Elsevier

The Journal of Pediatrics

Volume 138, Issue 2, February 2001, Pages 169-175
The Journal of Pediatrics

Original Articles
Impact of family structure and stability on academic outcome in preterm children at 10 years of age

https://doi.org/10.1067/mpd.2001.111945Get rights and content

Abstract

Objective: To compare school performance at age 10 years in a cohort of extremely preterm children and term control subjects and to examine the impact of family composition and stability on performance. Study Design: Prospective, longitudinal follow-up from birth to 10 years of age of a regional cohort of children born at 24 to 31 weeks of gestational age and sociodemographically matched term control subjects. Family composition, extent of parental care giving, and family moves were tracked sequentially. At 10 years, academic achievement and school performance were ascertained for 118 of 125 (94%) preterm survivors and 119 of 125 (95%) term children. Results: Term children were more likely to demonstrate optimal school outcome (appropriate grade level without additional classroom assistance) than were preterm children (odds ratio 3.4, 95% CI 1.9-6.0). Medical complications related to prematurity had little impact on school outcome. Among preterm children, optimal school outcome was significantly associated with increased parental education, child rearing by 2 parents (regardless of marital status), and stability in family composition and geographic residence over 10 years. These environmental influences were less pronounced among term control subjects. Conclusion: Although preterm children performed less well in school than term children, family factors were stronger predictors of school performance than were perinatal complications. (J Pediatr 2001;138:169-75)

Section snippets

Subjects

The study subjects consisted of all live-born neonates of 24 to 31 weeks' gestational age cared for at the Central New York Regional Perinatal Center at Crouse Hospital between July 1, 1985, and June 30, 1986. This is the sole tertiary care facility for central New York State's 26,000 annual births. A lower cutoff of 24 weeks' gestation was chosen because the regional policy was to intervene aggressively on behalf of the fetus and neonate beginning at that gestation. An upper cutoff of 31 weeks

Study participants

At 10 years of age, 118 (94%) of the preterm children and 119 (95%) of the term control subjects were evaluated. Preterm children not evaluated included one child who was adopted and could not be traced, 2 children who were severely disabled and could not be tested, and 4 children whose families declined to participate. Six term children were not evaluated because their families declined to participate. Both the preterm and term children were evaluated at a mean (± SD) age of 10.1 ± 0.1 years.

Discussion

The critical issue in evaluating long-term outcome of survivors of extreme prematurity is the ability of these children to adapt to society. School performance is one of the first measures of this achievement. Our study confirms the reports of other investigators showing a high incidence of school problems among preterm children.3, 4, 5, 7 These school problems were associated with lower cognitive and achievement scores and a greater likelihood of behavior problems.

We found that perinatal

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    Reprint requests: Steven J. Gross, MD, Crouse Hospital, Department of Neonatology, 736 Irving Ave, Syracuse, NY 13210.

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