Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 251-257 (doi:10.1542/peds.2008-2315)
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ARTICLE

Functioning at School Age of Moderately Preterm Children Born at 32 to 36 Weeks' Gestational Age

Anneloes L. van Baar, PhDa, John Vermaas, Msca,b, Edwin Knots, MD, Mscc, Martin J. K. de Kleine, MD, PhDd and Paul Soons, PhDa,e

a Department of Pediatric Psychology, Tilburg University, Tilburg, Netherlands
b Department of Medical Psychology, Twee Steden Hospital, Tilburg, Netherlands
c Department of Pediatrics, Catharina Hospital, Eindhoven, Netherlands
d Department of Neonatology, Máxima Medical Center, Veldhoven, Netherlands
e Department of Medical Psychology, St Anna Hospital, Geldrop, Netherlands

OBJECTIVE: To study outcome of low-risk moderately preterm birth between 32 and 36/7 weeks' gestation.

METHODS: 377 Moderately preterm children (M: 34.7, SD: 1.2 complete weeks), without need for neonatal intensive care and without dysmaturity or congenital malformations, were compared with 182 term children and assessed at eight years (M: 8.9, SD: 0.54). School situation, IQ, sustained attention, behavior problems, and attention-deficit/hyperactivity characteristics were studied.

RESULTS: Special education was attended by 7.7% of the moderately preterm children, more than twice the rate of 2.8% in the general Dutch population of this age. Additional exploration for two preterm subgroups of 32 to 33 versus 34 to 36 weeks' gestation showed a need for special education in 9.7% versus 7.3% and a significant difference in grade retention for 30% versus 17%, respectively. Of the children attending mainstream primary schools, grade retention was found in 19% of the preterm versus 8% of the comparison children. Adjusting for maternal education, a group difference of 3 points was found in IQ. The preterm children needed more time for the sustained attention task. The preterm children had more behavior problems (specifically internalizing problems with 27% scoring above the borderline cut-off), as well as more attention-deficit/hyperactivity disorder characteristics (specifically attention deficits).

CONCLUSIONS: Cognitive and emotional regulation difficulties affect functioning of moderately preterm children, as school problems, a slightly lower IQ, attention and behavioral problems are found when they are compared with term-born children. Identification and monitoring of precursors of these problems at younger age is needed in view of prevention purposes.

Key Words: preterm children • attention • behavior problems • IQ • school age

Abbreviations: ADHD—attention-deficit/hyperactivity disorder • CBCL—Child Behavior Checklist • TRF—Teacher Report Form

Accepted Nov 6, 2008.


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