Premature births lead to wide-ranging disabilities
But cognitive difficulties prove more prevalent than cerebral palsy.
Only a quarter of babies born after fewer than 26 weeks in the womb make it to childhood. And even those that do survive have just a 20% chance of being free of disability by the time they are six years old, British doctors have revealed.
The results are the latest from EPICure, the first study to follow the health of severely premature babies into early childhood. "We needed to find out what was happening to these children," says Kate Costeloe, a paediatrician at Queen Mary University of London and a principal investigator on the EPICure project.
The researchers compared severely pre-term children with their full-term classmates and found that they were more likely to suffer from a wide range of disabilities, including severe cerebral palsy, learning difficulties, below-average intelligence and problems with vision or hearing.
Paediatrician at Queen Mary University, London, and head of the EPIcure project
Although a mere 20% of the group had no disability at all, a further 34% had only mild problems such as poor eyesight, says Neil Marlow of the University of Nottingham, UK, who led the analysis. That means that 54% of the kids have a satisfactory quality of life, he says.
There were other surprises too. For example, it is generally believed that the most common problem associated with severe premature birth is cerebral palsy, Marlow says. But the study found that 76% are free of such coordination problems, and only 4% are severely afflicted with the condition. "Cerebral palsy is not the thing we should worry about most," he says.
More prevalent among the six-year-olds were problems with learning and cognition, the researchers say. Some 72% of severely premature children had impaired intelligence, compared with 14% of their classmates. The researchers report their result in the New England Journal of Medicine1.
Case by case
Spokesman, London-based charity BLISS, which sponsors the EPIcure project
But an ability to explain clearly to parents what might happen to their child further down the line will be valuable, Williams says. "The more information parents have, the more they are an active partner in the decision-making process," he says. Despite their low survival rates, particularly at 22 and 23 weeks, "the effort going into keeping these babies alive is well worth it", he argues.
The information could also help doctors learn how to stave off mild disabilities. "Twenty per cent of them have no disability; they're not even short-sighted," points out Williams. "We can learn a lot from these kids. What interventions helped them? What did the parents do after the baby went home?"
- Marlow N., et al. New England Journal of Medicine, 352. 9 - 19 (2005).