The Learning and Educational Attainment of Preterm and At-Risk Infants

/ABSTRACT Infants born prematurely (<37 weeks’ gestation) or at term with congenital anomalies or perinatal conditions are at increased risk of mortality, neurodevelopmental morbidity, and difficulty with academic achievement. Specifically, children born preterm show deficits in mathematics, language decoding, and reading comprehension subskills compared to term children. Academic performance is a useful summary marker for functional limitations caused by neurodevelopmental impairment and is an intermediate outcome for lifelong health. Most of our knowledge about the intersection of health and education is derived from studies that rely on parent recollection. Detailed longitudinal health information tied to educational outcomes is lacking. Moreover, our knowledge about the impact of participation in programs like High Risk Infant Follow Up (HRIF) and Early Intervention (EI) on downstream academic achievement is limited. We propose a 5-year study to examine whether universal early identification of neurodevelopmental disability and equitable and timely referral to and receipt of appropriate support services can mitigate developmental deficits and improve academic outcomes. We will leverage the unique partnership in Los Angeles between Kaiser Permanente Southern California (KPSC), one of the largest integrated health systems, and Los Angeles Unified School District (LAUSD), the second largest school district in the US. Academic outcomes will be measured using (1) standardized test scores using the California Assessment of Student Performance and Progress (Smarter Balance Summative Assessments, English Language Arts and Mathematics components), (2) attendance, (3) course grades and grade point average, and (4) graduation. We propose to A) merge electronic health and billing data from KPSC and academic measures from LAUSD. Using this novel data resource; we will B) use tree-based classification and multi-level growth mixture modelling to compare academic trajectories between at-risk preterm and term infants and low-risk term counterparts; C) identify predictors of referral and participation in HRIF and EI and examine mediators and moderators of the association between perinatal risk and participation in HRIF and EI using logistic and mixed effects negative binomial regression, mediation, moderation analyses; and D) examine the association between participation in HRIF and EI and academic outcomes with a matched propensity score analysis and subsequent mixed effects regression models. The proposed study aligns with the mission of the NIH NICHD to ensure that all children have the chance to achieve their full potential for productive lives. The association of service use (EI/HRIF) and educational outcomes identified in this study will inform policy and quality efforts to improve connections between developmental services, health systems, and school districts. Project Number: 1R01HD117746-01 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Ashwini Lakshmanan | Institution: KAISER FOUNDATION RESEARCH INSTITUTE, Oakland, CA | Award Amount: $694,528 | Activity Code: R01 | Study Section: Neurological, Mental and Behavioral Health Study Section[NMBH] View on NIH RePORTER: https://reporter.nih.gov/project-details/1R01HD11774601