P2C183: Risk of Learning Difficulties Throughout Elementary School in U.S. Moderately and Late Preterm Children

Background: One in ten infants in the United States is born preterm, defined as less than 37 completed weeks of gestation. Eighty-five percent of preterm infants are born between 32 and 36 completed weeks of gestation, classifying them as moderately to late preterm. Studies have shown that preterm infants continue to have learning difficulties and decreased school performance, even in the children born moderately and late preterm, despite preventive efforts in neonatal intensive care units and developmental clinics.

Methods: Using the Early Childhood Longitudinal Study (ECLS) Kindergarten class of 2011 cohort database sponsored by the National Center for Education Statistics within the U.S. Department of Education, we identified 14,350 full term infants and 1,195 moderate and late preterm infants to include in the analysis. All parents filled out survey information to evaluate demographic data. Teachers and schools provided information on student performance in the classroom and individual disabilities and education plan needs. All data were weighted to be representative of the U.S. population. Confounders included in the analyses were gender, race, household income level, school type, and home setting. SAS version 9.4 was used for all data analyses.

Results: Both moderately and late preterm children had higher odds of below grade performance compared to term gestation peers throughout school in reading, math, and science; for example, in kindergarten, moderately preterm children had adjusted odds ratios for reading, math, and science of 1.40 (95th percent confidence interval (CI) 1.03, 1.89), 1.49 (CI 1.02, 2.17), and 1.89 (CI 1.20, 2.99), respectively, compared to late preterm children who had adjusted odds ratios for reading, math, and science of 1.19 (CI 0.89, 1.60), 1.09 (CI 0.84, 1.42), and 1.05 (CI 0.83, 1.32), respectively (Figure 1). Moderately and late preterm children also had higher odds of requiring an individualized education plan (IEP) and having a learning disability diagnosis, with the highest odds in kindergarten for both groups, with an IEP at 2.43 (CI 1.48, 4.0) and 1.44 (CI 0.96, 2.16), for moderately and late preterm children respectively, and for a learning disability diagnosis at 2.41 (CI 1.61, 3.60) and 2.05 (CI 1.56, 2.69), respectively (Figure 2).

Conclusion: These data align with previous studies that prematurity is a risk factor for long-term academic complications, with concerns that moderately and late preterm children are at risk for poor school performance compared to full-term peers. Moderately and late preterm children are also at risk for learning difficulties, including learning disabilities and requiring individualized education plans, and likely benefit from continued support and services to improve achievement throughout school.