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Outi Hollo, MD, PhD; Päivi Rautava, MD, PhD; Tapio Korhonen, PhD; Hans Helenius, MSc; Pentti Kero, MD, PhD; Mattiä Sillanpää, MD, PhD

Arch Pediatr Adolesc Med. 2002;156:179-187.

Objectives  To provide current information on the academic achievement of small-for-gestational-age (SGA) children at age 10 years, to analyze predictors, and to evaluate the smallness of a newborn as a risk factor for school failure.

Design  Prospective, population-based birth cohort study with 10-year follow-up.

Participants  The SGA group consisted of 106 children born in 1985 whose birth weight had been below the 2.5th percentile on the population-based fetal growth chart. The control group consisted of 105 appropriate-for-gestational-age (AGA) children born as closely as possible in time to SGA infants and matched for gestational age and mode of delivery. Both groups were evaluated at age 10 years.

Main Outcome Measure  Academic achievement.

Results  Twenty-five percent of SGA children were school failures (vs 14% of AGA children; P = .05). There were significantly more SGA than AGA children with unfavorable backgrounds and deficient performances associated with poor academic achievement. Independent predictors of poor academic achievement in SGA and AGA children were inattention-passiveness as rated by their teachers (masked to grouping; corresponding to a 1-point increase in inattention-passiveness score: odds ratio, 5.1; 95% confidence interval, 2.1-12.1), a low verbal IQ score (psychologists masked; corresponding to a 10-point decrease in IQ score: odds ratio, 3.2; 95% confidence interval, 1.6-6.2), and restlessness at the follow-up visit (one examiner masked and the other not; odds ratio, 14.3; 95% confidence interval, 2.1-97.3).

Conclusion  Being SGA at birth has a clinically significant impact on the academic achievement of a 10-year-old child.

From the Department of Public Health (Dr Hollo), the Turku City Hospital (Dr Rautava); and the Departments of Child Psychiatry and Psychology (Dr Korhonen), Biostatistics (Mr Helenius), Paediatrics (Dr Kero), and Child Neurology (Dr Sillanpää), University of Turku, Turku, Finland.

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