40,000 infants are born each year weighing less than 3.3 lbs (1500g); they are considered as being born at very low birth weight (VLBW). 25 years ago the VLBW infant mortality rate was 36%. Because of improvements in neonatal care, the VLBW infant mortality rate has decreased to 16%; thus, the number of VLBW infants who survive is increasing. Previous studies of children who were born at a VLBW have shown that they are at a significant risk of developing cerebral palsy and of having impaired cognitive skills and poor elementary school performance. What is the status of VLBW infants who are now 20 years of age?

A team of investigators has reported on the status of 227 children born at VLBW during the period 1977-1979, comparing them to 366 normal birth weight children (the “controls”) born in the same institution during the same period.

At 20 years of age, the VLBW individuals had significantly higher rates of neurosensory impairment and were of meaningfully shorter height. The neuosensory impairments included:

• cerebral palsy: 15 as compared to 0 in the controls.
• hydrocephalus requiring a shunt: 5 as compared to 0 in the controls.
• blindness: 4 as compared to 0 in the controls.
• deafness: 3 as compared to 1 in the controls.

In terms of general health, 33% of the VLBW group had one or more chronic health problems as compared to 21% in the control group; a significant difference.

Fewer VLBW adults had graduated from high school or received a general equivalency diploma. Fewer VLBW men were enrolled in college level programs; there were no differences in women. VLBW adults had a significantly lower IQ score than the controls and had lower scores on tests of academic achievement.

Smoking did not differ meaningfully between the groups, but the VLBW group reported significantly lower rates of alcohol and marijuana use than the controls–primarily due to their low use by women. Fewer VLBW women reported ever having intercourse, being pregnant or having a baby. There were no significant differences between the VLBW and control groups in the rates of conviction for a crime or for time in jail or a juvenile detention facility.

Comment

There is a continuing increase in both the number of VLBW infants being born alive and surviving into childhood and adult life. Important research endeavors are underway to prevent both rematurity and VLBW. Also, research is addressing how to better protect the brain of these infants to prevent developmental brain damage (neuro-protection). Until these research objectives are realized, the number of brain injured children and then adults is to continuing to increase, with the probability that the neurodevelopmental impairment and poor school achievement reported for VLBW children will persist into adulthood. However, one very important finding in this study is that increased risk-taking behavior or criminal activity is not associated with VLBW; this is probably due to the increased and targeted attention these children receive by their families.

Thus, these young people have scholastic achievement problems in high school. However, as young adults they adjust well to family and community life.

United Cerebral Palsy Research and Educational Foundation, February 2002