Moderately Premature Infants May Have More Problems in School

From the WebMD Archives

June 22, 2001 -- Children born even a few weeks early may be at increased risk for learning difficulties and hyperactivity in school, according to British researchers.

But don't worry too much just yet. Pediatrician and study author Peter L. Hope, MD, of Oxford, England's John Radcliffe Hospital is quick to point out that the problems are generally minor, and that their findings are very preliminary and require further study.

"The last thing we want to do is cause panic with this study," he tells WebMD. "The fact is that by the time these kids are a year old, most of their parents have, to a large extent, forgotten they were premature. Our purpose with this report is to heighten awareness and prompt further examination, not to urge parents to get special treatment or evaluation. Because the majority of these kids will be just fine."

A pregnancy is considered full-term at a gestation of 38 to 42 weeks, based on the 40 weeks between the mother's last menstrual period and her due date. Babies born anywhere from 24 to 31 weeks are considered extremely premature, whereas babies born between 32 and 37 are considered mildly or moderately premature.

Children who are born very premature are known to have a high incidence of developmental problems, but few studies have examined such problems among those considered only moderately premature.

In this study, reported in the July issue of Archives of Disease in Childhood, researchers identified all children born between 32 and 35 weeks to mothers living in Oxfordshire, England in 1990. The children weighed about four to five pounds at birth, with the lowest weight being around three pounds.

Questionnaires evaluating the health, behavior, and education of the roughly 180 children were mailed to their parents, doctors, and teachers.

About one-third of the children were reported to have some degree of difficulty in school. Studies evaluating children in the general population using the same survey have found that 10-20% have similar difficulties, Hope says. He adds that approximately 4% of the premature children in the study had severe school problems, compared to about 2% of all children.

As far as behavior, either a parent or teacher reported hyperactivity in 28% of the premature children, but only 10% of children were assessed as hyperactive by both.

Pediatrician Michael Speer, MD, tells WebMD he has problems with the design of the study and believes the authors may actually be underestimating the occurrence of learning problems among moderately preterm children. He cites several major studies from the 1980s and 1990s, which found that approximately 65% of all premature children have some form of learning difficulty. Speer is a professor of pediatrics at Baylor College of Medicine in Houston and is a spokesperson for the American Academy of Pediatrics.

"Obviously, the closer to term you get, the less chance that there will be difficulties," he says. "Educational problems in preterm infants are common. And parents should not wait to have their child evaluated if that child is having problems in school."