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Academic Outcomes of School-Aged Children Born Preterm: A Systematic Review and Meta-analysis.

ABSTRACT: Importance:Children born preterm are at an elevated risk of academic underachievement. However, the extent to which performance across domain-specific subskills in reading and mathematics is associated with preterm birth remains unclear. Objective:To conduct a systematic review and meta-analysis of academic outcomes of school-aged children born preterm, compared with children born at term, appraising evidence for higher- and lower-order subskills in reading and mathematics. Data Sources:PubMed/MEDLINE, PsycINFO, and the Cumulative Index of Nursing and Allied Health Literature electronic databases from January 1, 1980, to July 30, 2018, were searched for population, exposure, and outcome terms such as child (population), preterm birth (exposure), and education* (outcome). Study Selection:Peer-reviewed English-language publications that included preterm-born children and a comparison group of term-born children aged 5 to 18 years and born during or after 1980 and that reported outcomes on standardized assessments from cohort or cross-sectional studies were screened. Of the 9833 articles screened, 33 unique studies met the inclusion criteria. Data Extraction and Synthesis:Data were analyzed from August 1 to September 29, 2018. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Two reviewers independently screened the databases and extracted sample characteristics and outcomes scores. Pooled mean differences (MDs) were analyzed using random-effects models. Main Outcomes and Measures:Performance on standardized assessment of higher-order subskills of reading comprehension and applied mathematics problems; lower-order reading subskills of decoding, pseudoword decoding, and word identification; and lower-order mathematics subskills of knowledge, calculation, and fluency. Results:Outcomes data were extracted for 4006 preterm and 3317 term-born children, totaling 7323 participants from 33 unique studies. Relative to children born at term, children born preterm scored significantly lower in reading comprehension (mean difference [MD], -7.96; 95% CI, -12.15 to -3.76; I2?=?81%) and applied mathematical problems (MD, -11.41; 95% CI, -17.57 to -5.26; I2?=?91%) assessments. Across the assessments of lower-order skills, children born preterm scored significantly lower than their term-born peers in calculation (MD, -10.57; 95% CI, -15.62 to -5.52; I2?=?92%), decoding (MD, -10.18; 95% CI, -16.83 to -3.53; I2?=?71%), mathematical knowledge (MD, -9.88; 95% CI, -11.68 to -8.08; I2?=?62%), word identification (MD, -7.44; 95% CI, -9.08 to -5.80; I2?=?69%), and mathematical fluency (MD, -6.89; 95% CI, -13.54 to -0.23; I2?=?72%). The associations remained unchanged after sensitivity analyses for reducing heterogeneity. Conclusions and Relevance:These findings provide evidence that preterm birth is associated with academic underperformance in aggregate measures of reading and mathematics, as well as a variety of related subskills.

SUBMITTER: McBryde M

PROVIDER: S-EPMC7125435 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Academic Outcomes of School-Aged Children Born Preterm: A Systematic Review and Meta-analysis.

McBryde Melinda M Fitzallen Grace C GC Liley Helen G HG Taylor H Gerry HG Bora Samudragupta S

JAMA network open 20200401 4

<h4>Importance</h4>Children born preterm are at an elevated risk of academic underachievement. However, the extent to which performance across domain-specific subskills in reading and mathematics is associated with preterm birth remains unclear.<h4>Objective</h4>To conduct a systematic review and meta-analysis of academic outcomes of school-aged children born preterm, compared with children born at term, appraising evidence for higher- and lower-order subskills in reading and mathematics.<h4>Dat ...[more]

PMID: 32242904

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Project description:BackgroundExecutive function deficits in children born very preterm (VPT) have been linked to anatomical abnormalities in white matter and subcortical brain structures. This study aimed to investigate how altered brain metabolism contributes to these deficits in VPT children at school-age.MethodsFifty-four VPT participants aged 8-13 years and 62 term-born peers were assessed with an executive function test battery. Brain metabolites were obtained in the frontal white matter and the basal ganglia/thalami, using proton magnetic resonance spectroscopy (MRS). N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, glutamate + glutamine (Glx)/Cr, and myo-Inositol (mI)/Cr were compared between groups and associations with executive functions were explored using linear regression.ResultsIn the frontal white matter, VPT showed lower Glx/Cr (mean difference: -5.91%, 95% CI [-10.50, -1.32]), higher Cho/Cr (7.39%, 95%-CI [2.68, 12.10]), and higher mI/Cr (5.41%, 95%-CI [0.18, 10.64]) while there were no differences in the basal ganglia/thalami. Lower executive functions were associated with lower frontal Glx/Cr ratios in both groups (β = 0.16, p = 0.05) and higher mI/Cr ratios in the VPT group only (interaction: β = -0.17, p = 0.02).ConclusionLong-term brain metabolite alterations in the frontal white matter may be related to executive function deficits in VPT children at school-age.ImpactVery preterm birth is associated with long-term brain metabolite alterations in the frontal white matter. Such alterations may contribute to deficits in executive function abilities. Injury processes in the brain can persist for years after the initial insult. Our findings provide new insights beyond structural and functional imaging, which help to elucidate the processes involved in abnormal brain development following preterm birth. Ultimately, this may lead to earlier identification of children at risk for developing deficits and more effective interventions.

Project description:Introduction: Prematurity (birth before 37 +0 weeks' gestation) is associated with wide-ranging neurodevelopmental impairment. Prognosis among moderate to late (32 +0 to <37 +0 weeks' gestation) preterm infants (MLPT) is better compared to their counterparts born very preterm (<32 +0 weeks' gestation). However the risk of developmental impairment among MLPT, who make up about 84% of all preterm infants, is 2-3 times higher when compared to infants born at term. Early interventions have aimed to improve outcomes in preterm infants generally, but there are limited data on their need and effect in MLPT specifically. Prioritising research, long-term follow-up and early interventions targeted at ameliorating the impact of preterm birth among MLPT is required. Objectives: To conduct a systematic review of the type of early childhood interventions (from birth until 4 years of age) offered to MLPT children and to evaluate their impact on neurodevelopmental outcomes (cognitive, neurobehavioural and motor) as assessed in these children during childhood (until 18 years of age). Methods and analysis: A systematic literature search in Web of Science, Medline Ovid, PsycINFO, CINAHL and EMBASE will be conducted. Data on MLPT children receiving developmental interventions until the age of 4 years will be evaluated. Interventions may involve parents or primary caregivers. Primary outcomes are cognitive, neurobehavioural and motor development as measured from birth until the age of 18 years. The Cochrane Risk of Bias Assessment Tool will be used to evaluate the methodological quality of randomised controlled trials (RCTs) included in the review and will be graded as low, high or unclear risk of bias. The quality of non-RCTs will be evaluated with the Newcastle-Ottawa Scale. The quality of evidence for each outcome will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation Approach. Publication and reporting bias will be assessed using Egger's test and funnel plots respectively.

Project description:Background To undertake a systematic review of studies describing the proportion of children admitted to a paediatric intensive care unit (PICU) for respiratory syncytial virus (RSV) and/or bronchiolitis who were born preterm, and compare their outcomes in PICU with children born at term. Methods We searched Medline, Embase and Scopus. Citations and references of included articles were searched. We included studies published from the year 2000 onwards, from high-income countries, that examined children 0–18 years of age, admitted to PICU from the year 2000 onwards for RSV and/or bronchiolitis. The primary outcome was the percentage of PICU admissions born preterm, and secondary outcomes were observed relative risks of invasive mechanical ventilation and mortality within PICU. We used the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies to assess risk of bias. Results We included 31 studies, from 16 countries, including a total of 18,331 children. Following meta-analysis, the pooled estimate for percentage of PICU admissions for RSV/bronchiolitis who were born preterm was 31% (95% confidence interval: 27% to 35%). Children born preterm had a greater risk of requiring invasive ventilation compared to children born at term (relative risk 1.57, 95% confidence interval 1.25 to 1.97, I2 = 38%). However, we did not observe a significant increase in the relative risk for mortality within PICU for preterm-born children (relative risk 1.10, 95% confidence interval: 0.70 to 1.72, I2 = 0%), although the mortality rate was low across both groups. The majority of studies (n = 26, 84%) were at high risk of bias. Conclusions Among PICU admissions for bronchiolitis, preterm-born children are over-represented compared with the preterm birth rate (preterm birth rate 4.4% to 14.4% across countries included in review). Preterm-born children are at higher risk of mechanical ventilation compared to those born at term. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-023-04150-7.

Project description:ImportanceChildren born preterm may experience learning challenges at school. However, there is a paucity of data on the school readiness of these children as they prepare to begin grade 1.ObjectiveTo examine the association between prematurity and school readiness in a population-based cohort of children.Design, setting, and participantsThis cohort study was conducted in the province of Manitoba, Canada, and involved 2 cohorts of children in kindergarten at the time of data collection. The population-based cohort included children born between January 1, 2000, and December 31, 2011, whose school readiness was assessed in kindergarten using the Early Development Instrument (EDI) data. The sibling cohort comprised children born preterm and their closest-in-age siblings born full term. Data were analyzed between March 12 and September 28, 2021.ExposuresPreterm birth, defined as gestational age (GA) less than 37 weeks.Main outcomes and measuresThe primary outcome was vulnerability in the EDI, defined as a score below the tenth percentile of the Canadian population norms for any 1 or more of the 5 EDI domains (physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge). Logistic regression models were used to identify the factors associated with vulnerability in the EDI. P values were adjusted for multiplicity using the Simes false discovery method.ResultsOf 86 829 eligible children, 63 277 were included, of whom 4352 were preterm (mean [SD] GA, 34 [2] weeks; 2315 boys [53%]) and 58 925 were full term (mean [SD] GA, 39 (1) weeks; 29 885 boys [51%]). Overall, 35% of children (1536 of 4352) born preterm were vulnerable in the EDI compared with 28% of children (16 449 of 58 925) born full term (adjusted odds ratio [AOR], 1.32; 95% CI, 1.23-1.41; P < .001]). Compared with children born full term, those born preterm had a higher percentage of vulnerability in each of the 5 EDI domains. In the population-based cohort, prematurity (34-36 weeks' GA: AOR, 1.23 [95% CI, 1.14-1.33]; <34 weeks' GA: AOR, 1.72 [95% CI, 1.48-1.99]), male sex (AOR, 2.24; 95% CI, 2.16-2.33), small for gestational age (AOR, 1.31; 95% CI, 1.23-1.40), and various maternal medical and sociodemographic factors were associated with EDI vulnerability. In the sibling cohort, EDI outcomes were similar for both children born preterm and their siblings born full term except for the communication skills and general knowledge domain (AOR, 1.39; 95% CI, 1.07-1.80) and Multiple Challenge Index (AOR, 1.43; 95% CI, 1.06-1.92), whereas male sex (AOR, 2.19; 95% CI, 1.62-2.96) and maternal age at delivery (AOR, 1.53; 95% CI, 1.38-1.70) were associated with EDI vulnerability.Conclusions and relevanceResults of this study suggest that, in a population-based cohort, children born preterm had a lower school-readiness rate than children born full term, but this difference was not observed in the sibling cohort. Child and maternal factors were associated with lack of school readiness among this population-based cohort.

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Academic Outcomes of School-Aged Children Born Preterm: A Systematic Review and Meta-analysis.

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Academic Outcomes of School-Aged Children Born Preterm: A Systematic Review and Meta-analysis.

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