Extremely premature babies are at high risk of learning difficulties in middle childhood

12 Mar 2009 00:01:00.000

PA 65/09

A major study charting the development of babies who were born extremely prematurely has found that they are at high risk of poor school performance and special educational needs at 11 years of age.

The findings come from the EPICure Study, which is led by researchers at The University of Nottingham and funded by the Medical Research Council (MRC). EPICure was established in 1995 to determine the chances of survival and the later health of all babies born less than 26 weeks gestational age in the United Kingdom and Ireland during that year.

This latest report, from the EPICure study group, done in collaboration with the University of Warwick, follows two earlier studies carried out when the children were two-and-a-half years and six years of age. Overall, just under half had serious disabilities that were likely to have an impact on their daily life. The most common serious disability was learning difficulties followed by cerebral palsy and impaired vision or hearing.

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In the latest stage of this study researchers recently followed-up 219 extremely premature children and compared them with 153 classmates who were born at term.  The results, published in Archives of Disease in Childhood Fetal and Neonatal Edition, showed that a significant proportion of extremely premature survivors require full-time specialist education and over half of those attending mainstream school need additional health or educational resources in order to access the national curriculum. Researchers warn that the prevalence and impact of special educational needs is likely to increase as these children approach the transition to secondary school.


The team of psychologists assessed the children’s progress at school using standardised tests combined with information collected from class teachers. Extremely preterm children had more problems across the whole school curriculum with particular difficulties in mathematics. Thirteen per cent attended a special school and of those in mainstream schools, 57 per cent had academic or behavioural special educational needs requiring additional support in school.


The researchers also studied the progress of children who entered compulsory education in an academic year earlier than if they had been born at their expected date of delivery. They found that these children had comparable academic attainment but had more special needs than the rest of the extremely preterm cohort. The researchers suggest that delayed school entry, based on the child’s expected date of delivery, may be beneficial for extremely preterm children but stress that further studies are required to address this issue.


Dr Samantha Johnson, who is a research Psychologist at The University of Nottingham said:  “These latest findings from the EPICure Study highlight the kinds of difficulties extremely preterm children are likely to face at school and what kind of help they may need in order to realise their potential. These children had poorer performance than their classmates across all national curriculum subjects, with the most prominent difficulties in maths, and around 2/3 had some degree of special educational needs. Our results also suggest that delaying school entry may be beneficial for children who start full time school in an earlier academic year because of their extremely preterm birth. As survival rates for extremely preterm babies continue to increase, studies such as these are crucial for educational planning and to aid in the development of programmes to optimise outcomes for these children.”


Neil Marlow, Professor of Neonatal Medicine at University College London Institute for Women's Health, formerly of The University of Nottingham’s School of Human Development, is senior author of the paper and chief investigator of the EPICure studies.


He said: “It is important that the funding of long-term studies such as Epicure continue. Outcome-based research such as the EPICure studies is extremely important in finding the ‘real’ impact of premature birth on the children and their education.”


Since 1995, the care given to very immature babies has improved markedly.  In view of this, the MRC has funded a repeat study to determine whether this has had any effect on survival rates and later health status: this second study of outcome following extremely premature birth was started in 2006 and is called EPICure-2. These children are currently being followed-up at two-and-a-half years of age in the same way as the 1995 cohort to determine whether outcomes have improved.  The initial results from the EPICure-2 studies are expected to be published in full later this year.


Professor Dieter Wolke, from the University of Warwick added: “As children get older there are increasing educational and social challenges. This study indicates that about two third of children born extremely premature find it difficult to cope with these educational demands. Initial neonatal special care needs to be followed with special services for these children and families to help them to make the best of early education. The demands are likely to increase further as they progress to secondary school.”


— Ends —


Notes to editors: The University of Nottingham is ranked in the UK's Top 10 and the World's Top 100 universities by the Shanghai Jiao Tong (SJTU) and Times Higher (THE) World University Rankings.


More than 90 per cent of research at The University of Nottingham is of international quality, according to RAE 2008, with almost 60 per cent of all research defined as ‘world-leading’ or ‘internationally excellent’. Research Fortnight analysis of RAE 2008 ranks the University 7th in the UK by research power. In 27 subject areas, the University features in the UK Top Ten, with 14 of those in the Top Five.


The University provides innovative and top quality teaching, undertakes world-changing research, and attracts talented staff and students from 150 nations. Described by The Times as Britain's "only truly global university", it has invested continuously in award-winning campuses in the United Kingdom, China and Malaysia. Twice since 2003 its research and teaching academics have won Nobel Prizes. The University has won the Queen's Award for Enterprise in both 2006 (International Trade) and 2007 (Innovation — School of Pharmacy), and was named ‘Entrepreneurial University of the Year’ at the Times Higher Education Awards 2008.


Nottingham was designated as a Science City in 2005 in recognition of its rich scientific heritage, industrial base and role as a leading research centre. Nottingham has since embarked on a wide range of business, property, knowledge transfer and educational initiatives (www.science-city.co.uk) in order to build on its growing reputation as an international centre of scientific excellence. The University of Nottingham is a partner in Nottingham: the Science City.


The Medical Research Council supports the best scientific research to improve human health. Its work ranges from molecular level science to public health medicine and has led to pioneering discoveries in our understanding of the human body and the diseases which affect us all. www.mrc.ac.uk


Additional information about the EPICure Study can be found at http://www.epicure.ac.uk/

Story credits

 More information is available from Professor Neil Marlow , Institute for Women’s Health on +44 (0)20 767 96060, n.marlow@ucl.ac.uk
Lindsay Brooke

Lindsay Brooke - Media Relations Manager

Email: lindsay.brooke@nottingham.ac.uk Phone: +44 (0)115 951 5751 Location: University Park

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