The Impact of Delayed School Entry on Developmental Outcomes in Very Preterm Infants

Objective To investigate whether delayed school entry (DSE) benefits outcomes related to everyday functioning and participation in very preterm-born children. Methods We conducted a systematic review according to Cochrane standard. Additionally, we analyzed data of 1620 children born before 32 weeks of gestation at five and ten years from a prospective cohort study. Children with DSE were compared to those with age-appropriate school entry (ASE) regarding everyday functioning and participation, using standardized parent and self-report questionnaires. Results Our systematic review identified one study reporting no benefit of DSE on academic skills (very low certainty of evidence). In the prospective cohort, DSE was associated with less favorable outcomes (mean [standard deviation]): participation (ASE 95.8 [8.5]; DSE 90.3 [14.0]; p<0.001), attention (ASE 3.6 [1.2]; DSE 4.1 [1.3]; p<0.001), internalizing problems (ASE 4.5 [3.3]; DSE 5.7 [4.0]; p=0.01), executive functioning (ASE 52 [11]; DSE 58 [13]; p<0.001) but not in quality of life (ASE 54.0 [6.2]; DSE 52.9 [6.4]; p=0.17). DSE children had higher special educational needs (34% vs. 9.8%; p<0.001). However, after adjustment for predefined confounders, no significant differences remained at ten years. ASE based on chronological age was associated with delayed transition to secondary school in contrast to ASE based on corrected age. Conclusion After adjustment, DSE had no effect on outcomes relating to everyday functioning and participation at ten years or the timely transition to secondary school. Age corrected for preterm birth should be used to determine school entry age. Further research is needed on the long-term academic implications of age at school entry.