Neonatal Morbidity at Term, Early Child Development, and School Performance: A Population Study

Abstract

OBJECTIVES: Investigate the association between severe neonatal morbidity (SNM) and child development and school performance among term infants. METHODS: The study population included term infants without major congenital conditions born between 2000 and 2007 in New South Wales, Australia, with a linked record of developmental assessment at ages 4 to 6 years in 2009 or 2012 (n = 144 535) or school performance at ages 7 to 9 years from 2009 to 2014 (n = 253 447). Developmental outcomes included special needs or being vulnerable and/or at risk in 1 of 5 developmental domains. School performance outcomes were test exemption, or performing <−1 SD on reading or numeracy tests. Binary generalized estimating equations were used to estimate associations between SNM and outcomes, adjusting for sociodemographic, perinatal, and assessment and/or test characteristics. RESULTS: Overall, 2.1% of infants experienced SNM. The adjusted odds ratio (95% confidence interval) for SNM and physical health was 1.18 (1.08–1.29), 1.14 (1.02–1.26) for language and cognitive skills, and 1.14 (1.06–1.24) and 1.13 (1.05–1.21) for scoring <−1 SD in reading and numeracy, respectively. SNM was most strongly associated with special needs 1.34 (1.15–1.55) and test exemption 1.50 (1.25–1.81). SNM infants born at 37 to 38 weeks’ gestation and who were small for gestational age had the greatest likelihood of poorer outcomes. CONCLUSIONS: Term infants with SNM have greater odds of poor neurodevelopment in childhood. These findings provide population-based information for families and can inform clinical counseling and guidelines for follow-up and early intervention.