Background Very-low-birth-weight infants (those weighing lessthan 1500 g) born during the initial years of neonatal intensivecare have now reached young adulthood.
Methods We compared a cohort of 242 survivors among very-low-birth-weightinfants born between 1977 and 1979 (mean birth weight, 1179g; mean gestational age at birth, 29.7 weeks) with 233 controlsfrom the same population in Cleveland who had normal birth weights.We assessed the level of education, cognitive and academic achievement,and rates of chronic illness and risk-taking behavior at 20years of age. Outcomes were adjusted for sex and sociodemographicstatus.
Results Fewer very-low-birth-weight young adults than normal-birth-weightyoung adults had graduated from high school (74 percent vs.83 percent, P=0.04). Very-low-birth-weight men, but not women,were significantly less likely than normal-birth-weight controlsto be enrolled in postsecondary study (30 percent vs. 53 percent,P=0.002). Very-low-birth-weight participants had a lower meanIQ (87 vs. 92) and lower academic achievement scores (P<0.001for both comparisons). They had higher rates of neurosensoryimpairments (10 percent vs. <1 percent, P<0.001) and subnormalheight (10 percent vs. 5 percent, P=0.04). The very-low-birth-weightgroup reported less alcohol and drug use and had lower ratesof pregnancy than normal-birth-weight controls; these differencespersisted when comparisons were restricted to the participantswithout neurosensory impairment.
Conclusions Educational disadvantage associated with very lowbirth weight persists into early adulthood.
The introduction of neonatal intensive care in the 1960s resultedin substantial improvements in outcomes for very-low-birth-weightinfants (those weighing less than 1500 g). By the 1970s, 80to 90 percent of survivors were reported to be free of serioushandicaps.1 However, at school age, very-low-birth-weight childrenhave poorer cognitive function and academic performance thannormal-birth-weight controls.2,3,4,5 Learning problems at schoolpersist into adolescence and are apparent even in children whohave normal intelligence and no neurologic impairment.6,7
Before the era of neonatal intensive care, when few very-low-birth-weightinfants survived, the majority of survivors were described ashaving average or above-average mental development.8 A morerecent report, however, indicated that fewer persons with birthweights of less than 1000 g than normal-birth-weight controlshad graduated from high school.9 Reports from Europe note thatvery-low-birth-weight young adults have similar levels of educationalattainment10,11 but more chronic illness and handicap11,12,13than members of the general population10,12,13 or normal-birth-weightcontrols.11
We undertook a longitudinal study of very-low-birth-weight childrenborn in 1977, 1978, or 1979, and we previously reported on outcomesat eight years of age.2,14,15,16,17 The current report extendsthe follow-up to 20 years of age. We hypothesized that, as comparedwith normal-birth-weight controls, very-low-birth-weight youngadults would have lower intelligence, lower levels of educationalachievement, and higher rates of chronic health conditions andrisk-taking behavior.
Methods
Very-Low-Birth-Weight Group
A cohort of 490 very-low-birth-weight infants were admittedto Rainbow Babies and Children's Hospital in Cleveland between1977 and 1979. A total of 316 children (64 percent) survivedto their second year. One child died of a brain tumor between2 and 8 years of age, and three died between 8 and 20 yearsof age — one from meningitis, one by drowning, and onefrom sequelae of severe spastic quadriplegia. Of the remaining312 subjects, 70 were not studied: 58 could not be located,5 lived out of state, 6 declined to participate, and 1 withsevere spastic quadriplegia could not be interviewed. The studypopulation thus included 242 very-low-birth-weight participants;this population represented 78 percent of the surviving birthcohort and included 232 (91 percent) of the 256 members of thecohort who had participated at eight years of age and an additional10 who had not participated at eight years of age. One parentof each of 227 of the study participants (94 percent) was alsointerviewed. The mother was the parent interviewed in 91 percentof the cases.
The 242 very-low-birth-weight participants had a mean birthweight of 1179 g and had been born at a mean gestational ageof 29.7 weeks; 110 (45 percent) had been born at the adjacentperinatal center of MacDonald Hospital for Women. Fifty-eight(24 percent) had a birth weight of less than 1000 g. Neonatalproblems had included respiratory distress syndrome in 181 infants(75 percent), apnea of prematurity in 123 (51 percent), sepsisin 34 (14 percent), and necrotizing enterocolitis in 9 (4 percent).Assisted ventilation had been provided to 107 of the infants(44 percent). There were no major congenital malformations orcongenital infections. The cohort was born before the adventof cerebral ultrasonography; thus, the rates of periventricularhemorrhage and leukomalacia are unknown. At the time of theirbirth, the mean age of their mothers was 24 years. A total of158 of the mothers (65 percent) were married, and 59 (24 percent)had less than a high-school education.
The very-low-birth-weight young adults who participated in thestudy did not differ significantly from those who had been lostto follow-up since birth in terms of the sociodemographic characteristicsof their mothers at the time of their birth: 35 percent of themothers of participants were unmarried, as compared with 39percent of the mothers of those lost to follow-up; 55 percentof the mothers were black, as compared with 46 percent amongthose lost to follow-up; and 24 percent had less than a high-schooleducation, as compared with 33 percent among those lost to follow-up.More of those who participated at 20 years of age than of thosewho were lost to follow-up had been born at the perinatal center(46 percent vs. 31 percent, P=0.03). However, the mean birthweight (1179 g vs. 1187 g), the mean gestational age at birth(29.7 weeks vs. 29.8 weeks), and the incidence of neonatal problems(including respiratory distress syndrome requiring ventilatortherapy, sepsis, and necrotizing enterocolitis) did not differbetween the groups. The mean IQ at 8 years of age was 95±18among those who participated at 20 years of age and 91±21among those who were subsequently lost to follow-up (P=0.27).
Control Group
The original control group included 366 normal-birth-weightchildren born at term in 1977, 1978, or 1979, who were selectedby means of a population-sampling procedure when they were eightyears of age.2 Three of the controls died between 8 and 20 yearsof age — one from a gunshot wound, one from a stab wound,and one by suicide. Of the remaining 363 controls, 130 werenot studied at 20 years of age: 91 could not be located, 1 livedout of state, and 38 declined to participate. The control populationthus included 233 participants — 64 percent of the cohortthat had been recruited at eight years of age. One parent ofeach of 218 of the controls (94 percent) was also interviewed;in 95 percent of cases, the parent interviewed was the mother.
The normal-birth-weight controls who participated at 20 yearsof age had had a significantly higher mean IQ score on the WechslerIntelligence Scale for Children–Revised (WISC-R) at 8years of age than those who did not participate (104±17vs. 93±14). Fewer mothers of the controls who participatedat 20 years of age than mothers of those who did not participatewere unmarried when the child was 8 years old (36 percent vs.61 percent), fewer had less than a high-school education (11percent vs. 27 percent), and fewer were black (55 percent vs.76 percent; P<0.001 for all comparisons).
Measures at 20 Years of Age
All subjects provided written informed consent to participatein the study. Information concerning educational attainment,current enrollment in an educational program, and other activitieswas obtained from the young adults by means of interviews. High-schoolgraduation was confirmed by means of school records. Intelligencewas assessed with the Short Form of the Wechsler Adult IntelligenceScale–Revised (WAIS-R); we used the Vocabulary and BlockDesign subtests, which measure verbal comprehension and perceptual-organizationskills, respectively.18,19 Academic skills were assessed withthe Letter–Word Identification and Applied Problems subtestsof the Tests of Achievement from the Woodcock–JohnsonPsycho-Educational Battery–Revised.20 Health status wasascertained from the participants by means of questions concerningchronic medical, neurologic, or psychiatric conditions thathad lasted 12 months or longer, as well as detailed questionsconcerning pregnancy and childbirth.21,22 Height was measuredwith a Harpenden stadiometer. The extent of engagement in risk-takingbehavior during the previous 12 months was ascertained by meansof self-administered questionnaires — a substance-abusechecklist and a Sexual Experience Scale23,24 — with additionalquestions concerning contact with the police. The subjects wereasked whether they had ever been in jail, including for severalhours or overnight or in juvenile detention, and whether theyhad been convicted of a crime, including driving under the influenceof alcohol. The parents completed questionnaires regarding theyoung adults' health21 and their knowledge about substance useby the participants.23
Statistical Analysis
Univariate comparisons between the very-low-birth-weight andnormal-birth-weight groups were made with the use of Student'st-test for continuous variables and with the chi-square testor Fisher's exact test for discrete variables. Logistic regressionwas used for dichotomous outcomes, and multiple linear regressionwas used for continuous outcomes. Because of the effects ofsociodemographic factors on outcomes, we controlled for sociodemographicstatus in the analyses.2,4,6 Because of differences in behaviorbetween the sexes, we performed separate analyses for each sex,comparing the groups after adjusting for sociodemographic status.We also compared the groups using pooled data from participantsof both sexes with adjustment for sex and sociodemographic status.If the interaction between birth-weight groups and sex was foundto be significant, indicating that the effect on the outcomediffered between male participants and female participants,then the adjusted difference from the pooled analysis was notpresented. A composite score representing the mother's sociodemographicstatus, which we used previously,2 was calculated by assigningone point for each of the following factors: unmarried status,black race, and less than a high-school education.2 The compositescore ranged from zero to three. We used the mother's maritaland educational status at the time the child was eight yearsold, since it was considered more relevant than her later statusto the period of child development that is critical for educationalattainment. This composite had a stronger correlation with theIQ at 8 years of age2 and at 20 years of age than did any ofits components analyzed separately. In separate sets of analyses,we compared the subgroups of very-low-birth-weight and normal-birth-weightparticipants who did not have neurosensory impairment, subnormalIQ, or chronic conditions.
Results
Sociodemographic Status and Chronic Health Conditions
The very-low-birth-weight and normal-birth-weight groups didnot differ significantly with regard to maternal marital statusat eight years of follow-up or maternal race. The level of maternaleducation was lower in the very-low-birth-weight group, butthe composite index of sociodemographic status did not differsignificantly between groups (Table 1). Six of the very-low-birth-weightyoung adults and one of the normal-birth-weight young adultswere married.
Table 1. Maternal Sociodemographic Status at Eight Years of Follow-up and Birth Data for Very-Low-Birth-Weight and Normal-Birth-Weight Participants.
Very-low-birth-weight participants had significantly higherrates of chronic conditions than the controls (33 percent vs.21 percent, P=0.002). The difference was primarily attributableto higher rates of neurosensory impairment and subnormal height25(Table 2). A total of 23 percent of the very-low-birth-weightparticipants had one chronic condition, 9 percent had two chronicconditions, and 1 percent had three or more chronic conditions.In comparison, 17 percent of the controls had one chronic condition,and 4 percent had two chronic conditions (P=0.005).
Table 2. Chronic Conditions at 20 Years of Age among Very-Low-Birth-Weight and Normal-Birth-Weight Participants.
Educational Attainment and Current Enrollment in an Educational Program
Fewer very-low-birth-weight participants than normal-birth-weightparticipants had graduated from high school or obtained a generalequivalency diploma by 20 years of age (74 percent vs. 83 percent,P=0.04) (Table 3). Forty percent of the very-low-birth-weightparticipants had repeated a grade in school, as compared with27 percent of the normal-birth-weight participants (P=0.003).Very-low-birth-weight participants who graduated from high schooldid so at a mean age of 18.2±0.6 years, as compared with17.9±0.6 years among the controls (P<0.001). Fewervery-low-birth-weight men were enrolled in postsecondary studies,of whom only 16 percent were in a four-year college program,as compared with 44 percent in the control group (P<0.001).
Table 3. Level of Education at 20 Years of Age among Very-Low-Birth-Weight and Normal-Birth-Weight Participants.
The differences in grade repetition, educational attainment,and current enrollment in educational programs remained significantwhen the comparisons were restricted to participants withoutneurosensory impairment or subnormal IQ (<70).
Intelligence and Academic Achievement
Very-low-birth-weight participants had significantly lower meanIQ scores than the controls (87 vs. 92, P<0.001) and hadlower scores on the subtests of academic achievement (Table 4).20 They also had a higher frequency of subnormal IQ (<70)and borderline IQ (70 to 84). Fifty-one percent of the very-low-birth-weightparticipants had an IQ in the normal range (85), as comparedwith 67 percent of the controls (P<0.001). These differencesremained significant when the comparisons were restricted tothe participants without neurosensory impairment. There wasa significant interaction of birth weight and sex in the scoreson the Applied Problems subtest of the Woodcock–JohnsonPsycho-Educational Battery–Revised, with a greater differencebetween groups for male participants than for female participants.
Table 5. Self-Reported Substance Use, Criminal Activity, and Sexual Activity at 20 Years of Age among Very-Low-Birth-Weight and Normal-Birth-Weight Participants.
Data have been lacking on the follow-up into adulthood of very-low-birth-weightsurvivors of neonatal intensive care in the United States. Thevery-low-birth-weight participants in our study had been treatedin an urban perinatal center, and our study population thusincluded more persons of lower socioeconomic status and minorityrace or ethnic group than the United States as a whole. Therates of chronic illness in our normal-birth-weight controlpopulation are similar to those reported for young adults nationally,21and their rates of substance abuse, contact with the police,and childbirth are in keeping with data from similar urban populations.26,27,28,29,30
We followed 78 percent of the birth cohort of very-low-birth-weightsubjects to 20 years of age, but only 64 percent of the normal-birth-weightsubjects enrolled at 8 years of age remained in the study untilthey were 20 years old. The loss of very-low-birth-weight subjectsoccurred mainly between birth and eight years of age. Thosewho were followed to 20 years of age were similar to the originalbirth cohort in terms of birth weight, gestational age at birth,and neonatal morbidity, although their mothers tended to havea higher level of education. The very-low-birth-weight and normal-birth-weightgroups were similar in terms of maternal sociodemographic characteristicsat eight years of age, when the normal-birth-weight group wasrecruited.2 From 8 to 20 years of age, both groups had greaterlosses to follow-up among children whose mothers had less education,but more of these losses occurred in the control group thanin the very-low-birth-weight group. This imbalance explainsthe discrepancy in maternal education between the very-low-birth-weightparticipants and the controls at 20 years of age. Previous studiesof very-low-birth-weight infants have similarly had greaterloss to follow-up among participants with lower IQs and thosewhose mothers had lower levels of education and were of lowersocial class.31,32 To control for this bias, we adjusted formaternal sociodemographic status, which included maternal educationallevel, in all the analyses. A weakness of the study is thatwe did not measure maternal IQ, an important predictor of children'seducational outcomes.33
The findings that fewer very-low-birth-weight participants thannormal-birth-weight participants had graduated from high schooland that they were less likely to be enrolled in a postsecondaryeducational program are not surprising, considering their lowerIQs and academic achievement scores and higher rates of graderepetition. A disadvantage in school performance among boyshas been previously reported in studies of very-low-birth-weightsubjects.34,35 Our finding of a lower rate of enrollment infour-year colleges among the very-low-birth-weight men, evenafter sociodemographic factors had been controlled for, indicatesthat this disadvantage extends into young adulthood. These findingssuggest that men who had very low birth weight will lag behindtheir normal-birth-weight peers in their ultimate educationaland occupational achievement, and thus in earning ability, socialstatus, and prestige.36
Lower rates of alcohol and drug use among very-low-birth-weightsubjects have not previously been reported. Bjerager et al.noted similar rates of alcohol and drug use for very-low-birth-weightyoung adults and controls.11 Chilcoat and Breslau reported anincrease in early drug use among 11-year-old low-birth-weightchildren that was associated with attention-deficit–hyperactivitydisorder rather than with birth weight per se.37 Risk-takingbehavior in children is associated with externalizing behavior,37low intelligence and academic performance,38 negative peer influences,39early puberty,24 poor self-esteem, and poor parental monitoring.23,40,41,42We do not have information on all of these correlated factors,but we postulate that the more limited risk-taking behaviorthat we have documented may result from increased parental monitoringof very-low-birth-weight children.
A problem inherent in the long-term follow-up of preterm infantsis that outcomes might not be relevant to survivors of currentneonatal intensive care. Recent survivors who weighed less than1000 g at birth have poorer outcomes than were previously reported.43,44There is, however, no evidence that the incidence of neurodevelopmentalsequelae of very low birth weight among children who weighedbetween 1000 and 1500 g at birth has changed since the late1970s.45 The majority of our 20-year-old cohort had birth weightsin this range. We thus suggest that our results have relevanceto current survivors with birth weights in the same range.
Supported by grants (RO1 HD34177 and General Clinical ResearchCenter grant M01 RR00080) from the National Institutes of Healthand by a grant (96-46) from the Genentech Foundation for Growthand Development. The latter did not participate in the studydesign, data collection, data analysis, or manuscript preparation.
We are indebted to Debra Hoffman, Anne Rivers, Susan McGrath,Miriam Curran, Terry Reid, and Elizabeth Carter for their assistancein compiling and analyzing the data, and to Drs. A.A. Fanaroff,D. Drotar, and H.G. Taylor for their critical comments on themanuscript.
Source Information
From the Departments of Pediatrics (M.H., D.J.F., M.S., L.C.) and Epidemiology and Biostatistics (E.B.), Case Western Reserve University, and the Department of Special Education, Cleveland State University (N.K.) — both in Cleveland; and the Institute for the Study and Prevention of Violence, Kent State University, Kent, Ohio (D.J.F.).
Address reprint requests to Dr. Hack at the Rainbow Babies and Children's Hospital of the University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106, or at mxh7{at}po.cwru.edu.
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(2008). Movement Training Advances the Emergence of Reaching in Infants Born at Less Than 33 Weeks of Gestational Age: A Randomized Clinical Trial. ptjournal
88: 310-322
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Constable, R. T., Ment, L. R., Vohr, B. R., Kesler, S. R., Fulbright, R. K., Lacadie, C., Delancy, S., Katz, K. H., Schneider, K. C., Schafer, R. J., Makuch, R. W., Reiss, A. R.
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Zwicker, J. G., Harris, S. R.
(2008). Quality of Life of Formerly Preterm and Very Low Birth Weight Infants From Preschool Age to Adulthood: A Systematic Review. Pediatrics
121: e366-e376
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Keltikangas-Jarvinen, L., Elovainio, M., Kivimaki, M., Raitakari, O. T., Viikari, J. S.A., Lehtimaki, T.
(2007). Dopamine Receptor D2 Gene Taq1A (C32806T) Polymorphism Modifies the Relationship Between Birth Weight and Educational Attainment in Adulthood: 21-Year Follow-up of the Cardiovascular Risk in Young Finns Study. Pediatrics
120: 756-761
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Limperopoulos, C., Bassan, H., Gauvreau, K., Robertson, R. L. Jr, Sullivan, N. R., Benson, C. B., Avery, L., Stewart, J., MD, J. S. S., Ringer, S. A., Volpe, J. J., duPlessis, A. J.
(2007). Does Cerebellar Injury in Premature Infants Contribute to the High Prevalence of Long-term Cognitive, Learning, and Behavioral Disability in Survivors?. Pediatrics
120: 584-593
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Hille, E. T. M., Weisglas-Kuperus, N., van Goudoever, J. B., Jacobusse, G. W., Ens-Dokkum, M. H., de Groot, L., Wit, J. M., Geven, W. B., Kok, J. H., de Kleine, M. J. K., Kollee, L. A. A., Mulder, A. L. M., van Straaten, H. L. M., de Vries, L. S., van Weissenbruch, M. M., Verloove-Vanhorick, S. P., for the Dutch Collaborative POPS 19 Study Group,
(2007). Functional Outcomes and Participation in Young Adulthood for Very Preterm and Very Low Birth Weight Infants: The Dutch Project on Preterm and Small for Gestational Age Infants at 19 Years of Age. Pediatrics
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Lindstrom, K., Winbladh, B., Haglund, B., Hjern, A.
(2007). Preterm Infants as Young Adults: A Swedish National Cohort Study. Pediatrics
120: 70-77
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Russell, R. B., Green, N. S., Steiner, C. A., Meikle, S., Howse, J. L., Poschman, K., Dias, T., Potetz, L., Davidoff, M. J., Damus, K., Petrini, J. R.
(2007). Cost of Hospitalization for Preterm and Low Birth Weight Infants in the United States. Pediatrics
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Farooqi, A., Hagglof, B., Sedin, G., Gothefors, L., Serenius, F.
(2007). Mental Health and Social Competencies of 10- to 12-Year-Old Children Born at 23 to 25 Weeks of Gestation in the 1990s: A Swedish National Prospective Follow-up Study. Pediatrics
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Greenley, R. N., Taylor, H. G., Drotar, D., Minich, N. M.
(2007). Longitudinal Relationships between Early Adolescent Family Functioning and Youth Adjustment: An Examination of the Moderating Role of Very Low Birth Weight. J Pediatr Psychol
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Kolevzon, A., Gross, R., Reichenberg, A.
(2007). Prenatal and Perinatal Risk Factors for Autism: A Review and Integration of Findings. Arch Pediatr Adolesc Med
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Skranes, J., Vangberg, T. R., Kulseng, S., Indredavik, M. S., Evensen, K. A. I., Martinussen, M., Dale, A. M., Haraldseth, O., Brubakk, A.-M.
(2007). Clinical findings and white matter abnormalities seen on diffusion tensor imaging in adolescents with very low birth weight. Brain
130: 654-666
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Saigal, S., Stoskopf, B., Boyle, M., Paneth, N., Pinelli, J., Streiner, D., Goddeeris, J.
(2007). Comparison of Current Health, Functional Limitations, and Health Care Use of Young Adults Who Were Born With Extremely Low Birth Weight and Normal Birth Weight. Pediatrics
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Nomura, Y., Chemtob, C. M.
(2007). Conjoined Effects of Low Birth Weight and Childhood Abuse on Adaptation and Well-being in Adolescence and Adulthood. Arch Pediatr Adolesc Med
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(2007). Noninitiation or Withdrawal of Intensive Care for High-Risk Newborns. Pediatrics
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Reijneveld, S A, de Kleine, M J K, van Baar, A L, Kollee, L A A, Verhaak, C M, Verhulst, F C, Verloove-Vanhorick, S P
(2006). Behavioural and emotional problems in very preterm and very low birthweight infants at age 5 years. Arch. Dis. Child. Fetal Neonatal Ed.
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Samuelsson, S., Finnstrom, O., Flodmark, O., Gaddlin, P.-O., Leijon, I., Wadsby, M.
(2006). A Longitudinal Study of Reading Skills Among Very-Low-Birthweight Children: Is There a Catch-up?. J Pediatr Psychol
31: 967-977
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Casey, P. H., Whiteside-Mansell, L., Barrett, K., Bradley, R. H., Gargus, R.
(2006). Impact of Prenatal and/or Postnatal Growth Problems in Low Birth Weight Preterm Infants on School-Age Outcomes: An 8-Year Longitudinal Evaluation. Pediatrics
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Dahl, L. B., Kaaresen, P. I., Tunby, J., Handegard, B. H., Kvernmo, S., Ronning, J. A.
(2006). Emotional, Behavioral, Social, and Academic Outcomes in Adolescents Born With Very Low Birth Weight. Pediatrics
118: e449-e459
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Vohr, B. R., Poindexter, B. B., Dusick, A. M., McKinley, L. T., Wright, L. L., Langer, J. C., Poole, W. K., for the NICHD Neonatal Research Network,
(2006). Beneficial Effects of Breast Milk in the Neonatal Intensive Care Unit on the Developmental Outcome of Extremely Low Birth Weight Infants at 18 Months of Age. Pediatrics
118: e115-e123
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Lofqvist, C., Engstrom, E., Sigurdsson, J., Hard, A.-L., Niklasson, A., Ewald, U., Holmstrom, G., Smith, L. E. H., Hellstrom, A.
(2006). Postnatal head growth deficit among premature infants parallels retinopathy of prematurity and insulin-like growth factor-1 deficit.. Pediatrics
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Wang, C. J., McGlynn, E. A., Brook, R. H., Leonard, C. H., Piecuch, R. E., Hsueh, S. I., Schuster, M. A.
(2006). Quality-of-Care Indicators for the Neurodevelopmental Follow-up of Very Low Birth Weight Children: Results of an Expert Panel Process.. Pediatrics
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Smith, K. E., Landry, S. H., Swank, P. R.
(2006). The Role of Early Maternal Responsiveness in Supporting School-Aged Cognitive Development for Children Who Vary in Birth Status. Pediatrics
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Watts, J L, Saigal, S
(2006). Outcome of extreme prematurity: as information increases so do the dilemmas.. Arch. Dis. Child. Fetal Neonatal Ed.
91: F221-F225
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Macklon, N. S., Stouffer, R. L., Giudice, L. C., Fauser, B. C. J. M.
(2006). The Science behind 25 Years of Ovarian Stimulation for in Vitro Fertilization. Endocr. Rev.
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Saigal, S., Stoskopf, B., Streiner, D., Boyle, M., Pinelli, J., Paneth, N., Goddeeris, J.
(2006). Transition of Extremely Low-Birth-Weight Infants From Adolescence to Young Adulthood: Comparison With Normal Birth-Weight Controls. JAMA
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Hack, M., Klein, N.
(2006). Young Adult Attainments of Preterm Infants. JAMA
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Allin, M., Rooney, M., Cuddy, M., Wyatt, J., Walshe, M., Rifkin, L., Murray, R.
(2006). Personality in Young Adults Who Are Born Preterm. Pediatrics
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Inder, T., Neil, J., Yoder, B., Rees, S.
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Hack, M., Taylor, H. G., Drotar, D., Schluchter, M., Wilson-Costello, D., Klein, N.
(2005). Long-term Outcomes for Extremely Low-Birth-Weight Infants--Reply. JAMA
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Hille, E.T.M., Elbertse, L., Gravenhorst, J. B., Brand, R., Verloove-Vanhorick, S.P., on behalf of the Dutch POPS-19 Collaborative Study,
(2005). Nonresponse Bias in a Follow-up Study of 19-Year-Old Adolescents Born as Preterm Infants. Pediatrics
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Sloan, F. A., Wang, J.
(2005). Disparities Among Older Adults in Measures of Cognitive Function by Race or Ethnicity. J. Gerontol. B Psychol. Sci. Soc. Sci.
60: P242-P250
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Lodygensky, G. A., Rademaker, K., Zimine, S., Gex-Fabry, M., Lieftink, A. F., Lazeyras, F., Groenendaal, F., de Vries, L. S., Huppi, P. S.
(2005). Structural and Functional Brain Development After Hydrocortisone Treatment for Neonatal Chronic Lung Disease. Pediatrics
116: 1-7
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Lee, W., Deter, R. L., McNie, B., Goncalves, L. F., Espinoza, J., Chaiworapongsa, T., Balasubramaniam, M., Romero, R.
(2005). The Fetal Arm: Individualized Growth Assessment in Normal Pregnancies. J Ultrasound Med
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Ekholm, K., Carstensen, J., Finnstrom, O., Sydsjo, G.
(2005). The Probability of Giving Birth among Women Who Were Born Preterm or with Impaired Fetal Growth: A Swedish Population-based Registry Study. Am J Epidemiol
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Litt, J., Taylor, H. G., Klein, N., Hack, M.
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Blanco, F., Suresh, G., Howard, D., Soll, R. F.
(2005). Ensuring Accurate Knowledge of Prematurity Outcomes for Prenatal Counseling. Pediatrics
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Marlow, N., Wolke, D., Bracewell, M. A., Samara, M., the EPICure Study Group,
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Wilson, S. L., Cradock, M. M.
(2004). Review: Accounting for Prematurity in Developmental Assessment and the Use of Age-Adjusted Scores. J Pediatr Psychol
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Strully, K. W., Conley, D.
(2004). Reconsidering Risk: Adapting Public Policies to Intergenerational Determinants and Biosocial Interactions in Health-Related Needs. Journal of Health Politics, Policy and Law
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Grunau, R. E., Whitfield, M. F., Fay, T. B.
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Aly, H.
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Hack, M., Youngstrom, E. A., Cartar, L., Schluchter, M., Taylor, H. G., Flannery, D., Klein, N., Borawski, E.
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Breslau, N., Paneth, N. S., Lucia, V. C.
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Gardner, F., Johnson, A., Yudkin, P., Bowler, U., Hockley, C., Mutch, L., Wariyar, U., on behalf of ELGA Steering Group,
(2004). Behavioral and Emotional Adjustment of Teenagers in Mainstream School Who Were Born Before 29 Weeks' Gestation. Pediatrics
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Gray, R. F., Indurkhya, A., McCormick, M. C.
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Castro, L., Yolton, K., Haberman, B., Roberto, N., Hansen, N. I., Ambalavanan, N., Vohr, B. R., Donovan, E. F.
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HOLDING, P. A., KITSAO-WEKULO, P. K.
(2004). DESCRIBING THE BURDEN OF MALARIA ON CHILD DEVELOPMENT: WHAT SHOULD WE BE MEASURING AND HOW SHOULD WE BE MEASURING IT?. Am J Trop Med Hyg
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Marlow, N
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Klassen, A. F., Lee, S. K., Raina, P., Chan, H. W.P., Matthew, D., Brabyn, D.
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Cooke, R W I
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Gale, C. R., O'Callaghan, F. J., Godfrey, K. M., Law, C. M., Martyn, C. N.
(2004). Critical periods of brain growth and cognitive function in children. Brain
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de Kleine, M J K, den Ouden, A L, Kollee, L A A, van der Sanden, M W G N., Sondaar, M, van Kessel-Feddema, B J M, Knuijt, S, van Baar, A L, Ilsen, A, Breur-Pieterse, R, Briet, J M, Brand, R, Verloove-Vanhorick, S P
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Lee, P. A., Kendig, J. W., Kerrigan, J. R.
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Hack, M., Schluchter, M., Cartar, L., Rahman, M., Cuttler, L., Borawski, E.
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Heird, W. C., Driscoll, J. M. Jr
(2003). Historical Perspectives: Total Parenteral Nutrition. NeoReviews
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Saigal, S., Pinelli, J., Hoult, L., Kim, M. M., Boyle, M.
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Johnson, A, Bowler, U, Yudkin, P, Hockley, C, Wariyar, U, Gardner, F, Mutch, L
(2003). Health and school performance of teenagers born before 29 weeks gestation. Arch. Dis. Child. Fetal Neonatal Ed.
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McQuillen, P. S., Sheldon, R. A., Shatz, C. J., Ferriero, D. M.
(2003). Selective Vulnerability of Subplate Neurons after Early Neonatal Hypoxia-Ischemia. J. Neurosci.
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Lee, B.E., Ha, E.H., Park, H.S., Kim, Y.J., Hong, Y.C., Kim, H., Lee, J.T.
(2003). Exposure to air pollution during different gestational phases contributes to risks of low birth weight. Hum Reprod
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Smuts, C. M., Huang, M., Mundy, D., Plasse, T., Major, S., Carlson, S. E.
(2003). A Randomized Trial of Docosahexaenoic Acid Supplementation During the Third Trimester of Pregnancy. Obstet Gynecol
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Ment, L. R., Vohr, B., Allan, W., Katz, K. H., Schneider, K. C., Westerveld, M., Duncan, C. C., Makuch, R. W.
(2003). Change in Cognitive Function Over Time in Very Low-Birth-Weight Infants. JAMA
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Rautava, P., Lehtonen, L., Helenius, H., Sillanpaa, M.
(2003). Effect of Newborn Hospitalization on Family and Child Behavior: A 12-Year Follow-up Study. Pediatrics
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Alexander, G. R., Kogan, M., Bader, D., Carlo, W., Allen, M., Mor, J.
(2003). US Birth Weight/Gestational Age-Specific Neonatal Mortality: 1995-1997 Rates for Whites, Hispanics, and Blacks. Pediatrics
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D'Angio, C. T., Sinkin, R. A., Stevens, T. P., Landfish, N. K., Merzbach, J. L., Ryan, R. M., Phelps, D. L., Palumbo, D. R., Myers, G. J.
(2002). Longitudinal, 15-Year Follow-up of Children Born at Less Than 29 Weeks' Gestation After Introduction of Surfactant Therapy Into a Region: Neurologic, Cognitive, and Educational Outcomes. Pediatrics
110: 1094-1102
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Harrison, H., Conley, D., Bennett, N. G., Zach, L. J., Tasman, W., Hack, M., Klein, N., Flannery, D. J., McCormick, M. C., Richardson, D. K.
(2002). Outcomes in Young Adulthood for Very-Low-Birth-Weight Infants. NEJM
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Zuckerman, B., Frank, D. A., Mayes, L.
(2002). Cocaine-Exposed Infants and Developmental Outcomes: "Crack Kids" Revisited. JAMA
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Moran, M.
(2002). Many 'Preemies' Don't Outgrow Cognitive, Other Problems. Psychiatr. News
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Lindsay, R. L.
(2002). Good News and Bad News About Outcomes of Very Low Birth Weight Infants As Young Adults. AAP Grand Rounds
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(2002). Very-Low-Birth-Weight Babies: What to Expect in the Young-Adult Years. JWatch Women's Health
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A correction has been published: N Engl J Med 2002;347(2):141.
85), as compared with 67 percent of the controls (P<0.001). These differences remained significant when the comparisons were restricted to the participants without neurosensory impairment. There was a significant interaction of birth weight and sex in the scores on the Applied Problems subtest of the Woodcock–Johnson Psycho-Educational Battery–Revised, with a greater difference between groups for male participants than for female participants. 
1000 g. Pediatr Res 1999;45:250A-250A.abstract
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