Low-birth-weight infants: can we enhance their development?

Article Abstract:

Dramatic improvements in neonatology, the medical care given to newborn infants, have led to the survival of increasingly smaller and sicker premature infants. Now that these babies are surviving, it is necessary to evaluate and treat the developmental disabilities that in many cases follow from their status as low-birth-weight infants. A landmark study on this topic is reported in the June 13, 1990 issue of The Journal of the American Medical Association. The study, conducted by the Infant Health and Development Program at Stanford University, compared a comprehensive intervention for preventing developmental delays and health problems with a standard protocol of pediatric care. One third of the 985 premature, low-birth-weight infants received the intervention. This included home visits during the first year of life, and from age one to three years, attendance at a child development center, more home visits, and group meetings for parents. The number of families that completed the three-year program was extraordinarily high (93 percent) for both control and intervention groups, suggesting that careful attention was paid to all subjects by the researchers. At age three, children in the intervention group had significantly higher IQ scores, and the rate of mental retardation was 2.7 times higher in the control group than the intervention group. Behavioral problems were less frequent in the intervention group as well. Therefore, this comprehensive enrichment program significantly enhanced the mental and behavioral functioning of a large group of premature, low-birth-weight children. The public policy implications include the suggestion that early intervention may prevent the need to spend money later for special education, if these children are better prepared to function in school. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Enhancing the outcomes of low-birth-weight, premature infants: a multisite, randomized trial

Article Abstract:

Improved medical care in the past decade has enabled the survival of more low-birth-weight (LBW) premature infants. These babies have been found to be at increased risk for developmental delays and various medical problems, as compared with infants born at a normal weight. Specifically, many LBW children score lower on tests of cognitive (mental) function, and even those who achieve normal scores tend to have difficulty learning, do poorly in academic tasks, and have behavioral problems. These deficits are more common among the very smallest babies, but do occur at above-average rates in LBW infants born at all weights below 2,500 grams (5.5 pounds). Many LBW infants are born into families that are socioeconomically disadvantaged, which puts them at even greater risk for developmental and learning problems. A study was performed to test a program of comprehensive early intervention designed to prevent developmental and health problems in LBW premature children. The Infant Health and Development Program was conducted at eight sites with 985 infants, who either received standard pediatric follow-up (control group) or pediatric follow-up in conjunction with an educational program to enhance child development and family support (intervention group). At the age of three years, the intervention group children had a significantly higher average IQ; scores were 13.2 points higher than controls for babies born weighing 2,001 to 2,500 grams, and 6.6 points higher for babies weighing 2,000 grams or under. The intervention children also exhibited significantly fewer behavior problems and a small but significant increase in minor illnesses (lower birth weight group only). The groups did not differ in terms of incidence of serious medical conditions. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Early discharge and evidence-based practice: good science and good judgment

Article Abstract:

Early discharge after childbirth illustrates the dilemma faced by third party payers when there is not enough evidence to support a particular treatment plan. Two 1997 studies present conflicting evidence on whether early discharge raises the risk of re-admission at a later date. One study denied any risk but it was too small to detect such a risk. The larger study found that there was a risk. Studies to confirm this risk would have to enroll at least 28,000 mother-infant pairs and it is questionable whether such a study would be ethical. Good judgment may play a major role in deciding how long to keep mother and baby in the hospital.

Management, Hospitals, Childbirth, Delivery (Childbirth), Hospital admission and discharge

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