Study highlights learning difficulties in children born extremely prematurely
Children born extremely prematurely (before the 26th week of pregnancy) face a high risk of developing learning difficulties by the age of 11, according to UK research published in the Archives of Disease in Childhood Fetal and Neonatal Edition. The findings are an outcome of the EPICure study, which was launched in 1995 with the goal of tracking the survival and long-term health of all babies born below 26 weeks gestation in the UK and Ireland during that year. Normally, pregnancy lasts around 40 weeks. Thanks to recent medical advances, increasing numbers of babies born before this point are surviving; even for babies born at 26 weeks gestation, the survival rate is now over 80%. Below this point, survival rates drop off sharply; of those born at 25 weeks, 63% survive to be discharged from hospital, a figure that falls to 41% for those born at 24 weeks and just 18% for those born at 23 weeks. In 1995, when the EPICure study started, 307 extremely premature babies survived. These children's progress was evaluated when they were two and a half and six years of age. Those studies revealed that just under half had serious disabilities that affected their daily lives. In this latest study, the researchers checked in on the children when they were 11 years of age and compared their performance to that of classmates who were born at term. The children underwent tests to investigate their cognitive ability and academic attainment. Their teachers were asked to rate each child's performance in seven key subjects (English, maths, science, technology, geography, information technology and history). The teachers also provided information on which children were classified as having Special Educational Needs (SEN). Children with SEN are defined as those with disabilities or learning problems that make it harder for them to learn than most children of their age. A range of services, such as educational psychology and one-to-one support, are offered to these children. The results highlight the ongoing challenges faced by those born extremely prematurely. Compared to their full term classmates, the EPICure children struggled across the whole range of subjects studied, especially maths. 'We found up to 44% of children had a serious impairment in core subjects such as reading and maths, and 50% had performance below the average range expected for their age,' summarised Professor Dieter Wolke of Warwick Medical School in the UK. 'Extremely pre-term children have a 13-fold increased risk of special educational needs requiring additional learning support.' The preterm children appeared to face particular difficulties with maths. Brain imaging studies have shown that preterm children have a reduced cortical volume, size and complexity. 'Specific deficits in maths skills may be a result of more specific impairment of regional brain areas,' the researchers write. 'Such abilities are related to working memory, executive function, attentional control and perceptual and visuospatial skills, which are also selectively impaired in preterm populations.' The researchers paid particular attention to the small group of children whose early birth meant they started school a year earlier than they would have had their gestation lasted the full 40 weeks. They found that while these children's performance compared well with that of the other preterm children, this group was more likely to have special educational needs. 'Our results suggest that delaying school entry may be beneficial for children who start full time school in an earlier academic year because of their extremely pre-term birth,' said Dr Samantha Johnson of the University of Nottingham in the UK. 'The problems we have identified at age 11 that impact on schooling are likely to increase over time,' commented Professor Wolke. 'Existing difficulties may cause further problems when the children reach secondary school and engage in more complex academic activities.' The care given to extremely premature babies has improved dramatically since the EPICure project started in 1995. To see if these changes have had an impact on survival and long term health, a second study, EPICure-2, was launched in 2006. Like the children in EPICure-1, the EPICure-2 children will have their progress checked when they are two and a half to see if their prospects differ from those of the 1995 group. '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,' said Dr Johnson.
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United Kingdom