Peer-reviewed article
Academic Outcomes of School-Aged Children Born Preterm
Melinda McBryde, Grace C. Fitzallen, Helen G. Liley, Hudson Gerry Taylor, Samudragupta Bora ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis examined academic outcomes in school-aged children born preterm compared to those born at term. The analysis of 33 studies involving over 7,000 children found that preterm-born children scored significantly lower across multiple reading and mathematics assessments, including both higher-order skills like comprehension and problem-solving, and lower-order skills like decoding and calculation. The performance gaps were consistent across sensitivity analyses, suggesting preterm birth is reliably associated with academic underperformance.
Key points
- Preterm-born children scored 7.96 points lower in reading comprehension and 11.41 points lower in applied mathematics compared to term-born peers
- Significant gaps were found in lower-order skills: calculation (10.57 points lower), decoding (10.18 lower), mathematical knowledge (9.88 lower), word identification (7.44 lower), and mathematical fluency (6.89 lower)
- The analysis included 4,006 preterm-born and 3,317 term-born children from 33 peer-reviewed studies published between 1980 and 2018
- Results remained consistent after sensitivity analyses addressing heterogeneity in the studies
- Academic underperformance affected both reading and mathematics across multiple subskill domains
Limitations
The review synthesises data from studies conducted over nearly 40 years with varying methodologies and assessment tools, which created substantial heterogeneity. The document does not report on potential moderating factors such as degree of prematurity, socioeconomic status, or access to early intervention services that might explain variations in outcomes.
Abstract
Importance: Children born preterm are at an elevated risk of academic underachievement. However, the extent to which performance across domain-specific subskills in reading and mathematics is associated with preterm birth remains unclear. Objective: To conduct a systematic review and meta-analysis of academic outcomes of school-aged children born preterm, compared with children born at term, appraising evidence for higher- and lower-order subskills in reading and mathematics. Data Sources: PubMed/MEDLINE, PsycINFO, and the Cumulative Index of Nursing and Allied Health Literature electronic databases from January 1, 1980, to July 30, 2018, were searched for population, exposure, and outcome terms such as child (population), preterm birth (exposure), and education* (outcome). Study Selection: Peer-reviewed English-language publications that included preterm-born children and a comparison group of term-born children aged 5 to 18 years and born during or after 1980 and that reported outcomes on standardized assessments from cohort or cross-sectional studies were screened. Of the 9833 articles screened, 33 unique studies met the inclusion criteria. Data Extraction and Synthesis: Data were analyzed from August 1 to September 29, 2018. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Two reviewers independently screened the databases and extracted sample characteristics and outcomes scores. Pooled mean differences (MDs) were analyzed using random-effects models. Main Outcomes and Measures: Performance on standardized assessment of higher-order subskills of reading comprehension and applied mathematics problems; lower-order reading subskills of decoding, pseudoword decoding, and word identification; and lower-order mathematics subskills of knowledge, calculation, and fluency. Results: Outcomes data were extracted for 4006 preterm and 3317 term-born children, totaling 7323 participants from 33 unique studies. Relative to children born at term, children born preterm scored significantly lower in reading comprehension (mean difference [MD], -7.96; 95% CI, -12.15 to -3.76; I2 = 81%) and applied mathematical problems (MD, -11.41; 95% CI, -17.57 to -5.26; I2 = 91%) assessments. Across the assessments of lower-order skills, children born preterm scored significantly lower than their term-born peers in calculation (MD, -10.57; 95% CI, -15.62 to -5.52; I2 = 92%), decoding (MD, -10.18; 95% CI, -16.83 to -3.53; I2 = 71%), mathematical knowledge (MD, -9.88; 95% CI, -11.68 to -8.08; I2 = 62%), word identification (MD, -7.44; 95% CI, -9.08 to -5.80; I2 = 69%), and mathematical fluency (MD, -6.89; 95% CI, -13.54 to -0.23; I2 = 72%). The associations remained unchanged after sensitivity analyses for reducing heterogeneity. Conclusions and Relevance: These findings provide evidence that preterm birth is associated with academic underperformance in aggregate measures of reading and mathematics, as well as a variety of related subskills.