273 - School Readiness Among a Population-Based Cohort of Children Born Preterm in Canada

Poster Number: 273
Publication Number: 273.225

DEEPAK LOUIS, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, WINNIPEG, MB, Canada; Sapna Oberoi, CancerCare Manitoba, Winnipeg, MB, Canada; M. Florencia Ricci, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Christy Pylypjuk, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Ruben Alvaro, University of Manitoba, Winnipeg, MB, Canada; Cecilia de Cabo, University of Manitoba, Winnipeg, MB, Canada; Diane Moddemann, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Mary Seshia, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Lisa M. Lix, University of Manitoba, Winnipeg, MB, Canada; Allan Garland, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Chelsea Ruth, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

Background: Preterm children can have learning challenges at school. However, there is a paucity of data on their school readiness, as they prepare to begin grade one.

Objective: To test the association between prematurity and school readiness in a population-based cohort of children.

Design/Methods: A retrospective cohort of children born between 2000-2011 in the province of Manitoba, Canada. Their school readiness assessed routinely in kindergarten using the Early Development Instrument (EDI) by public school division teachers was used for this study. A secondary sibling cohort was formed comprising of preterm children and their term sibling closest in age. We excluded children who (a) had a significant congenital anomaly (b) could not be linked to maternal records or school readiness outcomes and (c) had mothers without provincial health insurance coverage at least 2 years prior to the child’s birth. The primary outcome was 'vulnerability' in EDI, defined as a score below the 10th percentile on any of the five EDI domains of physical health and well-being, social competence, emotional maturity, language and thinking skills, and communication skills and general knowledge. Logistic regression models were used to identify predictors of vulnerability in EDI; odds ratios (ORs) and 95% confidence intervals (CIs) are reported.

Results: Of 86,829 eligible children, 63,277 children [4,352 preterm children (gestational age, median [IQR]: 35 weeks [34,36]) and 58,925 term children (40 weeks [38,40]) were included (Table 1). More than one-third (i.e., 35%) of preterm children were vulnerable in EDI compared to 28% of term children [OR: 1.4; 95% CI: 1.2-1.5, p < 0.001] (Table 2). A higher percentage of preterm children was vulnerable in each of the 5 EDI domains. In the population cohort, gestational age [ < 34 weeks OR: 1.72; 1.48-1.99, 34-36 weeks OR: 1.23; 1.14-1.33], male sex [OR: 2.24; 2.16-2.33], small for gestational age [OR: 1.31; 1.23-1.40] and various maternal medical and socio-demographic factors predicted EDI vulnerability (Table 4). In the sibling cohort, EDI outcomes were similar for preterm children and term siblings except on the communication skills and general knowledge domains (Table 3) while male sex [OR: 2.2; 1.63-2.98] was the only predictor of EDI vulnerability (Table 4).Conclusion(s): In this population-based cohort, preterm children had a lower school readiness rate than term children. However, this difference was not seen in the sibling cohort. We determined child-related and maternal predictors of lack of school readiness that can help identify high-risk preterm children.
Table 1: Baseline characteristics of the population and sibling cohortsIQR-interquartile range; SGA-small for gestational age; SEFI-2-Socioeconomic Factor Index-version 2 score.
Description of outcomes and odds ratios (95% confidence intervals) for the population cohort (Table 2) and sibling cohort (Table 3)EDI-Early Development Instrument; SD-standard deviation.