606 - School readiness in very preterm infants in Ontario: a pilot database study

Publication Number: 606.6145

Kamini Raghuram, Mount Sinai Hospital, Toronto, ON, Canada; Nicole Bando, Unity Health Toronto, Toronto, ON, Canada; Magdalena Janus, McMaster University, Hamilton, ON, Canada; Seungwoo Lee, Mount Sinai Hospital, Toronto, ON, Canada; Ashley Gaskin, McMaster University, Hamilton, ON, Canada; Amanda Offord, McMaster University, Hamilton, ON, Canada; Caroline Reid-Westoby, Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada; Rachel Ault, Ontario Institute for Studies in Education, Toronto, ON, Canada; Prakesh S. Shah, Mount Sinai Hospital, Toronto, ON, Canada

Background: Studies have shown that neurodevelopmental impairment (NDI) at 18-24 months corrected age in children born preterm is associated with school-age academic skills. The major limitation of these studies is that they do not address school readiness, which informs the degree of support needed in school and helps develop early interventions.

Objective: To describe the school readiness profile of children born very preterm and to determine its association with the neurodevelopment at 18-24 months corrected age (CA).

Design/Methods: A pilot database study retrospectively analyzing prospectively collected, standardized data was conducted on preterms born at < 29 weeks’ gestational age between 2009 and 2012 who completed the Bayley Scales of Infant and Toddler Development between 18 and 24 months CA. These data were linked using deterministic linkage with the Early Development Instrument (EDI) in Ontario, Canada. Neonatal and neurodevelopmental characteristics and school readiness were described and compared between children identified as having NDI and those without.

Results: Of 684 eligible infants, 112 (16%) had available EDI data (Figure 1). Children with NDI (N = 50, 45%) were more preterm, had lower birthweight, and had more frequent, significant brain injury and bronchopulmonary dysplasia. Compared to the general population, more children born very preterm with NDI were considered vulnerable, defined as scoring below the 10th percentile distribution cut-off, across all domains of the EDI (Table 1). On the other hand, more children without NDI showed vulnerability in the domains of social competence and language and cognitive development versus the general population. Thirty-four percent of very preterm children were vulnerable in 2 or more domains compared to 14% in the general population (p < 0.0001). The Bayley language score was most statistically significantly associated with vulnerability in physical health and well-being, language and cognitive development, and communication and general knowledge (Table 2). None of the Bayley subtests were associated with emotional maturity or social competence.

Conclusion(s): Neurodevelopmental impairment at 18-24 months was associated with all school readiness markers, while being born very preterm without NDI was still associated with vulnerability in two or more domains. Findings in this study may indicate that a focus on early language skills is needed to promote school readiness in children born very preterm. Other assessments may be needed for earlier insight into social competence and emotional maturity.

Figure 1: Flow chart of the study population
CA = corrected age; EDI = Early developmental instrument

Table 1: School readiness scores and vulnerability rates on the five domains of development and overall as measured using the EDI for children born < 29 weeks GA
Notes: the reported p-values were based on the comparison between two groups using Chi-square test or Fisher’s exact test for categorical variables and Student t test for continuous variables.

Table 2: Association between Bayley-III/IV subtests and EDI vulnerability
*Data analyzed using Chi-square tests or Fisher’s exact tests as appropriate. Bolded = p<0.05. Bayley-III/IV = Bayley Scales of Infant Development, 3rd or 4th edition, EDI = Early Developmental Instrument.

Figure 1: Flow chart of the study population
CA = corrected age; EDI = Early developmental instrument

Table 1: School readiness scores and vulnerability rates on the five domains of development and overall as measured using the EDI for children born < 29 weeks GA
Notes: the reported p-values were based on the comparison between two groups using Chi-square test or Fisher’s exact test for categorical variables and Student t test for continuous variables.

Table 2: Association between Bayley-III/IV subtests and EDI vulnerability
*Data analyzed using Chi-square tests or Fisher’s exact tests as appropriate. Bolded = p<0.05. Bayley-III/IV = Bayley Scales of Infant Development, 3rd or 4th edition, EDI = Early Developmental Instrument.