Tiniest preemies later struggle with school and adult life

Although extremely preterm birth is nolonger the death sentence it once was, many of the tiniestpreemies still struggle in school and have a harder time asadults, new studies suggest.

Pregnancy normally lasts about 40 weeks, and babies bornafter 37 weeks are considered full term. Most preterm babiesarrive between 34 and 37 weeks gestation. The two new studies,published in Pediatrics, focused on preemies who arrived evenearlier.

Like an uncooked cake,there isn't enough time for thingsto come together fully,- Dr. Margaret Kern, University of Melbourne

One study focused on the most vulnerable subset of preemies:those born at no more than 28 weeks gestation. More than half ofthese infants went on to have moderate to severe cognitivedeficits and had academic test scores well below average.

The second study looked at babies born before 32 weeksgestation. By the time they reached adolescence and adulthood,these individuals were more likely than their peers born fullterm to think that health problems lowered their quality oflife.

"In terms of extremely preterm infants, there are multiplereasons why we are seeing deficits and poor performance later,"said Dr. Margaret Kern, a researcher at the University ofMelbourne who wasn't involved in the studies.

"Biologically, there is a lot of key development that occursacross the cycle, and when that is cut off very early it raisesrisklike an uncooked cake, there isn't enough time for thingsto come together fully," Kern said by email.

Some of the same things that may have contributed to theirearly arrival may also make it harder for preemies to get helpin overcoming developmental deficits, Kern added.

Social, economic factors

"There are a whole host of related issues involved,including less knowledge and education by the mother and father,
if involved in the life at all, which often is not the case, andpoor nutrition and other health behaviours," Kern said.

Soon after birth, premature infants often have difficultybreathing and digesting food. Some preemies also encounter
longer-term challenges such as impaired vision, hearing, andcognitive skills as well as social and behavioural problems.

The life-saving medical care these infants receive inneonatal intensive care units can contribute to developmental
deficits, said Jill Zwicker, a pediatrics researcher at theUniversity of British Columbia who wasn't involved in the
studies.

"At this time of rapid brain development, these infants areexposed to procedures for their medical care, such as heel pokesto draw blood, tube insertions to help them breathe, medicationsetc.," Zwicker said by email. "Exposure to these `invasive'procedures is associated with slower brain development andpoorer cognitive outcomes."

Some drugs and procedures can prolong pregnancy to avoidearly arrivals or at least help preterm infants arrive closer tofull term, Robert Joseph, lead author of the study on academicoutcomes, said by email.

Inflammation may boost risk

It's possible that inflammation may increase the risk ofdevelopmental problems, and scientists are working to understandhow these things are connected and develop treatments to addressthe affects of inflammation after birth, Joseph added.

The studies were not designed to prove cause and effect,however.

By adulthood, lower quality of life can be influenced byeconomic and social factors, independent of whether people werepreemies or not, noted Dr. Dieter Wolke, a psychology researcherat the University of Warwick in the U.K. and senior author ofthe paper on teen and adult quality of life.

• Preemies more likely to develop anxiety, depression, ADHD: study

Sometimes, people think health issues diminish their qualityof life even when this isn't the case, Wolke said by email.

"Quality of life measures how people `value' and experiencetheir life," Wolke said. "It may or may not be related to
objective functioning. It may be summarized by `I can cry in myPorsche or I can cry on the bus.'"

• The trouble with preemies
• What to expect as the parent of a premature baby