Educational Attainments in Early Adolescence of Infants Who Required Major Neonatal Surgery By Lorraine Ludman, Lewis Spitz, and Angie Wade London, England Purpose: The aim of this study was to assess long-term educational attainment in adolescence of former infants who required major neonatal surgery. Methods: The study is an extension of a prospective longi- tudinal study begun in 1983 on 30 full-term newborns requir- ing major neonatal surgery, a matched healthy control group, and full-term infants requiring neonatal intensive care for medical reasons. Educational attainment levels were ob- tained from the results of compulsory national curriculum examinations taken at age 11 years in 3 core academic subjects, English, Mathematics, and Science and teachers’ assessments of current academic performance. Additionally, follow-up data on health were obtained from family general practitioners and parents. Results: Seventy percent of the original surgical group, 48% of the original control group, and 77% of the original medical group underwent follow-up. The participants were aged be- tween 11 and 13 years. After adjustment for social factors (gender, social group, and mother’s age), the surgical group was significantly behind on all measures of educational at- tainment (English, P  .0005; Mathematics, P  .02; Science, P  .0005; academic performance, P = .004), compared with the control group and medical group who did not differ from each other. Independent predictors of outcome were me- chanical ventilation for 4 days in the neonatal period and behavior problems at 3 years. At 12 months of age, indepen- dent predictors of cognitive functioning were length of hos- pitalization and, at 3 years of age, the number of operative procedures. Mechanical ventilation was not significantly as- sociated with cognitive functioning at previous stages of the study. Conclusions: These results show that, in early adolescence, children who required major neonatal surgery were perform- ing less well academically compared with their peers. This information can be used to increase awareness of the diffi- culties these children may experience during childhood so that intervention can be directed appropriately, thereby less- ening the risk of later educational problems. J Pediatr Surg 36:858-862. Copyright © 2001 by W.B. Saunders Company. INDEX WORDS: Major neonatal surgery, neonatal intensive care, mechanical ventilation, long-term follow-up, educa- tional attainment, adolescence. D URING THE PAST DECADE we have carried out a prospective longitudinal study of a group of full-term infants who required major surgery in the neonatal period. We compared their development from birth to 3 years of age with a group of healthy controls, and a smaller group who required intensive medical care at birth. 1-5 At 1 year the surgical and medical babies were per- forming significantly less well in almost all areas of development compared with the healthy 1 year olds. At 3 years of age, although there was a higher prevalence of behavior problems in the surgical and medical groups, the cognitive functioning of medical group children was very similar to the control children, whereas the com- posite IQ scores of those in the surgical group were significantly behind the medical and control groups. The area of cognition most affected was language develop- ment. Within the surgical group, language skills were less well developed in infants who had repeated opera- tive procedures or persisting medical problems. Because it is known that impaired language development and behavior problems in early childhood are associated with difficulties in academic studies in later childhood, the surgical group children appeared to be at risk for later academic difficulties. The first purpose of the current follow-up study was to extend our findings from the earlier study by examining the academic performance in early adolescence of the surgical group and compare their level of functioning with the 2 comparison groups, all now aged between 11 and 13 years; the second was to determine which neo- natal risk factors predict later academic performance. MATERIALS AND METHODS Subjects The sample comprises of a cohort of children who took part in a 3-year prospective longitudinal study that began in 1983. We have previously reported on the cognitive development of this sample over From the Institute of Child Health, London, England. This research was funded in part by a grant from Children Nation- wide Medical Research Fund, UK. Address reprint requests to Lorraine Ludman, PhD, Institute of Child Health, 30 Guilford St, London WC1N 1EH, England. Copyright © 2001 by W.B. Saunders Company 0022-3468/01/3606-0007$35.00/0 doi:10.1053/jpsu.2001.23954 858 Journal of Pediatric Surgery, Vol 36, No 6 (June), 2001: pp 858-862