Tiny Babies Suffer Despite Medical Advances

Almost half show developmental damage at age 8, study says

By Ed Edelson
HealthDay Reporter

TUESDAY, June 24 (HealthDayNews) -- While medical advances in recent years have increased the survival of babies who are at high risk because of extremely low birth weight or very premature delivery, those newborns still have a disturbingly high rate of problems, an Australian study finds.

Those problems include low IQ, lower than normal ability to read and do arithmetic, difficulty in focusing attention, and behavioral abnormalities, says a report in the June 25 issue of the Journal of the American Medical Association.

"The extent of damage is pretty similar to what we saw two decades ago," says Peter Anderson, a research fellow at the Murdoch Childrens Research Institute in Melbourne and a member of the team that did the study.

The study included every baby born in 1991 and 1992 in Victoria, the largest of Australia's six states, who had a birth weight lower than 1,000 grams (2.2 pounds) or were born before the 26th week of gestation.

The initial toll was high. Of 568 babies who met those criteria, 298 survived their first two years of life -- a mortality rate just under 50 percent. Those survivors were the subject of the study, which compared them to 262 full-term children of normal birth weight.

"More than 55 percent of them had at least one clinically important impairment," Anderson says of the very low birth weight/premature children.

Their average IQ was 95.5, compared to 104.9 for the full-term children. There was a difference of 6.8 points in verbal reasoning, 9.9 points in visual-spatial reasoning, 8.2 points in attention and working memory, and 6.7 points in processing speed.

There was also a significantly higher incidence of hyperactivity, attention difficulties, adaptive skills, and other behavioral problems in the low birth weight/very premature children.

The study is valuable because it includes a large number of children from a large geographic area, Anderson says. "Most other studies have included fewer children, so their results may not be representative of the general population," he says.

And what is true in Australia is almost certainly true for the United States and other developed countries, he adds.

"Prematurity is a big problem in the United States," says Dr. Nancy Green, medical director of the March of Dimes Birth Defects Foundation. The foundation has a ongoing program to reduce its incidence and warn parents of its dangers.

"As survival rates have increased, there has been a question about whether their long-term outcome improved," Green says. "The answer is that even at age 8, over half the children born very early and very small still have problems. How this translates into what they need in terms of neurological, psychological, and behavioral care is not addressed in this paper."

A message of the paper is that close attention should be paid to these children, Anderson says.

"These children should have ongoing follow-up and treatment quickly, to minimize the impact of their impairments," he says. "Otherwise they fall through the gap."

More information

To learn about premature birth and its prevention, consult Neonatology on the Web or the March of Dimes Birth Defects Foundation.