Brain Bleeds, Family Circumstances and School: How Children Born Very Early Get On in the Classroom

Three studies from Australia and England (Rees et al. 2025, Haider et al. 2026, Oftedal et al. 2026) on what newborn brain injury and home life tell us about school results

Babies born very early sometimes have bleeding or other injury in the brain, and parents naturally wonder how their child will manage at school. Three recent studies from Australia and England followed thousands of these children into the classroom and found that a severe brain bleed, and separately growing up with fewer family resources, were each linked to lower school results, while mild bleeds as a group were not.

Why parents and doctors have wanted these answers

If your baby was born more than eight weeks early, you may remember a doctor explaining the results of a head ultrasound, a painless scan done through the soft spot on top of the baby's head. One common finding is a bleed into the fluid-filled spaces inside the brain, called an intraventricular hemorrhage, or IVH. Doctors grade these bleeds from 1 (small) to 4 (largest). Once the newborn period is over, the question that stays with families is a practical one: will my child be able to read, write and do maths like other children? Until recently, doctors could mostly answer with information about toddlers, not schoolchildren.

How families and doctors faced this question before

The 1-to-4 grading of brain bleeds was first described in 1978, in a study of small premature babies [1]. Much of the research since then has followed children into the toddler years. A large review combining that research showed that children who had any bleed, and especially a large one, were more likely to have developmental problems as toddlers [2]. Studies that followed children all the way into school were rare, and few of them allowed for other differences between the children [3]. For the mild grades the picture was confusing: some studies suggested small effects, and how school performance was affected remained unclear [4]. A study of extremely premature children in the Australian state of Victoria found that at age 8 mild bleeds were not linked to school skills, but larger ones were linked to some of them [5]. Researchers also knew that, as a group, children born early find reading and maths harder than children born on time [6], and a Scottish study of 407 503 schoolchildren showed that the earlier a child was born, the more likely they were to need extra help at school [7]. A Canadian study had hinted that a mother's education might soften the effects of a brain injury on a child's thinking skills [8]. What families lacked was clear evidence on school results for children with each type of brain finding, considered alongside life at home.

Three studies, three ways of looking

These three studies were published between December 2025 and July 2026 by separate research teams, and each looks at the question from a different angle.

In New South Wales, Australia, Rees and colleagues linked hospital records of babies born before 32 weeks of pregnancy between 2007 and 2013 to the national reading, writing and maths tests that Australian children take at ages 8–9, 10–11 and 12–13 [9]. They compared 85 children who had a severe bleed (grade 3 or 4), 557 who had a mild bleed (grade 1 or 2) and 2557 very premature children with no bleed, and also used results from more than 400 000 children born at full term.

In England, Haider and colleagues linked records from newborn units across the country to school records for 15 857 children born before 32 weeks between 2008 and 2012 [10]. The linking was done through a research programme called neoWONDER, which joins up newborn and later records for premature and sick babies [11]. The team looked at whether children reached the expected level in teacher assessments at age 5 (often called "school readiness"), in a reading-sounds check at age 6 and in reading, writing, maths and science at age 7. Alongside medical problems, they looked at how deprived the family's neighbourhood was and whether the child qualified for free school meals, a sign of low household income.

In Brisbane, Australia, Oftedal and colleagues followed 133 children born before 31 weeks at one hospital, the Royal Brisbane and Women's Hospital, as part of a study called PREBO-6 (Prediction of childhood Brain Outcomes in infants using neonatal MRI and concurrent clinical biomarkers) [12]. These babies had two MRI scans, detailed brain pictures taken with magnets, one around 32 weeks and one around their original due date. Each scan received a score for how many differences from typical brain appearance it showed, using an established system [13]. Parents answered questions about family structure, education and work, and about half the children (68 of 133) were classed as having more disadvantage. At age 6, psychologists who did not know the scan results tested the children's reading and maths.

What the researchers found

Severe bleeds were linked to lower school results that lasted. In New South Wales, children who had a severe bleed scored clearly lower than other very premature children at every age tested, especially in maths [9]. Even so, at age 8–9 more than half of them, 49 of 85, met the national minimum standard. Fewer did so at older ages (27 of 54 at 10–11 and 7 of 21 at 12–13), although the older groups were small. One encouraging finding stood out: every group, including children born at full term, improved at a similar pace from year to year. Children with severe bleeds did not fall further behind as they grew older, but they did not catch up either. In England, severe bleeds, a type of brain damage called cystic periventricular leukomalacia, and a build-up of fluid in the brain (hydrocephalus) were all linked to lower school readiness [10]. In Brisbane, children whose newborn MRI showed more abnormalities tended to have somewhat lower reading and maths scores [12].

Mild bleeds, as a group, were reassuring. In both large studies, children who had grade 1 or 2 bleeds did about as well as very premature children with no bleed, once other factors were taken into account [9][10]. When the Australian team looked at the grades separately, grade 1 bleeds showed no difference, while the 145 children with grade 2 bleeds scored a little lower at age 8–9. Mild bleeds are also harder to grade reliably on ultrasound [14], so this is a reason for keeping an eye on progress, not for worry.

Home and neighbourhood mattered as well. In England, more than half of very premature children (8602 children) did not reach the expected level of school readiness at age 5, compared with about 35 in every 100 children nationally [10]. At age 6, about 1 in 5 (20.7%) did not pass the reading-sounds check, compared with fewer than 1 in 10 (8.7%) of all children. Children who qualified for free school meals were more likely not to reach it, and the researchers found this link was about as strong as the link with a severe brain bleed. Among the earliest-born children, about 3 in 4 from the most deprived neighbourhoods did not reach the expected level, compared with about half from the least deprived. In Brisbane, children from families with more disadvantage scored around 8 to 11 points lower on reading and maths tests, regardless of their brain scan [12]. The Brisbane study did not find that a family's circumstances changed how much a brain injury mattered, but it was small, so this question is still open (the English study did not look at this question).

What this means for your family

These studies describe patterns in large groups and cannot predict exactly how any one child will do. Many children with severe bleeds meet national standards and keep learning at the same pace as their classmates. For children with a mild bleed, especially grade 1, the overall news is reassuring. For all very premature children, good support at home and at school matters. It can help to tell your child's teachers about their early birth: a study in England found that an online learning resource improved teachers' knowledge and confidence about premature birth [15]. In the English study, very premature children born in the summer were more likely than autumn-born children not to reach the expected level at age 5 [10]. Some families therefore consider starting school a year later; research on this is mixed [16], so it is worth discussing with your child's doctors and school. If you want to read about how the number of weeks of pregnancy relates to school results, see our related article, which looks at a study suggesting that family factors explain much of that pattern for children born from 28 weeks onward [17].

What researchers are working on next

All three studies observed children rather than testing a treatment, so they show links, not causes. Researchers now want to study larger groups to find out whether a supportive home can soften the effects of a brain injury, to use MRI rather than ultrasound in big studies, to look at grade 1 and grade 2 bleeds separately, and to test which kinds of school support help children born very early the most.

In summary

Among children born very early, a severe brain bleed was linked to lower school results that appeared early and stayed steady, while a mild bleed as a group was not, with grade 2 bleeds worth watching. Family and neighbourhood circumstances were linked to school results about as strongly. Knowing both helps doctors, families and teachers give every child the support they need.

References

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