School Difficulties at Adolescence in a Regional Cohort of Children Who Were Extremely Low Birth Weight
Saroj Saigal, MD*,Lorraine A. Hoult, BA*,David L. Streiner, PhD,Barbara L. Stoskopf, RN, MHSc*, andPeter L. Rosenbaum, MD*
From the * Department of Pediatrics, McMaster University, Children's Hospital at Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada; and the Department of Psychiatry, University of Toronto, Toronto, Canada.
Objectives. To compare measures of psychometric assessment and school difficulties in a cohort of extremely low birth weight (ELBW) teenagers and term controls, and to determine whether there is stability in psychometric measures between age 8 and the teen years.
Study Design. Longitudinal follow-up; geographically defined region. Participants: 150 of 169 (89%) ELBW survivors born between 1977 and 1982 and 124 of 145 (86%) sociodemographically matched term controls between 12 and 16 years of age. Psychometric measures: Wechsler Intelligence Scale for Children-Revised, Wide Range Achievement Test-Revised, and a validated parent questionnaire.
Results. Neurosensory impairments were present in 28% of ELBW and 1% of controls. The mean Wechsler Intelligence Scale for Children-Revised scores were ELBW: 89 ± 19 and controls: 102 ± 13. ELBW children did less well on Wide Range Achievement Test-Revised Reading, Spelling, and Arithmetic measures with mean scores in the range from 75 to 85. ELBW children with those 750 g. A significantly higher proportion of ELBW children were receiving special educational assistance and/or had repeated a grade (ELBW: 58%; controls: 13%; odds ratio: 9.0). Paired analysis of within-cohort data at age 8 and teen years showed that for both cohorts Arithmetic scores declined, but there were small improvements in other measures, predominantly in the term children.
Conclusions. Differences of 13 to 18 points in psychometric measures in ELBW teens compared with controls are both statistically significant and clinically relevant. Decreasing birth weight was associated with increased risk on all measures. The high utilization of special educational resources has economic implications, and the incremental cost attributable to being extremely premature needs to be determined. Key words: extremely low birth weight, follow-up, adolescence.
PEDIATRICS Vol. 105 No. 2 February 2000, pp. 325-331. © 2000 American Academy of Pediatrics.
The sequelae of very low birth weight (VLBW) births seem to be lifelong. First, VLBW is a major contributor of neonatal and infant mortality and childhood neurodevelopmental morbidity.1,2 Second, VLBW infants experience significant general health problems, recurrent infections and hospitalizations, and poor physical growth compared with their peers.3-6 Third, behavioral and attentional disorders have been reported more frequently in VLBW children.7-9 Fourth, a review of the recent literature suggests that VLBW children are more likely to experience difficulties at school in mid-childhood and a high proportion require special educational assistance.10-29 However, there are limited studies from the recent era on follow-up of preterm children to adolescence30-34 and none for infants who were the available studies suffer from 1 or more methodological problems, such as small sample size, high attrition rates, lack of a suitable comparison group, and single hospital or tertiary care center births.35 Thus, it is difficult to obtain a true picture of the outcome of the survivors.
We have previously reported on the school-age outcome of a regional cohort of extremely low birth weight (ELBW) children, compared with term controls at 8 years of age.11 The focus of this article is to describe and compare the academic abilities, school performance, and utilization of special educational resources in the above cohort of ELBW infants who are now teenagers in comparison to same age term peers, and to determine whether there is stability in the academic measures between age 8 and the teen years.