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Extremely low-birth-weight children and their peers. A comparison of school-age outcomes
C L Halsey1, M F Collin, C L Anderson
1Loyola University Medical Center, Maywood, Ill, USA.
Insights
Extremely low-birth-weight (ELBW) children often require special educational services, with 20% experiencing significant disabilities. Even in supportive environments, half of ELBW children need educational support by age 7.
Area of Science:
- Pediatrics
- Developmental Psychology
- Educational Psychology
Background:
- Extremely low-birth-weight (ELBW) infants (<1000 g) face developmental challenges.
- Understanding long-term outcomes is crucial for early intervention and support.
Purpose of the Study:
- To assess 7-year developmental and educational outcomes in ELBW children.
- To determine the incidence of developmental disability and need for special education services in this cohort.
Main Methods:
- Observational study of 54 ELBW children and 58 matched comparison children (low birth weight and full-term).
- Utilized teacher reports on classroom placement and special education services.
- Administered cognitive, motor, language, and visual-motor integration tests.
Main Results:
- 50% of ELBW children required special educational services, compared to 30% and 7% in low-birth-weight and full-term groups, respectively.
- ELBW children scored significantly lower on all developmental tests, though often within the average range.
- 20% of ELBW children had significant disabilities (e.g., cerebral palsy, intellectual disability, autism).
Conclusions:
- A significant proportion of ELBW children, even in middle-class settings, experience developmental disabilities and require special education.
- Objective testing reveals persistent weaknesses across multiple domains in ELBW survivors compared to peers.
Objective:
To document 7-year developmental and educational outcomes in a cohort of predominantly white, middle-class, extremely low-birth-weight (ELBW, < 1000 g) children to address the incidence of increased developmental disability and the need for special educational services.
Design:
Observational study.
Patients:
Fifty-four ELBW children and 58 comparison children, who were matched for race, gender, and socio-economic status (30 with low birth weights [1500-2500 g] and 28 with birth weights > 2500 g). The ELBW cohort was drawn from 104 presurfactant survivors born between 1984 and 1986 and cared for in a single hospital.
Setting:
Suburban, university-based tertiary referral center.
Main Outcome Measures:
Teachers' reports of classroom placement and special education services and tests of cognitive, motor, language, and visual-motor integration abilities were studied.
Results:
Twenty-seven (50%) of 54 ELBW children were in regular classrooms with no special services compared with 21 (70%) of 30 in the low-birth-weight group and 27 (93%) of 28 in the full-term group, indicating a significant trend toward increasing need for special services with decreasing birth weight across the 3 groups (P < .001). The ELBW group scored significantly lower than the comparison groups on all tests, although generally within the average range. Seventy-nine percent of ELBW children had average cognitive scores, but they averaged 14 to 17 points lower than the 2 comparison groups. Twenty percent of the ELBW children had significant disabilities including cerebral palsy, mental retardation, autism, and low intelligence with severe learning problems.
Conclusions:
Even with optimal socioeconomic environments, 20% of ELBW children are significantly disabled, and 1 of every 2 ELBW children requires special educational services. Objective testing pinpointed weakness on all measures compared with matched peer groups.