Poor academic outcomes in infants with bronchopulmonary dysplasia: A population-linked data analysis of 1.83 million births

Introduction/Aim: The incidence of bronchopulmonary dysplasia (BPD) continues to rise despite advances in newborn care. Children with BPD are at increased risk of neurodevelopmental impairment in early life, but data on academic performance are limited. This study aimed to evaluate long-term educational outcomes in children with BPD.

Method: We conducted a population-based retrospective cohort study using linked data from New South Wales, Australia: the Perinatal Data Collection (birth data), Admitted Patient Data Collection (hospital diagnoses), and the National Assessment Program—Literacy and Numeracy (NAPLAN), a curriculum-based test administered to all children in grades 3, 5, 7, and 9 (ages 8–14 years). Infants born <32 weeks’ gestation between 2001 and 2020 with at least one NAPLAN assessment (2008–2021) were included. Outcomes were mean NAPLAN scores and proportions scoring below the National Minimum Standard (NMS), stratified by gestational age, year level, and domain.

Results: Of 1,834,779 births, we included all preterm children with BPD (n = 1,293) and all preterm controls without BPD (n = 8356). BPD infants consistently demonstrated poorer academic performance than their matched counterparts across all schooling years (mean NAPLAN scores 425.7 vs 454.7; p < 0.05), with larger deficits observed at lower gestational ages. These differences translated into substantially more BPD infants scoring below the NMS from Year 3 (24.5% vs 16.5%) to Year 9 (39.8% vs 28.2%), reflecting a persistently higher risk of failing to meet expected minimum achievement levels (Year 3 RR 1.42, 95% CI 1.18–1.71; Year 9 RR 1.35, 95% CI 1.06–1.73). Predictors of poor performance included remoteness (RR 1.7, 95% CI 1.24, 2.44), Indigenous status (RR 2.76, 95% CI 2.2, 3.47), maternal smoking (RR 2.03, 95% CI 1.66, 2.47), and having older siblings (RR 2.13, 95% CI 1.71,2.66).

Conclusion: BPD is associated with persistent academic under-achievement across all domains and year levels. These findings support early educational and developmental interventions to mitigate long-term disadvantage.