VERY PRETERM BIRTH was associated with reduced school readiness and educational attainment during early childhood, with social disadvantage and several early-life medical factors linked to poorer outcomes, according to a large cohort study of children born before 32 weeks’ gestation.
The retrospective cohort study analysed outcomes among 15,857 children born very preterm in England who received neonatal care and survived to discharge. Researchers linked neonatal clinical information from the National Neonatal Research Database with educational records from the National Pupil Database to assess school readiness at age 5 years and attainment in reading, writing, mathematics, and science at age 6–7 years.
More than half of children did not achieve expected educational levels during early school years. At age 5 years, 8,602 children (56.6%) did not meet expected school readiness standards. Between ages 6 and 7 years, 7,789 children (51.8%) did not reach expected writing attainment, while 7,216 (48.1%) did not reach expected mathematics levels. Lower proportions failed to meet expected standards in reading and science, affecting 6,354 (41.9%) and 5,449 (36.0%) children, respectively.
The study identified dose response associations between lower gestational age, socioeconomic deprivation, and educational underattainment. Children born at 23–24 weeks had higher odds of not meeting school readiness expectations compared with those born at 31 weeks (adjusted odds ratio: 2.86; 95% CI: 2.19–3.73).
Children living in the most deprived areas also had increased risk of poorer school readiness compared with those in the least deprived areas (adjusted odds ratio: 1.27; 95% CI: 1.11–1.45). Additional factors associated with lower attainment included male sex, season of birth, maternal smoking during pregnancy, postnatal corticosteroid exposure, neonatal brain injuries, and complications associated with preterm birth.
Severe neonatal brain injuries showed some of the strongest associations, including periventricular leukomalacia (adjusted odds ratio: 3.05; 95% CI: 2.04–4.58) and hydrocephalus (adjusted odds ratio: 2.47; 95% CI: 1.48–4.13).
The findings suggested that improving educational outcomes for children born very preterm may require approaches that address both social inequalities and modifiable early-life risks. The researchers highlighted potential intervention areas including reducing maternal smoking, supporting appropriate corticosteroid use, and promoting breastfeeding where possible.
The study also indicated that targeted academic support and consideration of deferred school entry may benefit some children born very preterm, particularly when factors such as birth season and individual developmental needs are considered. These findings reinforced the importance of collaboration between clinicians, families, educators, and policymakers to improve long-term outcomes after very preterm birth.
Reference
Haider S et al. Readiness and achievement among children born very preterm. JAMA Netw Open. 2026;9;(7):e2623068.
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