Study Examines Incidence of Disability After Extremely Preterm Birth

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Severe disability is common among children born extremely preterm and remains a major challenge in this group of children, concludes a study published in this week's New England Journal of Medicine. Researchers evaluated children born at 25 or fewer weeks of gestation in the United Kingdom and Ireland from March through December 1995, at a median age of 30 months. They found that disability "in the domain of mental and psychomotor development, neuromotor function, or sensory and communication function was present in about half of all survivors at 30 months of corrected age, with approximately one quarter meeting the criteria for severe disability."

Of the 283 children assessed, 138 had disability, including 64 who met the criteria for severe disability. In addition

• 53 had severely delayed development;
• 28 had severe disabilities of neuromotor function, and 39 had other neuromotor disabilities; and
• 7 were blind or perceived light only, and 8 had hearing loss that was uncorrectable or required hearing aids.

The authors state that "the comprehensive nature of our study allowed us to provide outcome data for virtually all live births at 25 completed weeks or less of gestation in a whole population. This information is important for obstetricians, midwives, and pediatricians to use in discussions with parents."

An accompanying editorial points out that the study suggests two goals for future research and public policy: 1) "In order to reduce the frequency of extremely premature birth, prevention strategies must be based on fundamental investigation of the genetic, infectious, nutritional, and environmental causes of premature delivery and must be translated into clinical practice." 2) "Public policy should emphasize increasing families' access to individualized information on risk, rather than the promulgation of a single policy by courts or insurance companies to fit all situations."

Wood NS, et al. 2000. Neurologic and developmental disability after extremely preterm birth. The New England Journal of Medicine 343(6):378-384.

Cole S. 2000. Extremely preterm birth--Defining the limits of hope. Editorial. The New England Journal of Medicine 343(6):429-43

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MCH Alert. 2001. Arlington, VA: National Center for Education in Maternal and Child Health. http://www.ncemch.org/alert.