S. Saigal et al., School difficulties at adolescence in a regional cohort of children who were extremely low birth weight, PEDIATRICS, 105(2), 2000, pp. 325-331
Objectives. To compare measures of psychometric assessment and school diffi
culties in a cohort of extremely low birth weight (ELBW) teenagers and term
controls, and to determine whether there is stability in psychometric meas
ures between age 8 and the teen years.
Study Design. Longitudinal follow-up; geographically defined region. Partic
ipants: 150 of 169 (89%) ELBW survivors born between 1977 and 1982 and 124
of 145 (86%) sociodemographically matched term controls between 12 and 16 y
ears of age. Psychometric measures: Wechsler Intelligence Scale for Childre
n-Revised, Wide Range Achievement Test-Revised, and a validated parent ques
tionnaire.
Results. Neurosensory impairments were present in 28% of ELBW and 1% of con
trols. The mean Wechsler Intelligence Scale for Children-Revised scores wer
e ELBW: 89 +/- 19 and controls: 102 +/- 13. ELBW children did less well on
Wide Range Achievement Test-Revised Reading, Spelling, and Arithmetic measu
res with mean scores in the range from 75 to 85. ELBW children <750 g were
more disadvantaged, compared with those greater than or equal to 750 g. A s
ignificantly higher proportion of ELBW children were receiving special educ
ational assistance and/or had repeated a grade (ELBW: 58%; controls: 13%; o
dds ratio: 9.0). Paired analysis of within-cohort data at age 8 and teen ye
ars showed that for both cohorts Arithmetic scores declined, but there were
small improvements in other measures, predominantly in the term children.
Conclusions. Differences of 13 to 18 points in psychometric measures in ELB
W teens compared with controls are both statistically significant and clini
cally relevant. Decreasing birth weight was associated with increased risk
on all measures. The high utilization of special educational resources has
economic implications, and the incremental cost attributable to being extre
mely premature needs to be determined.