School performance and behaviour in extremely preterm growth-retarded infants

Objective: To describe school performance and behaviour of extremely preter m, growth-retarded infants. Design: Cohort study at two tertiary care centr es. Included were all surviving, singleton infants (N=127) with fetal growt h retardation due to placental insufficiency. All were delivered by caesare an section because of signs of fetal distress before the beginning of labou r at a gestational age of 26 to 32 weeks during the years 1984-1989. Main o utcome measures were special education, mainstream education below the appr opriate age level and behaviour according to attention-deficit hyperactivit y criteria at school age (41/2-101/2 yrs). The children were divided into t wo subgroups according to age at follow-up (greater than or equal to 171/2 and <71/2 yr). A logistic regression analysis was performed with special sc hool or repeating a grade and behavioural disturbance as dependent variable s and gestational age, birth weight, sex of the infant, neonatal complicati ons (intra cerebral haemorrhage, respiratory distress syndrome, bronchopulm onary dysplasia or sepsis), age category at follow-up and sociodemographic factors as independent variables. Results. 114 (90%) had a complete follow- up. Special education was found in 14% of the assessed children. More child ren in the older age group than in the younger age group were placed in spe cial school (20% versus 10%). Behavioural problems were scored in 39% of th e assessed children attending mainstream education. Special education was r elated to neonatal complications (bronchopulmonary dysplasia), behavioural problems to the absence of either parent. Conclusion: This specific group o f growth-retarded children is at serious disadvantage for adequate performa nce in school, although the incidence of special education and behavioural problems was comparable to other preterm infants. Both special education an d behavioural problems were not related to obstetric variables as gestation al age and/or birth weight. (C) 1999 Elsevier Science Ireland Ltd. All righ ts reserved.