School-entry age and academic difficulties at 7 years of age in children born very preterm: a call for age-corrected schooling

Introduction: The long-term impact of iron deficiency anemia on female children was significantly reducing physical growth, neurological development and learning performance. There is limited data about the magnitude of iron deficiency anemia in Saudi Arabia in young children. This study aimed to assess the prevalence and determinants of iron deficiency anemia in children attending primary health care at the age of the school entry. Methods: This is a cross-sectional study including children at the age of school entry and they should be tested for detection of anemia after their parents sign an informed consent. Children with other types of anemia were excluded from this study. The minimal sample size is calculated using Raosoft calculator based on the equation for proportion estimation. Based on this proportion, at the confidence level of 95% and estimation error of 0.05 the initial sample size is calculated to be 384 participants. A questionnaire was used to collect data from the mothers or caregiver for the children. Results: A total sample of 384 attendants in PHC centers responded to the questionnaire, of them 59.5% were males. About 68% of the mothers have a high level of education as university or postgraduate studies and 83% were married. The prevalence of anemia was found to be 24% among children for both genders. Only nationality was a significant predictor for iron-deficiency anemia among children. Saudis children had a significantly lower prevalence of anemia than non-Saudis. Conclusions: The prevalence of anemia among children at age of school entry was high and more attention to the nutritional habits of children should be given by mothers and health specialists. Educational campaign should be conducted to increase awareness about proper children nutrition among women, particularly women with non-Saudi nationality.

<sec><st>Aim</st> Impaired lung function appears common amongst school children born very prematurely. In one study, 56% of such children had abnormal baseline spirometry at 11 years, but all were born at or < 25 completed weeks of gestation. Our aim was to determine if school aged children born at 26 to 28 weeks of gestation had similar impairment of lung function to those born at or < 25 weeks of gestation. </sec> <sec><st>Methods</st> Lung function was assessed at 12 years of age in 38 children, the first so far assessed in the follow-up of the randomised, neonatal study of high frequency oscillation versus conventional ventilation (UKOS). Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1:FVC, residual volume (RV), transfer factor for carbon monoxide (TLCO), functional residual capacity (FRC) and response to cold air challenge (CACh) were assessed. Results were considered abnormal if >1.64 standardised residuals (SR) below expected, except RV results which were abnormal if >1.64 SR above expected. The response to the CACh was considered positive if FEV1 fell by >10% of the baseline value post challenge. </sec> <sec><st>Results</st> Fifteen children were born between 26 and 28 weeks and 23 between 23 and 25 weeks of gestation. A greater proportion of the “23-25 week” children had been oxygen dependent at 28 days (93% versus 83%, p=0.63) and at discharge (35% versus 17%, p=0.26), in this small sample the differences did not reach statistical significance, but a significantly greater proportion of the “23-25 week” children had received postnatal corticosteroids (60% versus 17%, p=0.013). Overall, the lung function results abnormal in greater than 20% of the study population were FEV1 (24%), TLCO (26%) and RV (34%); 26% of the children had a positive CACh. The two groups, however, did not differ in their weight or height at follow-up, nor in any of the lung function results. </sec> <sec><st>Conclusion</st> These preliminary results suggest children born at 26-28 weeks of gestation also suffer lung function impairment at school age and of a similar degree to those born at 23-25 weeks of gestation. </sec>

The impact of intrauterine growth restriction (IUGR) on lung function in very preterm children is largely unknown as current evidence is mainly based on studies in children born small for gestational age but not necessarily with IUGR. Spirometry, transfer factor of the lung for carbon monoxide (TLco), and lung clearance index (LCI) were cross-sectionally evaluated at 8.0-15.0 years of age in children born <32 weeks of gestation with IUGR (n = 28) and without IUGR (n = 67). Controls born at term (n = 67) were also included. Very preterm children with IUGR had lower mean forced expired volume in the first second (FEV1) z-score than those with normal fetal growth (∆ -0.66, 95% confidence interval (CI) -1.12, -0.19), but not significant differences in LCI (∆ +0.24, 95% CI -0.09, 0.56) and TLco z-score (∆ -0.11, 95% CI -0.44, 0.23). The frequency of bronchopulmonary dysplasia (BPD) in the two groups was, respectively, 43% and 10% (P = 0.003). IUGR was negatively associated with FEV1 (B = -0.66; P = 0.004), but the association lost significance (P = 0.05) when adjusting for BPD. IUGR has an impact on conducting airways function of very preterm children at school age, with part of this effect being mediated by BPD. Ventilation inhomogeneity and diffusing capacity, instead, were not affected. IUGR does not necessarily imply a low birthweight for gestational age (and vice versa). While a low birthweight is associated with worse respiratory outcomes, the impact of IUGR on lung function in premature children is largely unknown. IUGR affects conducting airways function in school-age children born <32 weeks with IUGR, but not ventilation inhomogeneity and diffusing capacity. The impact of IUGR on FEV1 seems mainly related to the higher risk of BPD in this group.

This paper estimates peer effects on children’s school entry age, using a dataset on 4,165 children from rural northwestern China (Gansu province). Instrumental-variable estimation, exploiting variations in (older) peers’ home-to-school distance to identify the effect of their school entry age, reveals that a one-year increase in (older) peers’ school entry age raises a child’s school entry age by 0.43 years. This effect is much stronger than the effects of family-background factors such as parental education and family wealth, suggesting that the dominant driving force of delayed school enrollment lies outside of the family.

This article estimates the causal effect of primary school entry age on children's cognitive development in rural northwestern China, using data on nearly 1,800 primary school aged children from the Gansu Survey of Children and Families. Instrumental variable estimates, exploiting the discontinuity structure in children's school entry age around the enrolment cut‐off date, indicate that a 1‐year delay in school entry reduces children's scores on a cognitive ability test administered when they were aged 9–12 by 0.11–0.16 standard deviations (of the distribution of test scores). The negative late‐school‐entry effect is significantly larger in villages with no preprimary schools. It also persists as children advance to higher grades. These findings suggest that delayed school entry, even if it may be rural parents' rational response to resource constraints, can be harmful for children's cognitive development in developing areas with underdeveloped preprimary school systems.

Biometrical JournalVolume 46, Issue S1 p. 122-122 Poster Sessions Abstracts P2.01: Results of a study on “respiratory symptoms and allergies in children at school entry age in a rural region (AABEL)”: internal and external comparison of prevalence rates Michael Hoopmann, Michael Hoopmann Michael.Hoopmann@nlga.niedersachsen.de Search for more papers by this authorSandra Heidrich, Sandra HeidrichSearch for more papers by this authorFriederike Neisel, Friederike NeiselSearch for more papers by this author Michael Hoopmann, Michael Hoopmann Michael.Hoopmann@nlga.niedersachsen.de Search for more papers by this authorSandra Heidrich, Sandra HeidrichSearch for more papers by this authorFriederike Neisel, Friederike NeiselSearch for more papers by this author First published: 17 March 2004 https://doi.org/10.1002/bimj.200490181AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume46, IssueS1Supplement: Abstracts of the Joint Meeting of the IBS-DR and the DAEMarch 2004Pages 122-122 RelatedInformation

Despite significant advances in perinatal and neonatal care, intraventricular haemorrhage (IVH)—bleeding from blood vessels within the germinal matrix of the developing brain into the ventricular system—continues to affect 15%–20% of...

Objective Preterm birth alters typical brain development due to complex exposures related to neonatal illness, pain management, and brain injury. Despite an increased understanding of neonatal brain injury on developmental outcomes, the association of cerebellar maturation with school‐age motor and cognitive function remains incompletely understood. The current study evaluated neonatal clinical factors associated with regionally specific cerebellar volumes and white matter pathways at 8 years of age in children born preterm (24–32 weeks of gestational age). Methods Neuroimaging, clinical, and behavioral data were collected from 130 children born very preterm (24–32 weeks' gestational age) at BC Women's Hospital. Cerebellar subregions were automatically segmented using CerebNet, and cerebellar white matter connectivity was assessed using tractography. The relationships between cerebellar subregion volumes and neonatal clinical factors were examined using constrained principal component analysis. Cognitive and motor neurodevelopmental outcomes related to cerebellar volume and connectivity were also investigated. Results Neonatal clinical factors including mechanical ventilation, number of invasive procedures, and opioid exposures were associated with reduced cerebellar volumes in specific subregions. Acute neonatal mortality risk (i.e., SNAPPE‐II) was negatively associated with cerebellar connectivity at 8 years. Reduced cerebellar volumes and structural connectivity were related to poorer cognitive and motor outcomes. Interpretation In very preterm children, neonatal illness severity and exposure to invasive procedures and opioids are associated with reduced cerebellar volumes, connectivity, and poorer neurodevelopmental outcomes at 8 years.

To study cognitive function at 10y of age in a cohort of children who required neonatal intensive care within the Uppsala Neonatal Follow-up Study. 226 children, who were born in 1986-1989 and had required neonatal intensive care (NIC) and 72 full-term, healthy control children were enrolled in the study. NIC children were grouped according to gestational age (group I, 23-31 wk; subgroup IA, 23-27 wk; IB 28-31 wk; group II, 32-36 wk; group III, > 36 wk), with infants with congenital malformation (IWCM) included and excluded from the main groups. The Kaufman Assessment Battery for Children (K-ABC) was administered and results were analysed in relation to the K-ABC global scales: sequential, simultaneous, mental processing composite and achievement. The great majority of children had well-developed cognitive function, reaching scores at an average level or above. When groups were compared, full-term children that required NIC (group III) showed lower scores than controls on all scales measured by the K-ABC. Preterm children from all the studied groups (groups IA, IB, II) showed poorer performance than controls in the simultaneous processing scale, and group IA scored lower than controls in the achievement scale. The incidence of major cognitive impairment (IQ < 70) was low in NIC children (< 5%), but children from group IA showed significant higher frequency of impairment in the simultaneous, mental processing composite and achievement scales. Children from group IA presented a high frequency of discrepancy between the K-ABC scales, with lower simultaneous and higher sequential scores. Analysis with IWCM excluded from the main groups revealed identical results. Most children who needed neonatal intensive care had developed well their cognitive function at 10 y of age. The long-term effect of neonatal intensive care on cognitive function was more evident in extremely preterm infants (group IA), especially in tasks involving simultaneous ways of processing information.

BackgroundAdvances in neonatal healthcare have resulted in decreased mortality after preterm birth but have not led to parallel decreases in morbidity. Academic performance provides insight in the outcomes and specific...

Aims: To investigate the long term effects of age at surgery on the development of visual acuity (VA) by measuring VA from preschool age to puberty. Furthermore, to report the...

Relationship Between Age of School Entry and Behaviour Problems Recent studies demonstrated that children who are relatively young within a school year show more behaviour problems, are at greater risk of being diagnosed with attention- eficit/hyperactivity disorder (ADHD) and treated with stimulants compared to their older classmates. In this paper we examine the association of age at school entry and behavioural problems for a German sample of elementary school children, who were enrolled in 2009 (N = 928). We used teacher ratings on the Strengths and Difficulties Questionnaire (SDQ) as well as the prevalence of ADHD diagnosis and medication. Our analyses showed that those children with a relatively younger age at school entry were judged more hyperactive than their older peers when sex was controlled for. After stratifying for sex, the effect of age at school entry on hyperactivity was now only significant for boys. No association with age at school entry could be found for the other SDQ-subscales as well as for ADHD diagnosis and medication. Although we could only partially demonstrate a significant relationship between age at school entry and behavioral problems in German elementary school-children, understanding these associations may help to consider children´s maturity differences when evaluating the child´s behavior.

<b>Background:</b> Very preterm birth is associated with lung function impairment later in life, but the complete pattern is not known. <b>Aim:</b> To perform an extensive lung function testing in children at 12 years of age, born preterm, with and without BPD, and compare with matched term controls and associate to neonatal morbidities. <b>Methods:</b> In 136 preterm children (median 26+1 weeks) and 56 term children (median 39+4 weeks), pulmonary function tests were performed. <b>Results:</b> Premature born children showed an obstructive pattern mostly derived from the peripheral airways, with lower FEV1 (p&lt;0.001), FEV1/FVC (p=0.003) and FEF25-75 (p&lt;0.001) as well as higher airway resistance, measured as Rtot (p=0.017) by bodyplethysmography and R5 and R5-20, and impaired airway reactance, measured as X5, AX and Fres by impulse oscillometry (p&lt;0.001 in all). Diffusion capacity was significantly lower in premature born children and lung clearance index was higher (p&lt;0.001). Asthma(36% versus 11%), and wheezing at any time (38% versus 14%) was reported more frequently in children born premature (p£0.001). BPD during infancy showed more signs of airway obstruction, decreased diffusion capacity and affected airway resistance. Premature born children were more reversible in airway obstruction and resistance compared to term children Boys born premature have, in almost all tests, affected lung function parameters. <b>Conclusion:</b> Children born preterm showed more airway obstruction, mainly displayed in the peripheral airways, and those with BPD during infancy showed an impairment in the central airways. Being a preterm boys seems to have more implications at 12 years of age.

Background Few studies have examined the extent and nature of health service utilisation by obese and overweight children. We estimated the rate of hospital admission from five to 13.9 years of age in children who were clinically overweight or obese by age five years compared with their healthy weight peers, using linked electronic health records from a nationally representative prospective cohort of children in Wales and Scotland. Methods Data were available for 3306 singleton children participating in the Millennium Cohort Study (MCS), who were living in Wales (n=1840) or Scotland (n=1466), and whose parents consented to linkage to their health records up until their 14th birthday. Height and weight were measured at home interview at age five years and weight status was categorised according to the UK1990 clinical reference standards. Overall, 3269 (1678 boys) of these 3306 (98.9%) children were linked to the Welsh Demographic Service (n=1838) or their Scottish Community Health Index number (n=1431) via probabilistic and deterministic record matching. In turn, they were matched to Welsh and Scottish hospital admission records from the Patient Episode Database for Wales, and Scottish Morbidity Records, respectively. Using information on admissions from five to 14 years, we fitted negative binomial models adjusted by potential confounders in order to compare rates of inpatient admissions from any cause, for diseases of the digestive or respiratory system, or for injuries by weight status at age five. Results At age 5, 11.6% and 6.8% of children were overweight or obese respectively, and 37% had at least one subsequent hospital admission by their 14th birthday. Compared to children of a healthy weight, there was no increase in the rate of all-cause hospital admissions among overweight or obese children (confounder-adjusted rate ratio (RR), 95% confidence interval (CI): 0.9 (0.7, 1.1) and 1.2 (0.9, 1.5), respectively), or with diseases of the digestive or respiratory system or with injuries. Conclusion This is to our knowledge the first study to link childhood weight status to hospital admissions in a nationally representative cohort. We found that clinical obesity at primary school entry is not associated with a higher rate of subsequent hospital admissions up to age 14 years in children born in 2000/2001. Future analyses will examine primary care consultations and accident and emergency attendances. Longer-term follow up is also needed to determine whether rates increase with age.

To evaluate gross motor skills [Bruininks-Oseretsky Test of Motor Proficiency, 2nd ed (BOT-2)] of patients with idiopathic clubfoot initially treated nonoperatively with either the French functional physical therapy (PT) method or the Ponseti technique, at age 10 years. The BOT-2 was administered by trained physical therapists on patients with idiopathic clubfoot at age 10 years. The cohort was divided by initial treatment method (PT or Ponseti), and compared. Subsequent analyses included comparisons of: initial clubfoot severity (Dimeglio scores: ≤13 vs. >13), laterality (unilateral vs. bilateral), and surgical versus nonoperative outcome. Of the 183 patients tested, 172 were included. The Ponseti and PT groups did not significantly differ according to age, height, weight, body mass index, ankle dorsiflexion, sex, average initial Dimeglio score, laterality, or surgical versus nonsurgical outcome. Overall, patients with treated clubfoot had average gross motor BOT-2 scores compared with age-matched peers. Patients in the PT group scored higher on Running Speed/Agility (P=0.019), Body Coordination percentile rank (P=0.038), and Strength and Agility percentile rank (P=0.007) than patients treated by the Ponseti technique. Patients with bilateral clubfoot scored significantly lower on the Balance subtest (P<0.01), and Body Coordination percentile rank (P<0.01), than those with unilateral clubfoot. Patients who required surgery scored significantly lower on the Balance subtest (P=0.04) than those who did not require surgery. Clubfoot may impair balance in 10 year olds with bilateral involvement and those requiring surgery. Future research should evaluate whether components of the PT method may improve gross motor outcomes as a supplement to the Ponseti technique. Level II.