Skip to main content
PMC home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1997 Sep;77(2):F85–F90. doi: 10.1136/fn.77.2.f85

Extremely premature (⩽ 800 g) schoolchildren: multiple areas of hidden disability

M Whitfield, R Grunau, L Holsti
PMCID: PMC1720694  PMID: 9377151

Abstract

AIM—To examine the functional abilities of extremely low birthweight (ELBW, ⩽ 800 g) children at school age compared with full term children.
METHODS—ELBW children (n=115) in a geographically defined regional cohort born between 1974 and mid-1985 (comprising 96% of 120 survivors of 400 ELBW infants admitted to the Provincial Tertiary neonatal intensive care unit), were compared with (n = 50) children of comparable age and sociodemographic status. Each child was categorised by the pattern and degree of disability, using a system derived from the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM IV). Psycho-educational, behavioural, and motor results for ELBW children free of severe/multiple neurosensory disabilities (n=90; 91% return rate) were compared with the term children.
RESULTS—Severe/multiple neurosensory disabilities were present in 16 ELBW children (14%), and 15 (13%) had borderline intelligence. ELBW children of global IQ ⩾ 85 scored significantly lower in standardised tests of fine and gross motor control, visuo-motor pencil output, visual memory, and academic achievement (reading, arithmetic, written language). ELBW survivors were three times more likely to have learning disorders (47% vs 18%) and 22 (41%) of the 54 ELBW children with learning disorders had multiple areas of learning difficulty. Of the ELBW group, 30 (26%) were not disabled compared with 41 (82%) of the term group. Only five (12%) of the ELBW boys were not disabled, compared with 25 (35%) of the ELBW girls. Finally, ELBW children had significantly worse scores on ratings of behaviour during testing by the psychologist and behaviour by parental report.
CONCLUSION—The most likely outcome for ELBW survivors at school age is a learning disorder, often multiple, or borderline intellectual functioning, combined with behavioural and motor risk factors rather than severe/multiple disability. Mean scores on psycho-educational testing showed poorer performance of the ELBW children, but grossly understated the complex nature of the individual degree of educational difficulty faced by these children.

 Keywords: extremely low birthweight; psychology; disability; motor skills; learning disorder

Full Text

The Full Text of this article is available as a PDF (117.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Eight-year outcome in infants with birth weight of 500 to 999 grams: continuing regional study of 1979 and 1980 births. Victorian Infant Collaborative Study Group. J Pediatr. 1991 May;118(5):761–767. doi: 10.1016/s0022-3476(05)80044-7. [DOI] [PubMed] [Google Scholar]
  2. Grunau R. V., Kearney S. M., Whitfield M. F. Language development at 3 years in pre-term children of birth weight below 1000 g. Br J Disord Commun. 1990 Aug;25(2):173–182. doi: 10.3109/13682829009011972. [DOI] [PubMed] [Google Scholar]
  3. Hack M., Taylor H. G., Klein N., Eiben R., Schatschneider C., Mercuri-Minich N. School-age outcomes in children with birth weights under 750 g. N Engl J Med. 1994 Sep 22;331(12):753–759. doi: 10.1056/NEJM199409223311201. [DOI] [PubMed] [Google Scholar]
  4. Hall A., McLeod A., Counsell C., Thomson L., Mutch L. School attainment, cognitive ability and motor function in a total Scottish very-low-birthweight population at eight years: a controlled study. Dev Med Child Neurol. 1995 Dec;37(12):1037–1050. doi: 10.1111/j.1469-8749.1995.tb11965.x. [DOI] [PubMed] [Google Scholar]
  5. Klebanov P. K., Brooks-Gunn J., McCormick M. C. Classroom behavior of very low birth weight elementary school children. Pediatrics. 1994 Nov;94(5):700–708. [PubMed] [Google Scholar]
  6. Klebanov P. K., Brooks-Gunn J., McCormick M. C. School achievement and failure in very low birth weight children. J Dev Behav Pediatr. 1994 Aug;15(4):248–256. [PubMed] [Google Scholar]
  7. Saigal S., Szatmari P., Rosenbaum P., Campbell D., King S. Cognitive abilities and school performance of extremely low birth weight children and matched term control children at age 8 years: a regional study. J Pediatr. 1991 May;118(5):751–760. doi: 10.1016/s0022-3476(05)80043-5. [DOI] [PubMed] [Google Scholar]
  8. Stevenson R. C., McCabe C. J., Pharoah P. O., Cooke R. W. Cost of care for a geographically determined population of low birthweight infants to age 8-9 years. I. Children without disability. Arch Dis Child Fetal Neonatal Ed. 1996 Mar;74(2):F114–F117. doi: 10.1136/fn.74.2.f114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Stevenson R. C., Pharoah P. O., Stevenson C. J., McCabe C. J., Cooke R. W. Cost of care for a geographically determined population of low birthweight infants to age 8-9 years. II. Children with disability. Arch Dis Child Fetal Neonatal Ed. 1996 Mar;74(2):F118–F121. doi: 10.1136/fn.74.2.f118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Taylor H. G., Hack M., Klein N., Schatschneider C. Achievement in children with birth weights less than 750 grams with normal cognitive abilities: evidence for specific learning disabilities. J Pediatr Psychol. 1995 Dec;20(6):703–719. doi: 10.1093/jpepsy/20.6.703. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES