Tiny Babies Have Multiple Health Problems Later

NEW YORK (Reuters Health) - School-age children who were born prematurely and very small experience a host of chronic health conditions that limit how well they can function, according to a report in this week's Journal of the American Medical Association.

Advances in newborn care in the 1990s led to dramatic increases in the survival of infants weighing less than 1000 grams at birth, according to Dr. Maureen Hack and her associates at Case Western Reserve University in Cleveland. However, information about how these children function at school age is scarce.

Hack's group surveyed parents of 219 eight-year-olds who were extremely low birth weight (ELBW) babies, and another group of parents of 176 matched children of normal weight at birth.

Thirty-six ELBW children (16 percent) had neurological impairments, including cerebral palsy, deafness, and blindness, compared with none of the normal birth weight children.

ELBW children were also significantly more likely to have asthma requiring medical therapy (21 percent versus 9 percent), and to have lower intelligence, academic achievement, motor skills, and adaptive functioning.

Overall, 64 percent of the ELBW group had at least one functional limitation, compared with 20 percent of NBW children.

Nearly half -- 48 percent -- of the ELBW group needed medication, special diets, assistive devices or personal assistance compared with 23 percent of the control group. The ELBW children also needed more special school arrangements or regular clinic visits for chronic conditions than the other children -- 65 percent versus 27 percent.

"Our findings underscore the extraordinary costs of care that will be needed to manage the medical, educational, and other service needs of the large proportion of these ELBW children who develop chronic conditions," Hack and her associates maintain.

The group's findings "suggest that the proportion of ELBW survivors with adverse outcomes has not decreased among those born most recently," Drs. Jon E. Tyson and Saroj Saigal write in a related editorial.

Furthermore, "to help in addressing ethical dilemmas in the care of marginally viable infants," advise Dr. Tyson, from Houston Medical School in Texas, and Dr. Saigal, from McMaster University in Hamilton, Ontario, Canada, "the mortality and long-term morbidity of these infants should be related to treatment decisions to forgo or withdraw intensive care."

SOURCE: Journal of the American Medical Association, July 20, 2005.