Extremely low birthweight (ELBW) babies (2.2 lbs or less) have a higher prevalence of poor physical growth, ill health, and hospitalizations during mid-childhood compared with their peers. Two new studies supported by the Agency for Healthcare Research and Quality (HS08385) examined the physical growth and current health status of these infants by adolescence, as well as parents' attitudes toward saving these infants at birth. The first study shows some catch-up growth by adolescence, as well as fewer acute health problems and less use of health services. The second study reveals that most parents, compared with only a few health care professionals, believe that efforts should be made to save all ELBW infants. The studies are summarized here.
Saigal, S., Stoskopf, B.L., Streiner, D.L., and Burrows, E. (2001, August). "Physical growth and current health status of infants who were of extremely low birth weight and controls at adolescence." Pediatrics 108(2), pp. 407-415.
By adolescence, the physical growth of ELBW survivors continues to be compromised. However, there seems to be some catch-up growth, fewer acute health problems, and less use of medical services, according to this study. These adolescents were born between 1977 and 1982 to residents of central-west Ontario, Canada, and followed from birth. The researchers compared the physical growth and health status of 154 ELBW survivors between 12 and 16 years of age with 125 sociodemographically matched children (controls) recruited at 8 years of age from the same region.
As a group, ELBW adolescents were 5.8 cm (about 2¼ inches) shorter and weighed a mean of 5.8 kg (about 12¾ pounds) less than control adolescents. There was a catch-up in their growth parameters between age 8 and adolescence, with a significantly greater catch-up in weight (especially for girls) than in height. At adolescence, the mean head circumference of the ELBW group was significantly smaller than same-age controls by 1.8 cm (about ¾ of an inch). Subnormal head circumference has been reported to be associated with poor cognitive function and academic achievement.
In fact, over one-fourth (28 percent) of ELBW adolescents had neurosensory impairments compared with 2 percent of controls. ELBW survivors had a higher prevalence of visual problems (57 vs. 21 percent), seizures (7 vs. 1 percent), developmental delays (26 vs. 1 percent), learning disabilities (34 vs. 10 percent), and hyperactivity (9 vs. 2 percent). Twice as many ELBW adolescents as controls had functional limitations (81 vs. 42 percent). A third of the ELBW adolescents compared with 9 percent of controls were limited in their ability to participate in normal activities at school and elsewhere. However, only 5 percent had reduced self-care abilities. Finally, ELBW adolescents used more specialists and community resources than controls but less than when they were younger. The growth deficits reported may not apply to more recent survivors of neonatal intensive care, note the researchers.
Streiner, D.L., Saigal, S., Burrows, E., and others. (2001, July). "Attitudes of parents and health care professionals toward active treatment of extremely premature infants." Pediatrics 108(1), pp. 152-157.
Survival of ELBW infants often means significantly higher rates of neurodevelopmental problems, impaired health, recurrent hospitalizations, educational problems, and strain on the family. A new survey sheds some light on the attitudes of parents of normal-birthweight and ELBW children and doctors about the desirability of saving ELBW infants. The researchers found that most parents of term and ELBW children (nearly 64 percent) compared with only 6 percent of health professionals (HPs) believe that efforts should be made to save all LBW infants, regardless of their condition or weight at birth. Also, 83 percent of parents compared with 66 percent of HPs were against a standard policy on whether to save such infants. None of the five doctors who agreed that all infants should be saved cited the Hippocratic oath (first do no harm), and only three neonatologists and one neonatal nurse equated withholding treatment with killing.
In contrast to parents, HPs also believed that the economic costs to society should be a factor in deciding whether to save an ELBW infant. Of the doctors who disagreed that all ELBW infants should be saved, 83 percent believed that it was unethical to save infants who potentially would have severe disabilities because of the lifelong stress that this would impose on the family. Most parents and doctors agreed that parents and physicians should make the final decision about saving infants of borderline viability and that other groups, such as ethics committees or the courts, should not.
Doctors tended to be more optimistic than nurses about these babies' probability of survival and freedom from serious disabilities. As a result, they recommended to parents life-saving interventions for their children at earlier gestational ages than nurses. These findings underscore the importance of joint parent-doctor decisionmaking regarding intervention to save ELBW infants. They are based on a survey of 169 parents of ELBW children, 123 parents of term children, 98 neonatologists, and 99 neonatal nurses regarding active treatment of ELBW infants.
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