The long-term effect of very preterm birth on school readiness: exploring preschool mediating pathways.

Abstract

Very preterm children face developmental challenges at school entry, yet the mechanisms underlying these difficulties during preschool remain unclear. We examined the association between very preterm birth and children's math skills, behavioural, and emotional difficulties in children aged 8-12, and the mediating role of executive functions and receptive vocabulary from ages 3 to 6. Using data from the 'Encuesta Longitudinal de la Primera Infancia' Chilean cohort, the study involved 10,098 children (147 very preterm). Very preterm status and sociodemographics were assessed at ages 1-3 in 2010. Executive functions and receptive vocabulary were measured in 2012, and math skills, behavioural, and emotional difficulties in 2017. Structural equation modelling indicated that very preterm children exhibited significantly lower math skills compared to term-born peers. This association was partially mediated by reduced executive functions and receptive vocabulary at preschool. No total or direct effects were found between very preterm birth and behavioural or emotional difficulties, but indirect effects, via general cognitive abilities, were observed. This study highlights the long-term effects of very preterm birth on children's school readiness. Early interventions that enhance executive functions and receptive vocabulary at preschool may help mitigate the adverse effects of very preterm birth. Very preterm children show lower math skills at school age than full-term peers, mediated by early difficulties in executive functions and receptive vocabulary. Very preterm status does not have a direct association with children's behavioural and emotional difficulties at school age; however, an indirect pathway via early difficulties in general cognitive skills was identified. Findings add to the existing literature by identifying early cognitive mechanisms underlying long-term academic challenges for this high-risk group. Early intervention programs targeting executive functions and receptive vocabulary at preschool can help mitigate the adverse effects of very preterm birth on educational outcomes.