- The Washington Times - Tuesday, July 19, 2005

Babies who weigh only a pound or two at birth are far more likely to experience long-term health problems, functional deficits and intellectual limitations than those of normal birth weights, a new study says.

“The majority of babies born with extremely low birth weights do have major problems” that linger, Dr. Maureen Hack, professor of pediatrics at Rainbow Babies & Children’s Hospital in Cleveland, told The Washington Times.

Dr. Hack is the lead author of a report in yesterday’s issue of the Journal of the American Medical Association (JAMA) that compares the health outcomes at age 8 of 219 children with extremely-low birth weight (ELBW) born from 1992 to 1995 with 176 children born in that period who were of normal birth weight (NBW).

“Adjusting for sociodemographic status and sex, ELBW children had significantly more chronic conditions than NBW controls, including functional limitations (64 vs. 20 percent, respectively); compensatory dependency needs (48 percent vs. 23 percent); and services above those routinely required by children (66 vs. 27 percent),” the authors write.

An ELBW baby is one born after 22 to 23 weeks of gestation. Seventy percent of such ELBW infants survive today, she said, because of sophisticated neonatal technology. But she acknowledged that questions remain as to whether “extremely premature babies” are viable and should be resuscitated, given the tremendous costs for their care.

The researchers say “differences remained significant” even when 36 ELBW children with neurosensory impairments were excluded from the analysis.

According to the study:

• 14 percent of ELBW children have cerebral palsy; there were no such cases among NBW children.

• 21 percent of ELBWs have asthma; 9 percent of NBWs have the chronic disorder.

• 10 percent of ELBWs have vision less than 20/20; 3 percent of NBWs have poorer vision.

• 85 percent of ELBWs have a low intelligence quotient; 14 percent of NBWs have lower IQs than their peers.

• 47 percent of ELBWs have poor motor skills; 10 percent of NBWs have lesser skills.

The study points out that for every 100 children in each group, 24 more children in the ELBW group had lower IQs; 34 more in that group had a chronic condition; 43 more had a functional limitation; and 38 more received special medical, educational or other services.

Even so, Dr. Hack said, she was startled by recommendations made by two physicians in an accompanying editorial that focuses on the findings by the Cleveland team that deficiencies in ELBW children continue.

Noting that the ELBW group “fared substantially worse than the NBW group in every type of assessment,” Dr. Jon Tyson of the University of Texas Health Science Center in Houston and Dr. Saroj Saigal of McMaster University in Hamilton, Ontario, said in the editorial: “To help in addressing ethical dilemmas in the care of marginally viable infants, the mortality and long-term morbidity of these infants should be related to treatment decisions to forgo or withdraw intensive care.”

Asked to comment on that observation, Dr. Hack observed: “I didn’t want to get involved in ethical issues … just because a child has learning or health problems doesn’t mean he or she shouldn’t survive.”

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