Children born very prematurely are significantly more likely to face difficulties in the classroom, with educational gaps emerging before formal education even begins, according to a study published in JAMA Network Open.
The research followed almost 16,000 children born before 32 weeks of gestation in England between 2008 and 2012, linking neonatal hospital records with educational outcomes years later. Researchers found that more than half were not ready to start school at age five, placing them around 21 percentage points behind the national average for children of the same age.
Behind from the start
Preterm birth is a leading cause of atypical brain development, yet its effect on educational attainment has received relatively little attention.
To address this, researchers led by Professor James Boardman of the University of Edinburgh analysed data from the UK's National Neonatal Research Database and linked it to national school performance records.
The findings showed that just over half of children born very preterm failed to meet expected standards of school readiness at age five, a benchmark that includes communication, language, social development and early literacy skills.
Earlier birth, greater risk
The educational disadvantage persisted well beyond the first year of school.
By the age of seven, around half of the children were performing below expected levels in writing and mathematics, while roughly four in ten lagged behind in reading.
The earlier a child was born, the greater the risk of academic difficulties.
Among children born at 23 weeks' gestation, nearly nine in ten were not considered school-ready. Even after adjusting for other factors, those born at 23 or 24 weeks remained almost three times more likely to struggle than children born at 31 weeks.
Poverty compounds the challenge
The study also identified social disadvantage as one of the strongest predictors of poor educational outcomes.
Children from the most deprived communities were significantly more likely to fall behind than their peers from wealthier backgrounds, regardless of how prematurely they were born.
One of the strongest indicators was eligibility for free school meals, a widely used measure of low household income. Children who qualified were almost twice as likely to miss expected educational milestones.
Researchers found that the impact of deprivation on educational attainment was comparable to that of severe brain injury sustained around the time of birth.
"One of the most striking findings was that social disadvantage had an impact on attainment comparable to severe brain injury," said Dr Cheryl Battersby of Imperial College London.
Risk factors that may be preventable
While some factors, such as gestational age and biological sex, cannot be changed, the study identified several potentially modifiable risks.
Smoking during pregnancy was associated with poorer educational outcomes, while babies who received only formula milk during neonatal care were more likely to struggle later in childhood than those who received breast milk.
According to the researchers, children fed exclusively with formula were approximately one-and-a-half times more likely to fall behind academically by age five.
The findings build on earlier research by the University of Edinburgh, which found that greater exposure to breast milk in the first weeks of life was associated with healthier brain development in preterm infants and brain structures more closely resembling those of full-term babies.
Serious neonatal complications also carried substantial risks. Brain injuries, as well as the lung and intestinal conditions often seen in extremely premature babies, were associated with lower educational attainment later in childhood.
Does school starting age matter?
Researchers also identified a possible role for school starting age.
Children born during the summer months were more likely to struggle academically, partly because they begin school almost a year younger than some of their classmates.
The findings suggest that some very preterm children could benefit from delayed school entry or additional educational support during their earliest years in the classroom.
Early support could make a difference
The researchers stressed that poor outcomes are not inevitable.
Despite facing the highest risks, around one-third of the most premature children achieved all expected developmental milestones, demonstrating that a difficult start in life does not necessarily determine future success.
"The data revealed a very high burden of low attainment at primary school among children who were born preterm," said Professor Boardman.
He argued that improving outcomes for these children will require both medical and social interventions, including efforts to reduce childhood poverty, improve neonatal care and provide targeted support during the early years of education.
Researchers said identifying modifiable factors, from smoking during pregnancy and infant feeding practices to school-entry policies, could help improve outcomes for some of the most vulnerable children.
The study concludes that many of the challenges faced by very preterm children are already visible before formal education begins, making early intervention critical to narrowing educational gaps and improving long-term prospects.
Source: earth.com
