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Original Investigation
August 2017

Educational Performance of Children Born Prematurely

Author Affiliations
  • 1Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
  • 2Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 3Institute for Policy Research, Northwestern University, Evanston, Illinois
  • 4Human Development and Social Policy, Northwestern University School of Education and Social Policy, Evanston, Illinois
  • 5Department of Pediatrics, University of Florida, Gainesville
JAMA Pediatr. 2017;171(8):764-770. doi:10.1001/jamapediatrics.2017.1020
Key Points

Question  How well do children who were born prematurely perform in elementary and middle school?

Findings  In this population-based study of 1 301 497 children, those who were born prematurely frequently performed at levels comparable to the level of children born at full term on tests of kindergarten readiness and standardized mathematics and reading competences. A small proportion of children born near the limits of viability achieved gifted status.

Meaning  The effects of prematurity—including extreme prematurity—are not uniformly deleterious.


Importance  Survivors of preterm birth often present with medical morbidities; however, variation in their long-term educational performance has not been well described.

Objective  To estimate the association between gestational age and 4 outcomes in school-aged children: readiness to enter kindergarten, scores on standardized tests in elementary and middle school, gifted status, and low performance.

Design, Setting, and Participants  In a retrospective cohort study, children born in Florida between 1992 and 2002 at 23 to 41 weeks’ gestation who entered Florida’s public schools between 1995 and 2012 were assessed for kindergarten readiness and tested in mathematics and reading in grades 3 through 8. Data analysis was performed from January 12, 2016, to March 1, 2017.

Exposures  Gestational age at birth.

Main Outcomes and Measures  Kindergarten readiness, scores on the Florida Comprehensive Achievement Test (FCAT), classified as gifted, and classified as low performance.

Results  A total of 1 527 113 singleton infants with gestational ages of 23 to 41 weeks born between 1992 and 2002 were matched to Florida public school records. Of these, 1 301 497 children were included in the analysis; 641 479 (49.3%) were girls. A total of 301 (65.0%) Florida children born at 23 to 24 weeks’ gestation were designated as ready to start kindergarten. When the FCAT test scores were adjusted for potentially confounding maternal and infant variables, children born at 23 to 24 weeks’ gestation performed 0.66 SD (95% CI, −0.73 to −0.59) lower compared with those born at full term. A total of 123 554 (9.5%) of all Florida-born public school students were considered gifted, including 17 (1.8%) of those born at 23 to 24 weeks’ gestation. In comparison, 75 458 (5.8%) of all Florida-born public school students were low performing; 310 (33.5%) of these children had been born at 23 to 24 weeks’ gestation. Kindergarten readiness, FCAT scores, and gifted status were positively related to gestational age, whereas low performance was inversely related to gestational age.

Conclusions and Relevance  Although gestational age has long been associated with poor educational performance, a sufficient proportion of children born near the limits of viability performed within expected school norms, warranting further investigation into how and why certain children are able to overcome the educational burdens that may follow preterm birth.