Academic Outcomes of School-Aged Children Born Preterm
Authors: Melinda McBryde, Grace C. Fitzallen, Helen G. Liley, H. Gerry Taylor, Samudragupta Bora
Journal: JAMA Network Open (2020)

<h3>Importance</h3> 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. <h3>Objective</h3> 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. <h3>Data Sources</h3> 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<i>child</i>(population),<i>preterm birth</i>(exposure), and<i>education*</i>(outcome). <h3>Study Selection</h3> 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. <h3>Data Extraction and Synthesis</h3> 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. <h3>Main Outcomes and Measures</h3> 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. <h3>Results</h3> 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;<i>I</i><sup>2</sup> = 81%) and applied mathematical problems (MD, −11.41; 95% CI, −17.57 to −5.26;<i>I</i><sup>2</sup> = 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;<i>I</i><sup>2</sup> = 92%), decoding (MD, −10.18; 95% CI, −16.83 to −3.53;<i>I</i><sup>2</sup> = 71%), mathematical knowledge (MD, −9.88; 95% CI, −11.68 to −8.08;<i>I</i><sup>2</sup> = 62%), word identification (MD, −7.44; 95% CI, −9.08 to −5.80;<i>I</i><sup>2</sup> = 69%), and mathematical fluency (MD, −6.89; 95% CI, −13.54 to −0.23;<i>I</i><sup>2</sup> = 72%). The associations remained unchanged after sensitivity analyses for reducing heterogeneity. <h3>Conclusions and Relevance</h3> 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.