Wednesday, July 20, 2005

Extremely Low Birth Weight

From The New York Times:
Very Premature Babies Are Still at Risk, Researchers Find
By DENISE GRADY
The New York Times
Published: July 20, 2005

Children born prematurely at weights of 2.2 pounds or less during the 1990's have high rates of mental and physical disability, despite advances in treatment that doctors had hoped would improve their conditions, researchers are reporting today.

Although such infants were much more likely to survive than those born in previous decades - the survival rate was 70 percent in the 1990's, compared with 50 percent in the 1970's and 80's - they were just as likely to suffer from significant disabilities.

Asthma, cerebral palsy, vision and hearing disorders, low I.Q., poor school performance and social difficulties are among the problems described in The Journal of the American Medical Association by doctors at Rainbow Babies and Children's Hospital in Cleveland. Such disabilities were far more common in the children born prematurely than in normal-weight children from similar backgrounds. For example, 38 percent of those born prematurely had I.Q.'s below 85, as opposed to 14 percent of the normal-weight children. Among the premature, 21 percent had asthma, compared with 9 percent of those with normal weight.

"We were astonished by the high number who had at least one of those things," said Dr. Deanne Wilson-Costello, an author of the article in the journal. "The majority had some kind of special need."
[ ... Read the full article ... ]
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Here is the abstract from the JAMA paper:
 
Maureen Hack, MB, ChB; H. Gerry Taylor, PhD; Dennis Drotar, PhD; Mark Schluchter, PhD; Lydia Cartar, MA; Laura Andreias, MD; Deanne Wilson-Costello, MD; & Nancy Klein, PhD. Chronic conditions, functional limitations, and special health care needs of school-aged children born with Extremely Low-Birth-Weight in the 1990s. Journal of the American Medical Association. 2005; 294: 318-325.

Context.  Information on the school-age functioning and special health care needs of extremely low-birth-weight (ELBW, <1000 g) children is necessary to plan for medical and educational services.

Objective.  To examine neurosensory, developmental, and medical conditions together with the associated functional limitations and special health care needs of ELBW children compared with normal-birth-weight (NBW) term-born children (controls).

Design, Setting, and Participants.  A follow-up study at age 8 years of a cohort of 219 ELBW children born 1992 to 1995 (92% of survivors) and 176 NBW controls of similar sociodemographic status conducted in Cleveland, Ohio.

Main Outcome Measures.  Parent Questionnaire for Identifying Children with Chronic Conditions of 12 months or more and categorization of specific medical diagnoses and developmental disabilities based on examination of the children.

Results.  In logistic regression analyses adjusting for sociodemographic status and sex, ELBW children had significantly more chronic conditions than NBW controls, including functional limitations (64% vs 20%, respectively; odds ratio [OR], 8.1; 95% confidence interval [CI], 5.0-13.1; P<.001), compensatory dependency needs (48% vs 23%, respectively; OR, 3.0; 95% CI, 1.9-4.7; P<.001), and services above those routinely required by children (65% vs 27%, respectively; OR, 5.4; 95% CI, 3.4-8.5; P<.001). These differences remained significant when the 36 ELBW children with neurosensory impairments were excluded. Specific diagnoses and disabilities for ELBW vs NBW children included cerebral palsy (14% vs 0%, respectively; P<.001), asthma (21% vs 9%; OR, 3.0; 95% CI, 1.6-5.6; P = .001), vision of less than 20/200 (10% vs 3%; OR, 3.1; 95% CI, 1.2-7.8; P = .02), low IQ of less than 85 (38% vs 14%; OR, 4.5; 95% CI, 2.7-7.7; P<.001), limited academic skills (37% vs 15%; OR, 4.2; 95% CI, 2.5-7.3; P<.001), poor motor skills (47% vs 10%; OR, 7.8; 95% CI, 4.5-13.6; P<.001), and poor adaptive functioning (69% vs 34%; OR, 6.5; 95% CI, 4.0-10.6; P<.001).

Conclusion.  The ELBW survivors in school at age 8 years who were born in the 1990s have considerable long-term health and educational needs.
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Anthony H. Risser | | |

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