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Preemies' Problems Know No Borders

Low-birthweight children in different countries have similar behavioral difficulties

THURSDAY, May 24, 2001 (HealthDayNews) -- The first international study to look at the behavioral problems of low-birthweight children finds the same spectrum of difficulties from country to country.

"That was the unexpected part of the finding, that extremely low birthweight children from countries with somewhat different childbearing practices, schooling and other social practices have pretty much the same profile," says Judith F. Feldman, a research scientist at the New York State Psychiatric Institute.

Feldman was one of a group of researchers in the United States, Canada, the Netherlands and Germany who studied 408 children between the ages of 8 to 10 who had weighed no more than 2,000 grams (2.2 pounds) at birth. While such babies rarely survived in previous times, more are now being saved by advances in medical technology, says a report in the May 26 issue of The Lancet.

Parents of the children filled out a checklist containing 118 items covering such problems as socialization difficulties, anxiety or depression, attention difficulties, aggressive behavior and periodic dizziness or headaches. Their answers were compared to those given by parents of children born within the normal weight range.

The comparison showed that overall, the low-birthweight children had more difficulties on the social, thought and attention scales. But the problems did not affect all these children and generally do not call for treatment, Feldman says.

"Only a portion of them, albeit a higher portion than children of normal birthweight, do have such problems," she says. "And the kind of problems that were picked up are not what would be considered clinically treated conditions. But they may be a signal to watch for the development of more severe conditions."

It does not take skilled medical personnel to pick up a behavioral problem, she adds: "Any parent is aware if a child is not paying attention, is overactive, can't sit still."

There are several possible explanations for the problems, the researchers say. Physical damage to the central nervous system because of complications of childbirth can explain some of them, but "another possible mechanism for the social difficulties that we report might be differences in parental behavior," they write. Parents can become understandably overprotective of an infant whose life was threatened at birth, which could then hinder the child's adjustment to life.

A study that will follow the low-birthweight children for several years is continuing at the New York State Psychiatric Institute, says Dr. Agnes Whitaker, who heads the effort at the institute and is an associate professor of clinical psychiatry at the Columbia University College of Physicians and Surgeons. "We are looking at the behavioral and emotional outcomes as they move into adolescence," she says.

Results of the study should be available in three or four years and might help pinpoint the causes of the problems, Whitaker says. "We hope to shed some light on that," she says.

Attention must be paid to these children because their numbers are growing, the researchers say. "Ever-increasing numbers of extremely immature and sick babies with a high risk for cerebral problems now have a chance to survive, and could add to the total number of children with behavioral difficulties in the community."

The study adds an international perspective to U.S. studies of behavioral problems in low-birthweight children, says an American expert.

"What this study does is substantiate what we have already seen in our population in this country," says Dr. William Kanto, chairman of pediatrics at the Medical College of Georgia and a member of the American Academy of Pediatrics committee on the fetus and newborn. "It suggests that this is not a cultural issue, but a true developmental issue."

What To Do

"This is something for a parent to be aware of and keep an eye on," Kanto says. "If you have to develop an intervention, you do so."

For information on developmental problems, go to the American Psychological Association or the Developmental Disabilities Health Alliance.

Read other HealthDay articles about premature babies.

To find out what clinical trials are being done on reproductive disorders, check Veritas Medicine.

SOURCES: Interviews with Judith F. Feldman, Ph.D, research scientist, New York State Psychiatric Institute, New York; William Kanto, professor and chairman, department of pediatrics, Medical College of Georgia, Augusta; Agnes Whitaker, M.D., associate professor of clinical psychiatry, Columbia University College of Physicians and Surgeons, New York, N.Y.; May 26, 2001, The Lancet
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