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

Maureen Kessenich, MA

Disclosures

NAINR. 2003;3(3) 

In This Article

Rates of Developmental Handicap

Studies have demonstrated higher rates of both major developmental handicaps such as cerebral palsy, mental retardation, blindness, and deafness, and less severe developmental handicaps such as learning disabilities and attention deficits, in children born preterm and/or with low birth weights. These disabilities are believed to be the result of early brain injury associated with medical conditions such as poor oxygen intake (ie, hypoxia, apnea, chronic lung disease), intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), seizures, and sepsis, as well as physiological stress resulting from overstimulation and painful procedures in the nonuterine environment.[4,5,6,7,8,9] It is also posited that premature exposure to the extrauterine environment may negatively affect the proliferation, organization, and selective paring of neurons in the preterm infant's maturing brain[8,10,11] as well as regional brain volumes.[7]

For ELBW children (birth weight < 1,000 grams), studies have indicated rates of developmental disability ranging anywhere from 20% to 65%, depending on whether the definition of disability refers only to severe disabilities (ie, cerebral palsy, mental retardation, blindness, deafness, hydrocephalus, seizures) or includes mild to moderate disabilities as well (ie, developmental delay, learning disability, attention deficits). According to recent studies, approximately 10% to 15% of VLBW (birth weight between 1,001 and 1,500 grams) and 20% to 25% of ELBW children develop severe disabilities. More specifically, about 14% of VLBW children and 19% of ELBW children exhibit intelligence quotient (IQs) below the average range (<85), and anywhere from 8% to 32% of VLBW and ELBW children develop cerebral palsy.[12,13,14,15] Developmental disability rates vary across different time frames, hospitals, and sociodemographic populations.

When taking into account more moderate disabilities, studies have noted that 34% to 65% of children born with ELBW demonstrate learning disabilities and/or require special education services once they reach school age.[16,17,18,19] The majority of outcome studies comparing preterm, low birth weight children with those born full term demonstrate significantly higher rates of milder disabilities such as learning deficits, as well as more severe disabilities such as cerebral palsy and mental retardation. Significantly higher rates of enrollment in early intervention or special education classes are also documented in premature, low birth weight children throughout early childhood and the school-age years.[17,18,19,20,21,22,23]

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