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Followup of low birthweight babies to adolescence reveals many have learning and behavioral problems

Adolescents who weighed only 2 pounds or less at birth (very low birthweight, VLBW) suffer from more school difficulties and behavioral problems than their normal birthweight (NBW) peers, concludes a review of studies of six cohorts of infants born in the United States, Canada, Australia, and the United Kingdom. Extremely low birthweight (ELBW) adolescents (less than 750 g or 1.6 lbs) fared the worst on all behavioral, cognitive, and achievement measures, and they performed particularly poorly in mathematics. From 15 to 20 percent of VLBW and 30 to 50 percent of ELBW adolescents were receiving remedial assistance and/or had failed a grade.

ELBW adolescents had mean IQ scores 8 to 13 points lower than NBW adolescents, and 11 to 17 percent of ELBW adolescents had IQ scores below 70 compared with 0 to 7 percent of NBW peers. ELBW children also scored lower on standardized tests; 23 percent scored lower than 70 in reading, 24 percent scored that low in spelling, and 37 percent scored that low in math, compared with 2 percent, 2 percent, and 4 percent, respectively, of NBW adolescents. The likelihood of adolescents scoring less than 85 on these subjects was 8- to 13-fold higher for those who weighed less than 1.6 pounds at birth and 4- to 6-fold higher for those whose birthweight was 1.6 to 2.2 pounds (VLBW), compared with their NBW peers.

Most investigators reported that a significant proportion of VLBW children had school difficulties that required special educational assistance and/or grade repetition, according to Saroj Saigal, M.D., F.R.C.P., of McMaster University. Dr. Saigal's work was supported in part by the Agency for Healthcare Research and Quality (HS08385).

Parents in one study reported that 64 percent of ELBW children were in regular classrooms, 46 percent were receiving remedial assistance, and 21 percent had repeated a grade. Learning disabilities ranked among the most common problems among school-aged VLBW children. Apparently, earlier deficits do not resolve with time. In fact, in some areas, such as math, the problems became more apparent as the complexity of the tasks increased with age. Several studies also suggested that VLBW adolescents were at risk for a wide array of emotional and behavioral disorders, particularly attention deficit hyperactivity disorder (ADHD). A recent study suggests that atrophy of the corpus callosum part of the brain may account for the poor school performance of VLBW survivors, notes Dr. Saigal.

More details are in "Follow-up of very low birthweight babies to adolescence," by Dr. Saigal, in Seminars on Neonatology 5, pp. 107-118, 2000.

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