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Extremely premature (< or = 800 g) schoolchildren: multiple areas of hidden disability
M F Whitfield1, R V Grunau, L Holsti
1Department of Paediatrics, University of British Columbia, Vancouver, Canada. mwhitfield@wopg.childhosp.bc.ca
Insights
Extremely low birthweight (ELBW) children often face learning disorders and behavioral issues at school age. These ELBW survivors show poorer performance in cognitive and motor skills compared to full-term peers.
Area of Science:
- Neonatal care and developmental pediatrics
- Child psychology and developmental neuroscience
- Public health and epidemiology
Background:
- Extremely low birthweight (ELBW) infants (< or = 800 g) represent a vulnerable population with potential long-term developmental challenges.
- Understanding the functional abilities of ELBW survivors at school age is crucial for targeted interventions and support.
- Previous research indicates a higher risk of disabilities in ELBW children, but comprehensive school-age assessments are needed.
Purpose of the Study:
- To compare the functional abilities of extremely low birthweight (ELBW) children with those of full-term children at school age.
- To identify specific areas of cognitive, behavioral, and motor deficits in ELBW survivors.
- To determine the prevalence of learning disorders and borderline intellectual functioning in ELBW children.
Main Methods:
- A cohort of 115 ELBW children born between 1974 and mid-1985 was compared with 50 full-term children.
- Children were assessed using a system derived from the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM IV) for disability categorization.
- Psycho-educational, behavioral, and motor assessments were conducted on ELBW children without severe/multiple neurosensory disabilities.
Main Results:
- 14% of ELBW children had severe/multiple neurosensory disabilities, and 13% had borderline intelligence.
- ELBW children with IQ > or = 85 scored significantly lower in standardized tests of fine and gross motor control, visuo-motor skills, visual memory, and academic achievement.
- Learning disorders were three times more common in ELBW survivors (47% vs 18%), with many experiencing multiple difficulties. 26% of ELBW children were not disabled compared to 82% of term children.
Conclusions:
- The most probable outcome for ELBW survivors is a learning disorder, often multiple, or borderline intellectual functioning, alongside behavioral and motor challenges.
- Psycho-educational testing revealed poorer performance in ELBW children, but mean scores understated the complex individual educational difficulties.
- Early identification and intervention are critical for supporting the developmental trajectories of ELBW survivors.
Aim:
To examine the functional abilities of extremely low birthweight (ELBW, < or = 800 g) children at school age compared with full term children.
Methods:
ELBW children (n = 115) in a geographically defined regional cohort born between 1974 and mid-1985 (comprising 96% of 120 survivors of 400 ELBW infants admitted to the Provincial Tertiary neonatal intensive care unit), were compared with (n = 50) children of comparable age and sociodemographic status. Each child was categorised by the pattern and degree of disability, using a system derived from the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM IV). Psycho-educational, behavioural, and motor results for ELBW children free of severe/multiple neurosensory disabilities (n = 90; 91% return rate) were compared with the term children.
Results:
Severe/multiple neurosensory disabilities were present in 16 ELBW children (14%), and 15 (13%) had borderline intelligence. ELBW children of global IQ > or = 85 scored significantly lower in standardised tests of fine and gross motor control, visuo-motor pencil output, visual memory, and academic achievement (reading, arithmetic, written language). ELBW survivors were three times more likely to have learning disorders (47% vs 18%) and 22 (41%) of the 54 ELBW children with learning disorders had multiple areas of learning difficulty. Of the ELBW group, 30 (26%) were not disabled compared with 41 (82%) of the term group. Only five (12%) of the ELBW boys were not disabled, compared with 25 (35%) of the ELBW girls. Finally, ELBW children had significantly worse scores on ratings of behaviour during testing by the psychologist and behaviour by parental report.
Conclusion:
The most likely outcome for ELBW survivors at school age is a learning disorder, often multiple, or borderline intellectual functioning, combined with behavioural and motor risk factors rather than severe/multiple disability. Mean scores on psycho-educational testing showed poorer performance of the ELBW children, but grossly understated the complex nature of the individual degree of educational difficulty faced by these children.