Background Chronic liver disease (CLD) affects 2–10 per 10 000 children. While prior evidence links CLD to lower cognitive ability, its impact on school readiness remains unclear. Objective To study the association between early-onset chronic liver disease (CLD; <5 years) and school readiness at age 5. Design A population-based cohort study using linked health and education data from the Education and Child Health Insights from Linked Data project in England. Children born between 2002 and 2012 with teacher assessments at age 4–5 years (2007/2008–2016/2017) were included. CLD diagnoses were identified using the International Statistical Classification of Diseases and Related Health Problems, 10th revision and Operating Procedure Codes Supplement 4 hospital codes. Multivariable regression assessed standardised developmental outcomes in up to seven domains. Results Of 5 084 671 pupils, 0.1% (n=3672) were diagnosed with early-onset CLD by age 5. Of children in 2011/2012–2016/2017 with CLD, 55.8% did not achieve a good level of development, compared with 35.3% without CLD (adjusted relative risk: 1.40, 95% CI 1.34 to 1.46). Standardised total point scores were 0.69 lower (95% CI 0.58 to 0.81) in 2007/2008–2010/2011 and 0.41 lower (95% CI 0.36 to 0.46) in 2011/2012–2016/2017. Children with CLD performed worse than those without CLD in all areas of development, with the strongest effect sizes in the physical development domain. Larger effects were observed among girls, those with more severe disease and those from less deprived areas. Conclusions Children with early-onset CLD face greater cognitive risk than their peers affected by liver transplantation hospital stays. Further exploration of longitudinal educational outcomes and their relationship with specific liver disease-related factors is needed.
Libuy et al. (Mon,) studied this question.