Neonatal Brain Structure, Early Life Context, and Academic Achievement among Children Born Very Preterm

Objective: To examine whether neonatal brain abnormality severity was independently associated with academic achievement at 6 years and whether it modified the association between early life socioeconomic context and achievement in children born very preterm. Study design: A prospective cohort of 133 Australian infants born at <31 weeks' gestation at a tertiary hospital was followed up at age 6 years. Early life socioeconomic context was assessed using a composite index across 6 variables at term-equivalent age (score range, 0-12) and dichotomized, with scores of 2 or higher classified as indicating higher disadvantage (n = 68 [51%]). Brain magnetic resonance imaging was performed early (at 32 weeks postmenstrual age) and at term-equivalent age and scored using the Kidokoro criteria (Global Brain Abnormality Score). Academic achievement was assessed using Woodcock-Johnson-IV Tests of Achievement, broad reading and mathematics clusters. Results: Higher disadvantage was consistently associated with poorer academic achievement outcomes (range b = -10.73 to -7.95; 95% CI, -16.90 to -2.30). Greater brain abnormality on early magnetic resonance imaging was associated with poorer mathematics (b = -0.95; 95% CI, -1.58 to -0.32) but not reading achievement. Greater brain abnormality at term-equivalent age was associated with poorer achievement in both reading (b = -0.86; 95% CI, -1.64 to -0.09) and mathematics (b = -1.00; 95% CI, -1.56 to -0.43). No statistically significant interactions were observed. Conclusions: Greater neonatal brain abnormality and higher early life disadvantage were independently associated with poorer academic achievement in children born very preterm. Brain abnormality severity did not modify the association between early life disadvantage and academic achievement. These findings support the assessment of both biological risk and socioeconomic disadvantage in neonatal follow-up. Clinical trial registry: Australian New Zealand Clinical Trials Registry ANZCTR12619000155190.