The early educational environment at five years of age in a European cohort of children born very preterm: challenges and opportunities for research
Authors: Smith-Longee Alyssa , Johnson Samantha , Aubert Adrien M. , Seppänen Anna-Veera , Pierrat Veronique , Zemlin Michael , Lebeer Jo , Sarrechia Iemke , Siljehav Veronica , Zeitlin Jennifer , Sentenac Mariane ,   On behalf of the SHIPS research group, Van Reempts P. , Bruneel E. , Cloet E. , Oostra A. , Ortibus E. , Boerch K. , Huusom L. , Pedersen P. , Weber T. , Toome L. , Varendi H. , Männamaa M. , Ancel P. Y. , Burguet A. , Jarreau P. H. , Truffert P. , Maier R. F. , Misselwitz B. , Schmidt S. , Wohlers L. , Cuttini M. , Di Lallo D. , Ancora G. , Baronciani D. , Carnielli V. , Croci I. , Faldella G. , Ferrari F. , Franco F. , Gargano G. , van Heijst A. , Koopman-Esseboom C. , Gadzinowski J. , Mazela J. , Montgomery A. , Pikuła T. , Barros H. , Costa R. , Graça LMendes , do Céu Machado M. , Rodrigues C. , Rodrigues T. , Aden U. , Bonamy A. K. Edstedt , Norman M. , Draper E. S. , Boyle E. M. , Fenton A. , Johnson S. J. , Manktelow B. N. , Milligan D. W. A. , Mader S. , Thiele N. , Walz J. M. , Petrou S. , Bonet M. , Bonnet C. , Rafei REl , Piedvache A. , Seppanen A. V. 
Published: May 2024

Abstract
Background
Early childhood education offers opportunities for stimulation in multiple developmental domains and its positive impact on long-term outcomes and wellbeing for children is well documented. Few studies have explored early education in children born very preterm (VPT; <32 weeks of gestation) who are at higher risk of neurodevelopmental disorders and poor educational outcomes than their term-born peers. The purpose of the study is to describe and compare the educational environment of children born VPT in European countries at 5 years of age according to the degree of perinatal risk.

Methods
Data originated from the population-based Screening to Improve Health In very Preterm infants (SHIPS) cohort of children born VPT in 2011/2012 in 19 regions from 11 European countries. Perinatal data were collected from medical records and the 5-year follow-up was conducted using parental questionnaires. Outcomes at 5 years were participation in early education (any, type, intensity of participation) and receipt of special educational support, which were harmonized across countries.

Results
Out of 6,759 eligible children, 3,687 (54.6%) were followed up at 5 years (mean gestational age 29.3 weeks). At 5 years, almost all children (98.6%) were in an educational program, but type (preschool/primary), attendance (full-time/part-time) and use and type of school support/services differed by country. In some countries, children with high perinatal risk were more likely to be in full-time education than those with low risk (e.g. Estonia: 97.9% vs. 87.1%), while the inverse pattern was observed elsewhere (e.g. Poland: 78.5% vs. 92.8%). Overall, 22.8% of children received special educational support (country range: 12.4–34.4%) with more support received by children with higher perinatal risk. Large variations between countries remained after adjustment for socio-demographic characteristics.

Conclusions
There are marked variations in approaches to early education for children born VPT in Europe, raising opportunities to explore its impact on their neurodevelopment and well-being.