Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Division of Pediatric Hematology/Oncology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
JAMA Pediatr. 2022 Oct 1;176(10):1010-1019. doi: 10.1001/jamapediatrics.2022.2758.
Children born preterm may experience learning challenges at school. However, there is a paucity of data on the school readiness of these children as they prepare to begin grade 1.
To examine the association between prematurity and school readiness in a population-based cohort of children.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted in the province of Manitoba, Canada, and involved 2 cohorts of children in kindergarten at the time of data collection. The population-based cohort included children born between January 1, 2000, and December 31, 2011, whose school readiness was assessed in kindergarten using the Early Development Instrument (EDI) data. The sibling cohort comprised children born preterm and their closest-in-age siblings born full term. Data were analyzed between March 12 and September 28, 2021.
Preterm birth, defined as gestational age (GA) less than 37 weeks.
The primary outcome was vulnerability in the EDI, defined as a score below the tenth percentile of the Canadian population norms for any 1 or more of the 5 EDI domains (physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge). Logistic regression models were used to identify the factors associated with vulnerability in the EDI. P values were adjusted for multiplicity using the Simes false discovery method.
Of 86 829 eligible children, 63 277 were included, of whom 4352 were preterm (mean [SD] GA, 34 [2] weeks; 2315 boys [53%]) and 58 925 were full term (mean [SD] GA, 39 (1) weeks; 29 885 boys [51%]). Overall, 35% of children (1536 of 4352) born preterm were vulnerable in the EDI compared with 28% of children (16 449 of 58 925) born full term (adjusted odds ratio [AOR], 1.32; 95% CI, 1.23-1.41; P < .001]). Compared with children born full term, those born preterm had a higher percentage of vulnerability in each of the 5 EDI domains. In the population-based cohort, prematurity (34-36 weeks' GA: AOR, 1.23 [95% CI, 1.14-1.33]; <34 weeks' GA: AOR, 1.72 [95% CI, 1.48-1.99]), male sex (AOR, 2.24; 95% CI, 2.16-2.33), small for gestational age (AOR, 1.31; 95% CI, 1.23-1.40), and various maternal medical and sociodemographic factors were associated with EDI vulnerability. In the sibling cohort, EDI outcomes were similar for both children born preterm and their siblings born full term except for the communication skills and general knowledge domain (AOR, 1.39; 95% CI, 1.07-1.80) and Multiple Challenge Index (AOR, 1.43; 95% CI, 1.06-1.92), whereas male sex (AOR, 2.19; 95% CI, 1.62-2.96) and maternal age at delivery (AOR, 1.53; 95% CI, 1.38-1.70) were associated with EDI vulnerability.
Results of this study suggest that, in a population-based cohort, children born preterm had a lower school-readiness rate than children born full term, but this difference was not observed in the sibling cohort. Child and maternal factors were associated with lack of school readiness among this population-based cohort.
早产儿在学校可能会面临学习挑战。然而，关于这些孩子在准备开始一年级时的学校适应情况的数据很少。
研究一个基于人群的儿童队列中早产与学校适应能力之间的关联。
设计、地点和参与者：这项队列研究在加拿大马尼托巴省进行，涉及在数据收集时上幼儿园的两个儿童队列。基于人群的队列包括 2000 年 1 月 1 日至 2011 年 12 月 31 日期间出生的儿童，他们的学校适应能力在幼儿园使用早期发展工具（EDI）数据进行评估。兄弟姐妹队列由早产儿及其最接近年龄的足月出生的兄弟姐妹组成。数据于 2021 年 3 月 12 日至 9 月 28 日进行分析。
早产定义为胎龄（GA）小于 37 周。
主要结果是 EDI 中的脆弱性，定义为任何一个或多个 EDI 领域（身体健康和幸福感、社会能力、情感成熟度、语言和认知发展以及沟通技巧和一般知识）的得分低于加拿大人群标准的第十个百分位数。使用逻辑回归模型确定与 EDI 脆弱性相关的因素。使用 Simes 虚假发现率法对多重性进行调整 P 值。
在 86829 名合格儿童中，有 63277 名儿童入选，其中 4352 名儿童早产（平均[标准差]GA 34[2]周；2315 名男孩[53%]），58925 名儿童足月（平均[标准差]GA 39[1]周；29885 名男孩[51%]）。总体而言，与足月出生的儿童相比，4352 名早产儿童中有 35%（1536 名）在 EDI 中表现脆弱，而 58925 名足月出生的儿童中有 28%（16449 名）（调整后的优势比[OR]，1.32；95%置信区间[CI]，1.23-1.41；P<.001）。与足月出生的儿童相比，早产儿在 EDI 的五个领域中都有更高的脆弱性比例。在基于人群的队列中，GA 为 34-36 周的早产儿（OR，1.23[95%CI，1.14-1.33]）和 GA 小于 34 周的早产儿（OR，1.72[95%CI，1.48-1.99]）的脆弱性比例更高。男性（OR，2.24；95%CI，2.16-2.33）、小于胎龄儿（OR，1.31；95%CI，1.23-1.40）和各种母亲的医疗和社会人口统计学因素与 EDI 脆弱性相关。在兄弟姐妹队列中，除了沟通技巧和一般知识领域（OR，1.39；95%CI，1.07-1.80）和多重挑战指数（OR，1.43；95%CI，1.06-1.92）外，早产和足月出生的儿童的 EDI 结果相似，而男性（OR，2.19；95%CI，1.62-2.96）和母亲分娩年龄（OR，1.53；95%CI，1.38-1.70）与 EDI 脆弱性相关。
这项研究的结果表明，在基于人群的队列中，早产儿的学校准备率低于足月出生的儿童，但在兄弟姐妹队列中没有观察到这种差异。儿童和母亲的因素与这一基于人群的队列中缺乏学校准备能力有关。
