Article Text

Download PDFPDF
Academic attainment and special educational needs in extremely preterm children at 11 years of age: the EPICure study
  1. S Johnson1,2,
  2. E Hennessy3,
  3. R Smith2,
  4. R Trikic2,
  5. D Wolke4,
  6. N Marlow1,2
  1. 1
    Institute for Women’s Health, University College London, London, UK
  2. 2
    School of Clinical Sciences, University of Nottingham, Nottingham, UK
  3. 3
    Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  4. 4
    Department of Psychology and Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
  1. Dr Samantha Johnson, Institute for Women’s Health, 86–96 Chenies Mews, London WC1E 6HX, UK; s.j.johnson{at}


Aim: To assess academic attainment and special educational needs (SEN) in extremely preterm children in middle childhood.

Methods: Of 307 extremely preterm (⩽25 weeks) survivors born in the UK and Ireland in 1995, 219 (71%) were re-assessed at 11 years of age and compared to 153 classmates born at term, using standardised tests of cognitive ability and academic attainment and teacher reports of school performance and SEN. Multiple imputation was used to correct for selective dropout.

Results: Extremely preterm children had significantly lower scores than classmates for cognitive ability (−20 points; 95% CI −23 to −17), reading (−18 points; −22 to −15) and mathematics (−27 points; −31 to −23). Twenty nine (13%) extremely preterm children attended special school. In mainstream schools, 105 (57%) extremely preterm children had SEN (OR 10; 6 to 18) and 103 (55%) required SEN resource provision (OR 10; 6 to 18). Teachers rated 50% of extremely preterm children as having below average attainment compared with 5% of classmates (OR 18; 8 to 41). Extremely preterm children who entered compulsory education an academic year early due to preterm birth had similar academic attainment but required more SEN support (OR 2; 1.0 to 3.6).

Conclusions: Extremely preterm survivors remain at high risk for learning impairments and poor academic attainment in middle childhood. A significant proportion require full-time specialist education and over half of those attending mainstream schools require additional health or educational resources to access the national curriculum. The prevalence and impact of SEN are likely to increase as these children approach the transition to secondary school.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: None.

  • Funding: This study was funded by the Medical Research Council.

  • i Using K-ABC test data, 13.7% (95% CI 9.5% to 19.1%) of extremely preterm children had serious cognitive impairment compared with no classmates. Adjusting for loss to follow-up, the estimated proportion rose to 17.4% (12.4% to 22.4%).

  • ii Results exclude Ireland. Scotland adopts a similar process to England and Wales and data are therefore included. The prevalence of statements in England and Wales was not significantly different in the full cohort (35% extremely preterm vs 0.8% classmates; OR 70; 95% CI 10 to 512) and in mainstream schools (25% extremely preterm vs 0.8% classmates; OR 43; 6 to 320).

  • The EPICure website is at

  • Ethics approval: The study was approved by the Southampton and South West Hampshire Research Ethics Committee.

  • ▸ An additional table is published online only at