Article| Volume 34, ISSUE 5, e59-e76, September 2020

Umbrella Review of School Age Health Outcomes of Preterm Birth Survivors

      Preterm birth affects approximately 10% of U.S. births, with survival rates close to 95%. All health care providers, regardless of population or setting, are treating preterm birth survivors. The purpose of this manuscript is to present an umbrella review of the health outcomes of 2- to 12-year-old children who were born preterm. The current umbrella review consisted of 29 reviews, 14 meta-analyses, eight systematic reviews, and seven described as both meta-analysis and systematic review. Studies were grouped into six health outcome categories: neurodevelopmental, motor and/or cerebral palsy, pulmonary, mental and/or behavioral health, quality of life and/or leisure, and eczema. The analysis supports a resounding recommendation to recognize preterm birth, at all gestations, as a risk factor to health and educational outcomes. Increased attention to developmental screenings is critical, specifically recognition that children who are on the lower ranges of normal may benefit from therapies or interventions that support the attainment of future skills.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Health Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aarnoudse-Moens C.S.H.
        • Weisglas-Kuperus N.
        • van Goudoever J.B.
        • Oosterlaan J.
        Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children.
        Pediatrics. 2009; 124: 717-728
        • Agrawal S.
        • Rao S.C.
        • Bulsara M.K.
        • Patole S.K.
        Prevalence of autism spectrum disorder in preterm infants: A meta-analysis.
        Pediatrics. 2018; 142e20180134
        • Allotey J.
        • Zamora J.
        • Cheong-See F.
        • Kalidindi M.
        • Arroyo-Manzano D.
        • Asztalos E.
        • Thangaratinam S.
        Cognitive, motor, behavioural and academic performances of children born preterm: A meta-analysis and systematic review involving 64 061 children.
        British Journal of Obstetrics and Gynaecology. 2018; 125: 16-25
        • American Academy of Pediatrics Committee on Fetus and Newborn
        Hospital discharge of the high-risk neonate.
        Pediatrics. 2008; 122: 1119-1126
        • Aromataris E.
        • Fernandez R.
        • Godfrey C.M.
        • Holly C.
        • Khalil H.
        • Tungpunkom P.
        Summarizing systematic reviews: Methodological development, conduct and reporting of an umbrella review approach.
        International Journal of Evidence-Based Healthcare. 2015; 13: 132-140
        • Barre N.
        • Morgan A.
        • Doyle L.W.
        • Anderson P.J.
        Language abilities in children who were very preterm and/or very low birth weight: A meta-analysis.
        The Journal of Pediatrics. 2011; 158: 766-774
        • Been J.V.
        • Lugtenberg M.J.
        • Smets E.
        • van Schayck C.P.
        • Kramer B.W.
        • Mommers M.
        • Sheikh A.
        Preterm birth and childhood wheezing disorders: A systematic review and meta-analysis.
        PLoS Medicine. 2014; 11e1001596
        • Boone K.M.
        • Nelin M.A.
        • Chisolm D.J.
        • Keim S.A.
        Gaps and factors related to receipt of care within a medical home for toddlers born preterm.
        Journal of Pediatrics. 2019; 207: 161-168
        • Briggs J.
        The Joanna Briggs Institute Reviewers’ Manual 2014.
        2014 (Retrieved from)
        • Cantrell M.A.
        • Franklin A.
        • Leighton K.
        • Carlson A.
        The evidence in simulation-based learning experiences in nursing education and practice: An umbrella review.
        Clinical Simulation in Nursing. 2017; 13: 634-667
        • Cassiano R.G.M.
        • Gaspardo C.M.
        • Linhares M.B.M.
        Prematurity, neonatal health status, and later child behavioral/emotional problems: A systematic review.
        Infant Mental Health Journal. 2016; 37: 274-288
        • Chan E.
        • Leong P.
        • Malouf R.
        • Quigley M.A.
        Long‐term cognitive and school outcomes of late‐preterm and early‐term births: A systematic review.
        Child: Care, Health and Development. 2016; 42: 297-312
        • Dahan-Oliel N.
        • Mazer B.
        • Majnemer A.
        Preterm birth and leisure participation: A synthesis of the literature.
        Research in Developmental Disabilities. 2012; 33: 1211-1220
        • de Kieviet J.F.
        • Piek J.P.
        • Aarnoudse-Moens C.S.
        • Oosterlaan J.
        Motor development in very preterm and very low-birth-weight children from birth to adolescence: A meta-analysis.
        Journal of the American Medical Association. 2009; 302: 2235-2242
        • Dempsey A.G.
        • Keller-Margulis M.
        • Mire S.
        • Abrahamson C.
        • Dutt S.
        • Llorens A.
        • Payan A.
        School-aged children born preterm: Review of functioning across multiple domains and guidelines for assessment.
        Advances in School Mental Health Promotion. 2015; 8: 17-28
        • den Dekker H.T.
        • Sonnenschein-van der Voort A.M.M.
        • de Jongste J.C.
        • Anessi-Maesano I.
        • Arshad S.H.
        • Barros H.
        • Duijts L.
        Early growth characteristics and the risk of reduced lung function and asthma: A meta-analysis of 25,000 children.
        Journal of Allergy and Clinical Immunology. 2016; 137: 1026-1035
        • Domellöf E.
        • Johansson A.M.
        • Rönnqvist L.
        Handedness in preterm born children: A systematic review and a meta-analysis.
        Neuropsychologia. 2011; 49: 2299-2310
        • Edwards J.
        • Berube M.
        • Erlandson K.
        • Haug S.
        • Johnstone H.
        • Meagher M.
        • Zwicker J.G.
        Developmental coordination disorder in school-aged children born very preterm and/or at very low birth weight: A systematic review.
        Journal of Developmental and Behavioral Pediatrics. 2011; 32: 678-687
        • Edwards M.O.
        • Kotecha S.J.
        • Lowe J.
        • Watkins W.J.
        • Henderson A.J.
        • Kotecha S.
        Effect of preterm birth on exercise capacity: A systematic review and meta-analysis.
        Pediatric Pulmonology. 2015; 50: 293-301
        • Ferrero D.M.
        • Larson J.
        • Jacobsson B.
        • DiRenzo G.C.
        • Norman J.E.
        • Martin J.N.
        • Simpson J.L.
        Cross-country individual participant analysis of 4.1 million singleton births in 5 countries with very high human development index confirms known associations but provides no biologic explanation for 2/3 of all preterm births.
        PLoS One. 2016; 11e0162506
        • FitzGerald T.L.
        • Kwong A.K.L.
        • Cheong J.L.Y.
        • McGinley J.L.
        • Doyle L.W.
        • Spittle A.J.
        Body structure, function, activity, and participation in 3- to 6-year-old children born very preterm: An ICF-based systematic review and meta-analysis.
        Physical Therapy. 2018; 98: 691-704
        • Geldof C.J.A.
        • van Wassenaer A.G.
        • de Kieviet J.F.
        • Kok J.H.
        • Oosterlaan J.
        Visual perception and visual-motor integration in very preterm and/or very low birth weight children: A meta-analysis.
        Research in Developmental Disabilities. 2012; 33: 726-736
        • Johnson S.
        • Marlow N.
        Early and long-term outcome of infants born extremely preterm.
        Archives of Disease in Childhood. 2017; 102: 97-102
        • Kelly M.M.
        Assessment of life after prematurity in 9- to 10- year-old children.
        MCN American Journal of Maternal Child Nursing. 2014; 39 (quiz 33): 26-32
        • Kelly M.M.
        Health and educational implications of prematurity in the United States: National survey of children's health 2011/2012 data.
        Journal of the American Association of Nurse Practitioners. 2018; 30: 131-139
        • Kelly M.M.
        • Dean S.
        Utilization of the Premature Birth Knowledge Scale to assess pediatric provider knowledge of neurodevelopmental outcomes.
        Journal of Pediatric Health Care. 2017; 31: 476-483
        • Kelly M.M.
        • Griffith P.B.
        The influence of preterm birth beyond infancy: Umbrella review of outcomes of adolescents and adults born preterm.
        Journal of the American Association of Nurse Practitioners. 2019; 32: 555-562
        • Kelly M.M.
        • Li K.
        Poverty, toxic stress, and education in children born preterm.
        Nursing Research. 2019; 68: 275-284
        • Kotecha S.J.
        • Edwards M.O.
        • Watkins W.J.
        • Henderson A.J.
        • Paranjothy S.
        • Dunstan F.D.
        • Kotecha S.
        Effect of preterm birth on later FEV1: A systematic review and meta-analysis.
        Thorax. 2013; 68: 760-766
        • Kotecha S.
        • Clemm H.
        • Halvorsen T.
        • Kotecha S.J.
        Bronchial hyper-responsiveness in preterm-born subjects: A systematic review and meta-analysis.
        Pediatric Allergy and Immunology. 2018; 29: 715-725
        • Kovachy V.N.
        • Adams J.N.
        • Tamaresis J.S.
        • Feldman H.M.
        Reading abilities in school-aged preterm children: A review and meta-analysis.
        Developmental Medicine and Child Neurology. 2015; 57: 410-419
        • Litt J.S.
        • McCormick M.C.
        The impact of special health care needs on academic achievement in children born prematurely.
        Academic Pediatrics. 2016; 16: 350-357
        • Luu T.M.
        • Mian M.O.R.
        • Nuyt A.M.
        Long-term impact of preterm birth: Neurodevelopmental and physical health outcomes.
        Clinics in Perinatology. 2017; 44: 305-314
        • Martin J.A.
        • Hamilton B.E.
        • Osterman M.J.K.
        • Driscoll A.K.
        • Drake P.
        Births: Final data for 2017.
        National Vital Statistics Reports. 2018; 67: 1-50
        • Mathewson K.J.
        • Chow C.H.T.
        • Dobson K.G.
        • Pope E.I.
        • Schmidt L.A.
        • Van Lieshout R.J.
        Mental health of extremely low birth weight survivors: A systematic review and meta-analysis.
        Psychological Bulletin. 2017; 143: 347-383
        • Moore G.P.
        • Lemyre B.
        • Barrowman N.
        • Daboval T.
        Neurodevelopmental outcomes at 4 to 8 years of children born at 22 to 25 weeks’ gestational age: A meta-analysis.
        JAMA Pediatrics. 2013; 167: 967-974
        • Moreira R.S.
        • Magalhães L.C.
        • Alves C.R.L.
        Effect of preterm birth on motor development, behavior, and school performance of school-age children: A systematic review.
        Jornal de Pediatria. 2014; 90: 119-134
        • Oskoui M.
        • Coutinho F.
        • Dykeman J.
        • Jetté N.
        • Pringsheim T.
        An update on the prevalence of cerebral palsy: A systematic review and meta‐analysis.
        Developmental Medicine and Child Neurology. 2013; 55: 509-519
        • Raju T.N.K.
        • Pemberton V.L.
        • Saigal S.
        • Blaisdell C.J.
        • Moxey-Mims M.
        • Buist A.S.
        Long-term healthcare outcomes of preterm birth: An executive summary of a conference sponsored by the National Institutes of Health.
        Journal of Pediatrics. 2017; 181 (e1): 309-318
        • Ritchie K.
        • Bora S.
        • Woodward L.J.
        Social development of children born very preterm: A systematic review.
        Developmental Medicine and Child Neurology. 2015; 57: 899-918
        • Ronkainen E.
        • Dunder T.
        • Peltoniemi O.
        • Kaukola T.
        • Marttila R.
        • Hallman M.
        New BPD predicts lung function at school age: Follow-up study and meta-analysis.
        Pediatric Pulmonology. 2015; 50: 1090-1098
        • Sonnenschein-van der Voort A.M.M.
        • Arends L.R.
        • de Jongste J.C.
        • Annesi-Maesano I.
        • Arshad S.H.
        • Barros H.
        • Duijts L.
        Preterm birth, infant weight gain, and childhood asthma risk: A meta-analysis of 147,000 European children.
        Journal of Allergy and Clinical Immunology. 2014; 133: 1317-1329
        • Synnes A.
        • Hicks M.
        Neurodevelopmental outcomes of preterm children at school age and beyond.
        Clinics in Perinatology. 2018; 45: 393-408
        • van Noort-van der Spek I.L.
        • Franken M.C.
        • Weisglas-Kuperus N.
        Language functions in preterm-born children: A systematic review and meta-analysis.
        Pediatrics. 2012; 129: 745-754
        • Vieira M.E.B.
        • Linhares M.B.M.
        Quality of life of individuals born preterm: A systematic review of assessment approaches.
        Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2016; 25: 2123-2139
      1. World Health Organization. (2018). Preterm birth fact sheets. Available at Retrieved June 18, 2020.

        • Williams J.
        • Lee K.J.
        • Anderson P.J.
        Prevalence of motor-skill impairment in preterm children who do not develop cerebral palsy: A systematic review.
        Developmental Medicine and Child Neurology. 2010; 52: 232-237
        • Zhu T.
        • Zhao J.
        • Qu Y.
        • Zhang L.
        • Mu D.
        Association of very preterm birth with decreased risk of eczema: A systematic review and meta-analysis.
        Journal of the American Academy of Dermatology. 2018; 78 (e8): 1142-1148


      Michelle M. Kelly, Associate Professor, Pediatric Nurse Practitioner Program, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA.


      Patricia B. Griffith, Advanced Senior Lecturer, Adult Gerontology Acute Care Nurse Practitioner Program, The University of Pennsylvania School of Nursing, University of Pennsylvania, Philadelphia, PA.