Disadvantages associated with very-low-birthweight continue into adulthood

מתוך medicontext.co.il
NEW YORK (Reuters Health) – Educational and other disadvantages that have been linked with very-low-birthweight persist into young adulthood, researchers report in The New England Journal of Medicine for January 17.

Dr. Maureen Hack, from the Rainbow Babies and Children's Hospital of the University Hospitals of Cleveland, and colleagues collected data on 242 very-low-birthweight infants born between 1977 and 1979. The researchers compared these subjects with 233 controls who had normal birthweight.

When the subjects were in their 20s, fewer of the very-low-birthweight subjects (74%) had completed high school compared with controls (83%; p = 0.04), and significantly fewer very-low-birthweight men attended 4-year or community colleges compared with controls (30% versus 53%; p = 0.002).

Subjects in the very-low-birthweight group also had lower mean IQs than did controls (87 versus 92, respectively) and lower academic achievement scores (p < 0.001 for both), the researchers found.

Compared with controls, the very-low-birthweight subjects had higher rates of neurosensory impairments (10% versus < 1%; p < 0.001) and higher rates of subnormal height (10% versus 5%; p = 0.04). Alcohol and drug use and pregnancy rates were also lower among the very-low-birthweight subjects compared with controls, Dr. Hack's team reports.

In an accompanying editorial, Dr. Michael F. Greene, from Massachusetts General Hospital, Boston, says the bad news from this study is that very-low-birthweight infants have a higher incidence of "neurosensory deficits, a greater burden of illness, lower IQ scores, and poorer educational achievement than their peers of normal birthweight."

However, "the good news is that in the very-low-birthweight cohort, 51% have IQ scores within the normal range, 74% have completed high school, and 41% are pursuing postsecondary education…Obstetricians and pediatricians should use this information to create realistic expectations for outcomes and to plan their treatments accordingly," Dr. Greene suggests.

"Hack and her colleagues have documented that very-low-birthweight infants remain at risk for physical and developmental problems into adulthood," Dr. Marie C. McCormick, from the Harvard School of Public Health, and Dr. Douglas K. Richardson, from Beth Israel Deaconess Medical Center, both in Boston, note in a second journal editorial.

"The next step is to focus on personal and environmental factors that influence these outcomes and to identify effective interventions to aid these vulnerable children," they advise.

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