ELBW infants appear to be reaching functional outcomes as young adults similar to NBW infants

The majority of extremely low-birth-weight infants appear to be attaining similar levels of education, employment and independence as young adults, compared with normal birth-weight infants, according to a study in the February 8 issue of JAMA.

Despite the recent dramatic improvements in survival, extremely low-birth-weight (ELBW, weighing less than 2.2 lbs.) and very low-birth-weight (VLBW, weighing less than 3.3 lbs.) children and adolescents remain disadvantaged on many measures of cognition, academic achievement, behavior, and social adaptation, according to background information in the article. Survivors from the early postneonatal intensive care era have only now reached young adulthood. Although some aspects of longer-term outcomes on VLBW young adults have been reported in a few studies, details of certain functional outcomes of former ELBW infants at young adulthood are unknown.

Saroj Saigal, M.D., F.R.C.P.C., of McMaster University, Ontario, Canada and colleagues conducted a study to determine the outcomes at young adulthood of former ELBW infants followed from birth in comparison to a group of normal birth-weight (NBW) children, recruited at age 8 years. Measures of successful transition to adulthood included educational attainment, student and/or worker role, independent living, getting married, and parenthood. The study included 166 ELBW participants who weighed 1.1 to 2.2 lbs. at birth (1977-1982) and 145 sociodemographically comparable NBW participants assessed at young adulthood (22-25 years). Participants were administered questionnaires between January 1, 2002, and April 30, 2004.

The proportion of participants who graduated from high school was similar (82 percent vs. 87 percent). Overall, no statistically significant differences were observed in the education achieved to date. A substantial proportion of both groups were still pursuing postsecondary education (32 percent vs. 33 percent). No significant differences were observed in employment/school status; 48 percent ELBW vs. 57 percent NBW young adults were permanently employed. No significant differences were found in the proportion living independently, married/cohabiting, or who were parents. The age of attainment of the above markers was similar for both groups. These findings hold even though participants with disabilities (27 percent ELBW vs. 2 percent NBW) were included.

"Against our expectations and many odds, a significant majority of ELBW young adults have overcome earlier difficulties to become functional members of society. It is not clear what factors contributed to the positive outcome beyond adolescence, as all through childhood the ELBW cohort was significantly compromised in comparison with their peers," the authors write. "Our study should provide hope to parents for an equivalent, if not a better, future for their premature children in the longer term. Ongoing studies from research centers with established cohorts from the recent era are warranted."

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(JAMA. 2006;295:667-675. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: This study was supported by grants from the Canadian Institutes of Health Research and from the National Institute of Child Health and Development.

Editorial: Young Adult Attainments of Preterm Infants

In an accompanying editorial, Maureen Hack, M.B., Ch.B., and Nancy Klein, Ph.D., of Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, discuss the findings of the study on young adult outcomes of ELBW infants.

"The extent to which the outcomes of ELBW children who survived during the initial years of neonatal intensive care in the late 1970s and early 1980s can be used to counsel families of current ELBW births is questionable. Technological and therapeutic advances in neonatal intensive care that have accrued over the last 20 years have doubled the rate of survival to 70 percent to 80 percent. Although some neonatal complications are not yet preventable, new therapies may ameliorate outcomes."

"Longer-term studies are … needed to evaluate the ultimate educational and occupational achievement of Canadian and other ELBW and VLBW cohorts as they enter mature adulthood in their late 20s, and to assess their independence and adult social relationships," the authors write.

(JAMA. 2006;295:695-696. Available pre-embargo to the media at www.jamamedia.org)


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