Dr Jayne Trickett and Professor Camilla Gilmore conduct research into academic attainment following preterm birth, in collaboration with Professor Samantha Johnson at the University of Leicester and colleagues at the University of Nottingham and Ulster University. In this blog post, they outline why research into school-based outcomes following preterm birth is important. 

In the UK, each year around 8% of babies are born preterm, i.e., before the start of the 37^th week of pregnancy. This means that, on average, two children in a typical sized-classroom may have been born preterm. Over the past three decades, improvements in medical care mean that more preterm-born babies survive and fewer have medical complications. However, compared with children who are born at term, children born preterm are at higher risk of difficulties with cognitive skills which can impact their learning and attainment in school. As a result, children born preterm have higher rates of special educational needs than children born at term.

The earlier that a child is born, the higher the risk of difficulties in school. Only around 1% of all babies are born at less than 32 weeks of gestation. However, babies born this early are at the greatest risk for poorer academic outcomes in childhood. Using data from the Millennium Cohort study, researchers have investigated children’s educational outcomes at age 11 years. For children born full-term, only 10% had special educational needs, but among children born at 32 to 36 weeks of gestation this was 11-17%, and for children born before 32 weeks of gestation, 27% had special educational needs. 

However, it is important to note that preterm birth is a risk factor for poorer learning outcomes, not a diagnosis. A child born prematurely may have no difficulties, or quite significant difficulties that impact upon their learning. Children born preterm may also have more subtle difficulties with processing information that impact upon their learning, but not to the extent that they would be recognised as having special educational needs.

The impact of being born preterm on school outcomes.

Children born preterm, at all gestations, have on average lower scores on standardised assessments of reading and mathematics than children born at term. Mathematics is the subject that children born very preterm tend to have the greatest difficulty with. These difficulties can start early: children born at less than 32 weeks of gestation are more likely to have poor school readiness compared with children who are born at term. This difference persists through the primary and secondary school years, so children born very preterm do not simply “catch up” with their peers born at term. As a result, preterm-born adolescents, at the end of their school years, still have significantly poorer academic outcomes than adolescents born full-term. 

Why are preterm children at particular risk for persistent problems with mathematics? 

Through examining a range of general cognitive and specific numerical skills, we have shown that preterm children’s difficulties with mathematics were not due to specific difficulties with representing and manipulating numbers, but instead stemmed from difficulties with cognitive skills that are important for learning mathemtics. Children born very preterm tend to have poorer working memory (the ability to hold and manipulate information in mind) and visuospatial processing (the ability to perceive and analyse visual information). Poorer working memory and visuospatial processing explains most of the difference in mathematics outcomes between children born very preterm and at term. Support for children born preterm therefore needs to specifically target the cognitive difficulties they have, for example by reducing the amount of information they need to process at once, or by providing appropriate visual supports when learning mathematics. 

Support for educational professionals

In a survey of education professionals, most reported receiving no training in the educational consequences of preterm birth and are unaware of the potential cognitive and educational difficulties. We have therefore developed an e-learning resource to provide education professionals with information on the long-term consequences of preterm birth and provide suggestions for how to support children in school.The resource was co-developed with teachers, educational psychologists, parents of preterm children and preterm-born young adults and is freely available to use at pretermbirth.info, thanks to funding from children’s charity Action Medical Research. This resource has been shown to improve teacher’s knowledge of outcomes following preterm birth and their confidence in supporting children.

Research continues to investigate learning and educational outcomes for children born preterm to better understand how we can support them throughout their time in school. Please email J.Trickett@lboro.ac.uk if you would like more information about this work.