Study shows later school performance of preemies is often comparable to full-term infants

GAINESVILLE, Fla. – While premature babies sometimes display developmental impairments, a study by a group that includes a University of Florida researcher indicates that not all preemies perform poorly in school.

The study examined birth and public school records of 1.3 million children born in Florida between 1992 and 2002 and found that premature infants in public schools often performed at levels comparable to children born at full term on tests of kindergarten readiness and standardized math and reading tests.

In fact, the study showed that about two-thirds of those born extremely prematurely — at 23 to 24 weeks gestation — later were considered ready to enter kindergarten. Additionally, nearly 2 percent were categorized as “gifted” by middle school age. While these extremely premature babies often scored low on standardized tests, preterm infants born 25 weeks or later performed only slightly lower than full-term infants. In fact, as the length of pregnancy increased after 28 weeks, the differences in test scores were negligible.

The study is published today in JAMA Pediatrics by a group led by a team of Northwestern University physicians and economists that also includes Jeffrey Roth, Ph.D., research professor emeritus in the UF College of Medicine’s department of pediatrics’ division of neonatology.

“The conventional wisdom is that extreme prematurity is very deleterious to educational accomplishment,” said Roth. “The fact that two thirds of these kids showed up ready to start school is very reassuring. When physicians talk with parents about the prospects for their newborn infant, they can say that some very premature babies do brilliantly.  That’s comforting to both parents and physicians.”

The study’s lead author echoed those thoughts.

“What excites me about this study is that it changes the focus for the clinician and families at the bedside from just focusing on the medical outcomes of the child to what the future educational outcomes might be for the child born early,” said Craig Garfield, M.D, also an attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and an associate professor of pediatrics and of medical social sciences at Northwestern’s Feinberg School of Medicine.

The study examined birth certificates from the Florida Bureau of Vital Statistics for all babies born from 23 to 41 weeks’ gestation. Researchers then matched the certificates with Florida public school records from the Florida Department of Education. Those included scores on the Florida Comprehensive Achievement Test, or FCAT, for students in third through eighth grade.

Roth said Florida’s willingness to link health and education data makes it an ideal location for conducting this kind of longitudinal analysis and one of the few places in the United States where such a large study could take place.

Roth acknowledged that a weakness of studies that use these kinds of administrative data sets is that birth and school records do not contain other information about important events in a student’s life that may affect cognitive performance.

“We have a snapshot at birth and we have a snapshot at school,” he said. “We don’t yet have a lot of information about what happened in between: What illnesses did these premature children contract? Did they live near a toxic waste site? How good was their pre-school? What elements in their environment could be optimized to help them develop academically over the long term?”

While the study noted that degree of prematurity was associated with worse educational outcomes, Roth said the results were generally encouraging in that most babies born extremely premature end up performing reasonable well in school.

“Our future work in this area will focus on what parents and service providers can do to help future premature children to achieve their full potential,” Garfield said.

The study was led by faculty members at Northwestern’s Feinberg School of Medicine in Chicago and the Institute for Policy Research in Evanston. Funding support was provided by the National Science Foundation, the U.S. Department of Education, the Smith Richardson Foundation and the Bill and Melinda Gates Foundation through the National Center for the Analysis of Longitudinal Data in Education Research.