V.26 and R program software.

RESULTS

The sample comprised 48.3 % males with a mean gestational age of 32.10 weeks. Bayley Scale analysis revealed significant associations of Intrauterine Growth Restriction, Pneumothorax, and Bronchopulmonary Dysplasia with impairments in all domains. Diabetes in Pregnancy, Surfactant use, and Necrotizing Enterocolitis were also significantly linked to various impairments. Lower Apgar scores, gestational age, birth weight, and extended hospitalization and oxygen therapy durations correlated with several domain impairments. Logistic regression showed hospitalization duration impacted the coarse motor domain (OR = 0.92, p = 0.019), oxygen therapy duration influenced cognitive, perceptual, and fine motor domains.

CONCLUSION

This study underscores the importance of considering neonatal and maternal factors when assessing developmental outcomes in preterm infant. Long hospital stays and increase duration of oxygen therapy associated with negative developmental outcomes in different domains of Bayley scales. Early identification of these risk factors and targeted interventions may improve long-term outcomes for preterm children.

Preterm Birth is Associated with Lower Academic Attainment at Age 12 Years: A Matched Cohort Study by Linkage of Population-Based Datasets

OBJECTIVE

To compare academic attainment at age 12 years in preterm children born below 30 weeks of gestation with matched term-born peers, using standardized, nationwide and well-validated school tests.

STUDY DESIGN

This population-based, national cohort study was performed by linking perinatal data from the nationwide Netherlands Perinatal Registry with educational outcome data from Statistics Netherlands and included 4677 surviving preterm children born at 25^0/7-29^6/7 weeks of gestational age and 366 561 controls born at 40 weeks of gestational age in 2000-2007. First, special education participation rate was calculated. Subsequently, all preterm children with academic attainment test data derived at age 12 years were matched to term-born children using year and month of birth, sex, parity, socioeconomic status, and maternal age. Total, language, and mathematics test scores and secondary school level advice were compared between these 2 groups.

RESULTS

Children below 30 weeks of gestation had a higher special education participation rate (10.2% vs 2.7%, P < .001) than term-born peers. Preterm children had lower total (-0.37 SD; 95% CI -0.42 to -0.31), language (-0.21 SD; 95% CI -0.27 to -0.15), and mathematics (-0.45 SD; 95%CI -0.51 to -0.38) z scores, and more often a prevocational secondary school level advice (62% vs 46%, P < .001).

CONCLUSIONS

A substantial proportion of children born before 30 weeks of gestation need special education at the end of elementary schooling. These children have significant deficits on all measures of academic attainment at age 12 years, especially mathematics, compared with matched term-born peers.

Executive function training in very preterm children: a randomized controlled trial

Objective of the current study was to assess whether game-formatted executive function (EF) training, is effective in improving attention, EF and academic performance in very preterm and/or extremely low birthweight children aged 8-12 years. A multi-center, double-blind, placebo- and waitlist controlled randomized trial (NTR5365) in two academic hospitals in The Netherlands was performed. Eighty-five very preterm children with parent-rated attention problems on the Child Behavior Checklist were randomized to one of three treatment conditions: EF training, placebo training or waitlist condition. EF or placebo training was completed at home (6 weeks, 25 sessions of 30-45 min each). At baseline, 2 weeks after training or being on the waitlist, and five months after first follow-up visit, children underwent assessments of primary outcomes (parent and teacher ratings of attention) and secondary outcomes (parent and teacher ratings of daily-life EF, computerized EF tasks and academic performance). Linear mixed model analyses were performed for all outcome measures. There were no significant differences in improvement over time on parent- and teacher ratings of attention, parent- and teacher ratings of daily-life EF, computerized EF tasks, and academic performance (arithmetic and reading) between the EF training, placebo training and waitlist condition. In conclusion, game-formatted EF training does not improve attention, EF or academic performance in very preterm children with parent-rated attention problems.

Preterm children's long-term academic performance after adaptive computerized training: an efficacy and process analysis of a randomized controlled trial

BACKGROUND

Adaptive computerized interventions may help improve preterm children's academic success, but randomized trials are rare. We tested whether a math training (XtraMath®) versus an active control condition (Cogmed®; working memory) improved school performance. Training feasibility was also evaluated.

METHODS

Preterm born first graders, N = 65 (28-35 + 6 weeks gestation) were recruited into a prospective randomized controlled multicenter trial and received one of two computerized trainings at home for 5 weeks. Teachers rated academic performance in math, reading/writing, and attention compared to classmates before (baseline), directly after (post), and 12 months after the intervention (follow-up). Total academic performance growth was calculated as change from baseline (hierarchically ordered-post test first, follow-up second).

RESULTS

Bootstrapped linear regressions showed that academic growth to post test was significantly higher in the math intervention group (B = 0.25 [95% confidence interval: 0.04-0.50], p = 0.039), but this difference was not sustained at the 12-month follow-up (B = 0.00 [-0.31 to 0.34], p = 0.996). Parents in the XtraMath group reported higher acceptance compared with the Cogmed group (mean difference: -0.49, [-0.90 to -0.08], p = 0.037).

CONCLUSIONS

Our findings do not show a sustained difference in efficacy between both trainings. Studies of math intervention effectiveness for preterm school-aged children are warranted.

IMPACT

Adaptive computerized math training may help improve preterm children's short-term school performance. Computerized math training provides a novel avenue towards intervention after preterm birth. Well-powered randomized controlled studies of math intervention effectiveness for preterm school-aged children are warranted.

Intestinal Dysbiosis As a Possible Predictor of Very Early Preterm Labor in Pregnant Women With Metabolic Syndrome

The work assessed the state of the intestinal microbiocenosis in 52 puerperae at the in whom the pregnancy developed against the background of the metabolic syndrome. The diagnosis of metabolic syndrome was determined according to the criteria approved by the World Health Organization for pregnant women. The state of intestinal microbiocenosis was assessed by a bacteriological examination of feces immediately after delivery. The content of the main representatives of the obligate microflora (bifidobacteria, lactobacilli, native intestinal bacilli, fecal streptococci) and facultative (conditionally pathogenic) microorganisms (representatives of the genus Prоteus, Klebsiella, pathogenic strains of E. coli, Staphylococcus epidermidis, Enterobacter, Citrobacter, Clostridium difficile, Candida fungi) was determined. Cultures were made on appropriate growth media.

At the time of birth, all patients of group I showed signs of intestinal microbiocenosis disorder. At the same time, 13 (54.2%) puerperae were diagnosed signs of dysbiosis of II degree, 9 (37.5%) with signs of III degree, which were generally characterized by a significant decrease in the content of the main representatives of obligate microflora (Bifidobacterium, Lactobacillus, Escherichia coli, Fecal streptococci) with simultaneous high contamination of Candida albicans and Clostridium difficile. So, it can be considered as a possible predictor of very early preterm birth in women with MS. In pregnant women with MS, but who gave timely birth (group II), dysbiotic disorders were detected to a lesser extent. Thus, in 13 (46.4%) patients, initial signs of intestinal dysbiosis (first degree) were detected in 4 (14.3%) patients (second degree). In 11 (39.3%) puerperae of group II, microbial indices indicated normal eubiotic ratios.

School performance is age appropriate with support services in very preterm children at 11 years of age

Aim

This Finnish regional birth‐cohort study compared the school performance of very preterm and full‐term children when they reached 11 years of age.

Methods

Teachers rated the educational abilities of 123 preterm children and 133 full‐term controls at the age of 11 years as well as the support services they received. The children were all born in the Turku University Hospital between 2001 and 2005. In the preterm group, neurosensory impairments were confirmed at two years of corrected age, and full‐scale intelligence quotient (IQ) was assessed at 11 years of age using the Wechsler Intelligence Scale, Fourth Edition.

Results

Educational abilities, including academic skills and classroom functioning, did not differ between the two groups after excluding the children with a full‐scale IQ < 70. However, 40% of the preterm group and 26% of the controls had received at least one support service (p <0.02). The 13 preterm children with a full‐scale IQ <70 and the 10 with neurosensory impairment received more support services. Boys in both groups displayed more classroom‐functioning problems than girls.

Conclusion

A full‐scale IQ ≥ 70 and age‐appropriate educational abilities do not exclude a significant need for support services in very preterm children at the age of 11 years.

Association Between Funisitis and Childhood Intellectual Development: A Prospective Cohort Study

Background: Previous studies have suggested that prenatal inflammation could damage the immature brain of preterm infants. In this study, we aimed to investigate whether funisitis could affect childhood neurodevelopment. We hypothesized that childhood neurodevelopment would vary across groups with or without funisitis.

Material sand Methods: Using data from the U.S. Collaborative Perinatal Project (1959–1976), 29,725 subjects with available intelligence quotient (IQ) were studied. Detailed placental examinations were conducted according to a standard protocol with quality control procedures. Multivariate logistic regression models were applied to evaluate the relationship between funisitis and IQ at age 4 or 7 years after adjusting for confounders.

Results: Early preterm birth children with funisitis had a 3.0-fold (95% confidence interval 1.2, 7.3) risk of low full-scale IQ (<70) at age 4 years, which disappeared until age 7 years. Term birth children with funisitis had 1.9-fold (95% confidence interval 1.2, 3.0) risk of low performance IQ at age 7 years, but they did not have increased risk of low full-scale IQ. No difference in IQ score was found in late preterm birth children.

Conclusion: Funisitis may injure the developmental brain of infants, leading to the relative low IQ in childhood at age 4, but the negative effect is only existed in performance IQ at age of 7.

Prediction of school outcome after preterm birth: a cohort study

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.

Visual perceptive skills account for very preterm children's mathematical difficulties in preschool

BACKGROUND

Already in preschool, very preterm (VP) children perform worse than term born-children on preschool mathematical skills tests. Strong associations have been found between preschool mathematical skills, cognition and visual-motor integration.

AIMS

To compare VP children and their term-born peers on preschool mathematical achievement at the corrected age of five years, and determine whether cognitive, visual-perceptive, visual-motor, and motor-coordination skills, account for any significant differences observed.

STUDY DESIGN

Single-center, consecutive cohort study with a term-born comparison group.

SUBJECTS

54 five-year-old VP children and 28 term-born comparison children.

OUTCOME MEASURES

Standardized test for preschool mathematical skills (Dutch pupil monitoring system), cognitive skills (Wechsler Preschool and Primary Scale for Intelligence - third edition), visual-perception, visual-motor integration, and motor-coordination (Beery Visual-Motor Integration test - sixth edition). Group differences were analyzed with ANCOVAs, adjusting for maternal education, preschool grade, and time of assessment. Sobel's mediation analyses tested for possible mediation effects.

RESULTS

Preschool mathematical skills and visual perceptive skills were significantly lower in VP children than in term-born children (Cohen's d = 0.63, p = 0.01; Cohen's d = 0.84, p < 0.01, respectively). Sobel's test indicated a significant mediating effect of visual perceptive skills on the association between VP birth and preschool mathematical skills.

CONCLUSIONS

At preschool age, VP children have poorer preschool mathematical skills compared to term-born peers; deficits that were fully accounted for by poor visual perceptive skills. Our findings indicate the relevance of screening visual perceptive skills at preschool age, enabling timely identification of children at risk for mathematical difficulties.