Developmental Outcomes of Premature, Low Birth Weight, and Medically Fragile Infants

Maureen Kessenich, MA


NAINR. 2003;3(3) 

In This Article

Abstract and Introduction

Technological advances and improved newborn and infant care have resulted in better survival rates of newborn intensive care graduates. This change in health status does come with a price—long-term consequences after discharge home. As newborn and infant nurses, we need to be more aware of the possible developmental outcomes of premature, low birth weight, and medically fragile infants. This article presents a review of literature on these outcomes with special emphasis in the areas of cognition and learning.

Each year, hundreds of thousands of medically fragile infants spend their first few weeks or months of life in the neonatal intensive care unit (NICU) because of problems such as hypoxia, respiratory disorders, cardiovascular disorders, congenital infection, intrauterine drug exposure, brain injury, and prematurity, with premature infants comprising the majority of NICU patients. Twelve percent of babies in the United States are born prematurely, and many of these preterm infants present with dangerously low birth weights. Since the early 1980s, the rate of prematurity has risen by 17%, and the rate of low birth weight has increased by 10%.[1] Furthermore, the introduction of surfactant and other medical and technological advances in neonatal care has led to a significant improvement in neonatal mortality rates for the smallest of infants, with survival rates of more than 90% for very low birth weight infants (VLBW) weighing 1,001 to 1,500 grams, 80% for extremely low birth weight infants (ELBW) weighing 750 to 1,000 grams, and about 50% for ELBW infants weighing less than 750 grams.[2]

Research has consistently documented the greater risk of developmental disabilities as these medically fragile infants progress from infancy through adolescence. For example, brain injuries such as hypoxic ischemic encephalopathy, periventricular leukomalacia, seizures, and intraventricular hemorrhages have been associated with neuromotor and cognitive deficits. Oxygen deprivation and respiratory problems requiring oxygen supplementation, which can cause permanent injury to the brain, have also been linked to later cognitive and motor deficits. Children prenatally exposed to cocaine have been shown to exhibit poorer cognitive skills, attention, and executive functioning as well as behavior problems—although such findings have recently come under debate.[3] And preterm, low birth weight infants, who often suffer from one or more of these preceding conditions in addition to their prematurity, have also demonstrated a variety of disabilities in the areas of cognitive, academic, sensorimotor, social-emotional, and behavioral development.

In addition to the negative influences of specific medical complications on development, infants in the NICU are exposed to an environment that—while necessary to sustain life—is suboptimal in terms of supporting and nurturing normal development. Infants are subjected to an extrauterine environment fraught with loud noises, bright lights, frequent handling, and painful procedures that may adversely affect their neuropsychological development.[4,5,6,7,8,9]

The following is a review of the literature regarding the long-term developmental outcomes of NICU graduates—namely in the areas of cognition and learning, as well as social-emotional and behavioral development. While the discussion will touch on outcomes of medically fragile, full-term NICU infants at risk for later developmental disabilities, the majority of the review will examine the developmental outcomes of premature, low birth weight infants, which comprise the majority of the NICU population.


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