The study team, led by Maureen Hack, MD, neonatalogist and medical director of the high-risk followup clinic of the neonatal unit at Rainbow Babies & Children’s Hospital, followed 242 babies born weighing between two and three pounds, between 1977 and 1979. They assessed the level of education, cognitive and academic achievement, rates of chronic illness and risk-taking behavior at 20 years of age.
The young adults who had very-low-birth-weight were more likely to have one or more chronic health problems, especially neurosensory conditions (cerebral palsy, blindness, or deafness), and shorter height than normal weight babies. They also had lower IQs and lower scores on academic achievement tests, and were less likely to have graduated from high school or have enrolled in a four-year college. However, 51% have IQ scores within the normal range; 74% have completed high school; and 41% are pursuing postsecondary education.
The most promising and surprising aspect of the findings is that these young adults were less likely to engage in risk-taking behavior, to use alcohol or illicit drugs, or to engage in sexual activities or become pregnant. “We believe that this limited risk-taking behavior may result from increased parental monitoring of very-low-birth-weight children,” says Dr. Hack, professor of pediatrics at CWRU.
“What is unexpected is their relative success despite such difficulties. These are children who face substantial challenges, beginning very early in their schooling, because of cognitive and behavioral problems,” comments Marie McCormick, MD, ScD, of Harvard School of Public Health and Douglas Richardson, MD, MBA, of Beth Israel Deaconess Medical Center, in an accompanying editorial. “The fact that they are almost as successful as the members of the normal-birth-weight comparison group in completing school and at least as successful in avoiding risk-taking behavior speaks to a resilience in these young persons and their families that needs to be examined further.”
Researchers believe that the findings of this pioneering study are applicable to babies born today with similar birth weight, because rates of neurodevelopmental complications have not changed substantially for this birth-weight group since the 1970s. The study, partly funded by the National Institutes of Health and the Genentech Foundation for Growth and Development, included researchers from The Research Institute of University Hospitals of Cleveland, Cleveland State University and Kent State University.
Journal
New England Journal of Medicine