Impact of family structure and stability on academic outcome in preterm children at 10 years of age

Objective: To compare school performance at age 10 years in a cohort of ext remely preterm children and term control subjects and to examine the impact of family composition and stability on performance. Study design: Prospective, longitudinal 'follow-up from birth to 10 years o f age of a regional cohort of children born at 24 to 31 weeks of gestationa l age and sociodemographically matched term control subjects. Family compos ition, extent of parental care giving, and family moves were tracked sequen tially. At 10 years, academic achievement and school performance were ascer tained for 118 of 125 (94%) preterm survivors and 119 of 125 (95%) term chi ldren. Results: Term children were more likely to demonstrate optimal school outco me (appropriate grade level without additional classroom assistance) than w ere preterm children (odds ratio 3.4, 95% CI 1.9-6.0). Medical complication s related to prematurity had little impact on school outcome. Among preterm children, optimal school outcome was significantly associated with increas ed parental education, child rearing by 2 parents (regardless of marital st atus), and stability in family composition and geographic residence over 10 years. These environmental influences were less pronounced among term cont rol subjects. Conclusion: Although preterm children performed less well in school than te rm children, family factors were stronger predictors of school performance than were perinatal complications.