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Newborns weighing 2.2 pounds or less have long-term behavior problems related mostly to social and attention deficits

Extremely low birthweight (ELBW) babies, who weigh about 2.2 pounds or less at birth, often suffer from major disabilities such as cerebral palsy, mental retardation, blindness, and deafness. A new four-country study of ELBW babies shows that 8 to 10 years later, these children suffer from behavioral difficulties as well. They tend to have trouble making friends, be immature, repeat acts, be impulsive, and have trouble with concentration.

In spite of cultural differences, ELBW children in the Netherlands, Germany, Canada, and the United States had very similar difficulties in thought, social interactions, and attention compared with normal birthweight (NBW) babies or national norms. This suggests that biological mechanisms contribute to the behavior problems of ELBW children. They should be monitored for the development of these behavior problems in order to prevent subsequent learning difficulties and improve social integration, concludes Elysee T.M. Hille, Ph.D., of TNO Prevention and Health, the Netherlands.

In a study supported by the Agency for Healthcare Research and Quality (HS08385), Dr. Hille and her European and North American colleagues examined results of the Child Behavior Checklist (CBCL) completed by parents or guardians of 78 to 150 ELBW children in each of the four countries. The children were 8 to 10 years of age at the time of the study. The "total problem score" resulting from the CBCL comprises eight behavior scales divided into three bands: aggressive and delinquent behavior (externalizing score); anxious, somatic, and withdrawn behavior (internalizing score); and social, thought, and attention problems.

ELBW children in each country had significantly higher scores only for social, thought, and attention problems, which were from 0.5 to 1.2 standard deviations higher in ELBW than NBW children or national norms. ELBW children were no more likely than other children to be withdrawn, anxious, depressed, aggressive, or delinquent (steal or swear). Central nervous system insult due to prenatal or neonatal complications can explain some of the behavior problems, notes Dr. Hille. Another possible mechanism for the social difficulties might be differences in parental behavior as a result of life-threatening events in the perinatal period. Also, problems with social relationships have been found to be more frequent in ELBW children, whose poor processing of multiple cognitive stimuli may produce problems in social situations that demand processing of several cues at the same time.

For more information, see "Behavioural problems in children who weigh 1,000 grams or less at birth in four countries," by Dr. Hille, A. Lya den Ouden, M.D., Saroj Saigal, M.D., and others, in the May 26, 2001, Lancet 357, pp. 1641-1643.

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