1. In this cohort study, preterm children were more likely to be not school ready in kindergarten compared to children born full term as measured by the Early Development Instrument tool
Evidence Rating Level: 2 (Good)
Preterm children are at risk for neurodevelopmental challenges such as learning disabilities. School readiness can be assessed using the Early Development Instrument (EDI) tool, which includes 5 domains (physical health and well-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge). In this cohort study, 4353 preterm children (gestational age <37 weeks) were compared to 58 925 full term children (gestational age > 37 weeks). Children born preterm had differences in their baseline characteristics including being less likely to be born by caesarean delivery and to mothers who had diabetes, were smokers and were receiving income assistance, and more likely to be entered into Child and Family Services care. Adjusted outcomes in this population cohort showed 35% of preterm children to have vulnerable EDI scores compared to 28% of full-term children (adjusted odds ratio [AOR], 1.32; 95% CI, 1.23- 1.41; P < .001]), including a dose response among preterm children (higher percentage of those being born at earlier gestational age being vulnerable in any EDI domain). The least affected domains were found to be social competence and emotional maturity. A secondary analysis was done on a sibling cohort, which included children born preterm and their closest in age sibling. 1296 of the 4352 preterm children had a full term born sibling. Similar EDI vulnerability were seen between preterm children and their full term siblings in most domains with the exception of vulnerability in the communication skills and general knowledge EDI domain (AOR, 1.39; 95% CI, 1.07-1.80). Strengths of this study include using the EDI tool in a larger cohort which allowed data to be collected in a natural environment over an entire school year. Limitations to the study include small population size, and social determinants as confounding variables. Overall, in the population cohort, preterm children had a lower rate of school readiness compared to full term, with no differences seen in the sibling cohort.
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