First Report Published from the 11 year Assessments

Press release from the University of Nottingham

Extremely premature babies are at high risk of learning difficulties in middle childhood

A major study charting the development of babies who were born extremely prematurely has found that they are at high risk of poor school performance and special educational needs at 11 years of age.

The findings come from the EPICure Study, which is lead by researchers at The University of Nottingham and funded by the Medical Research Council (MRC). EPICure was established in 1995 to determine the chances of survival and the later health of all babies born less than 26 weeks gestational age in the United Kingdom and Ireland during that year.

This latest report, from the EPICure study group, done in collaboration with the University of Warwick, follows two earlier studies carried out when the children were two-and-a-half years and 6 years of age. Overall, just under half had serious disabilities that were likely to have an impact on their daily life. The most common serious disability was learning difficulties followed by cerebral palsy and impaired vision or hearing.

In the latest stage of this study researchers recently followed-up 219 extremely premature children and compared them with 153 classmates who were born at term. The results, published today in Archives of Disease in Childhood Fetal and Neonatal Edition, showed that a significant proportion of extremely premature survivors require full-time specialist education and over half of those attending mainstream school need additional health or educational resources in order to access the national curriculum. Researchers warn that the prevalence and impact of special educational needs is likely to increase as these children approach the transition to secondary school.

The team of psychologists assessed the children’s progress at school using standardised tests combined with information collected from class teachers. Extremely preterm children had more problems across the whole school curriculum with particular difficulties in mathematics. Thirteen per cent attended a special school and of those in mainstream schools, 57% had academic or behavioural special educational needs requiring additional support in school.

The researchers also studied the progress of children who entered compulsory education in an academic year earlier than if they had been born at their expected date of delivery. They found that these children had comparable academic attainment but had more special needs than the rest of the extremely preterm cohort. The researchers suggest that delayed school entry, based on the child’s expected date of delivery, may be beneficial for extremely preterm children but stress that further studies are required to address this issue.

Dr Samantha Johnson, who is a research Psychologist at The University of Nottingham said: “These latest findings from the EPICure Study highlight the kinds of difficulties extremely preterm children are likely to face at school and what kind of help they may need in order to realise their potential. These children had poorer performance than their classmates across all national curriculum subjects, with the most prominent difficulties in maths, and around 2/3 had some degree of special educational needs. Our results also suggest that delaying school entry may be beneficial for children who start full time school in an earlier academic year because of their extremely preterm birth. As survival rates for extremely preterm babies continue to increase, studies such as these are crucial for educational planning and to aid in the development of programmes to optimise outcomes for these children.”

Since 1995, the care given to very immature babies has improved markedly. In view of this, the MRC has funded a repeat study to determine whether this has had any effect on survival rates and later health status: this second study of outcome following extremely premature birth was started in 2006 and is called EPICure-2. These children are currently being followed-up at two and a half years of age in the same way as the 1995 cohort to determine whether outcomes have improved. The initial results from the EPICure-2 studies are expected to be published in full later this year.

Professor Dieter Wolke, from the University of Warwick added: “As children get older there are increasing educational and social challenges. This study indicates that about two third of children born extremely premature find it difficult to cope with these educational demands. Initial neonatal special care needs to be followed with special services for these children and families to help them to make the best of early education. The demands are likely to increase further as they progress to secondary school.”

Read the article here.