Extremely low-birth-weight problems persist into adolescence

Health problems persist into adolescence for extremely low-birth-weight (ELBW) infants, and pediatricians should employ interventions not only for neurodevelopmental disorders but also for conditions such as asthma and obesity, according to a new study.

"Our results may have relevance to current survivors. The ELBW status may be considered a marker for the risk of multiple chronic conditions that warrant closer than average health surveillance during adolescence,” said Maureen Hack, MB, ChB, of Case Western Reserve University in Cleveland, and colleagues who conducted a study to examine changes in the rates of chronic conditions of ELBW children aged between 8 and 14 years.

“In addition to therapy for neurodevelopmental disorders, ELBW children with asthma or obesity should receive interventions such as smoking prevention and exercise encouragement to reduce the consequences of these conditions and to possibly enhance their long-term adult outcomes," researchers said.

Improved perinatal care in the 1990s meant improved survival for ELBW infants, defined as weighing less than 2.2 lbs. Previous studies indicated high levels of chronic health conditions and developmental problems compared to children born at normal weight.

Noting few studies of ELBW infants who had reached adolescence, researchers said they sought to find out more about the effects, especially since the teenage years are “a time of enormous social, health, and developmental change," according to background information in the article.

Their current study, conducted from 2004 through 2009, involved 181 ELBW children from the previous study compared to 115 normal birth weight controls of similar sociodemographic status, born from 1992 through 1995.

Although overall rates of chronic conditions did not vary much in children aged 8 (75%) and 14 years (74%) within the ELBW group, the average number of chronic conditions per child decreased significantly. For example, on measures of functional limitation, rates dropped from 56% to 46%. Still, the ELBW youths remained far behind their peers.

"At age 14 years, 46% of ELBW children had functional limitations compared with 16%, including mental or emotional delay, trouble understanding simple instructions, and speaking and communicating," the investigators noted.

The rate of asthma in the ELBW children compared to children at normal weight ceased to be significant by age 14-23% versus 17%, respectively. Although the rate of obesity in ELBW children spiked from 12% at 8 years to 19% by age 14, it also was not much different from the controls.

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