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Correction
to
Hack et al.,
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I disagree. As the parent of a very-low-birth-weight adult, the moderator of an Internet list for parents of preterm children, and the author of a book on prematurity, I am in close contact with many families with very-low-birth-weight children. Our children, even when they do not have major neurosensory handicaps, often have cognitive and behavioral deficits that isolate them from both their peers and their peers' risk-taking behavior. Our children's isolation and withdrawal are actually caused by a lack of social and intellectual resilience. As a result, many of us worry that our children will never become fully functioning members of society.
Unfortunately, recent research supports our fears. In a report on a national cohort of prematurely born teens in the Netherlands, Walther et al.3 estimate that, because of social and cognitive problems, 40 percent of very-low-birth-weight children will never live independently. This Dutch cohort was born only a few years later than the group studied by Hack et al. and has a similar rate of neurosensory impairment (10 percent).
Helen Harrison
1144 Sterling Ave.
Berkeley, CA 94708
helen1144{at}aol.com
References
In addition, it is not surprising that the less fortunate very-low-birth-weight adults who have chronic disabilities such as blindness, cerebral palsy, or lung disease would be unlikely to be found on the wrong side of the law. Hack and her colleagues state that the relation persisted when they limited their comparison to healthy very-low-birth-weight adults and normal-birth-weight adults. These results should be presented.
Dalton Conley, Ph.D., M.P.A.
New York University
New York, NY 10003
dalton.conley{at}nyu.edu
Neil G. Bennett, Ph.D.
City University of New York
New York, NY 10010
References
It is known that low-birth-weight babies are at risk for cognitive deficits. What parents of these babies want to know is the nature and extent of this risk. Hack et al. do not emphasize that 120 of the low-birth-weight adults had normal IQs of 85 or higher.
Lillian J. Zach, Ph.D.
Ferkauf Graduate School of Psychology
Bronx, NY 10461
William Tasman, M.D.
Wills Eye Hospital
Philadelphia, PA 19107
wst1{at}ureach.com
To the Editor: We agree with Harrison that social isolation may have a role in the study subjects' tendency to engage in less risk-taking behavior. However, we do not have information on social relationships.
The estimate of Walther et al. that 40 percent of very-low-birth-weight children will not live independently was based on the responses to questions asked over the telephone of parents of 14-year-old children.1 We interviewed and tested young adults. Although fewer very-low-birth-weight men than control men were in college, more were working (47 percent vs. 27 percent, P<0.01). Very-low-birth-weight women did not differ significantly from control women in terms of rates of college enrollment or employment. These results indicate that most very-low-birth-weight adults will be able to work and live independently, although men might lag behind in educational attainment.
In response to Conley and Bennett: we performed additional analyses excluding subjects with a general equivalency diploma. The rates of high-school graduation for very-low-birth-weight and normal-birth-weight men were 60 percent and 68 percent, respectively (P=0.28); the rates for women were 77 percent and 84 percent, respectively (P=0.07). When subjects with neurosensory impairment, a subnormal IQ, or both were excluded, the rates of alcohol use for very-low-birth-weight and normal-birth-weight subjects were 69 percent and 84 percent, respectively (P=0.001), and the rates of illicit-drug use were 37 percent and 47 percent, respectively (P=0.02). Fewer men with very low birth weight than with normal birth weight had been in contact with the police for drug-related or alcohol-related offenses (13 percent vs. 29 percent, P=0.008). When we excluded all subjects with chronic conditions (neurosensory, medical, or psychiatric conditions or subnormal IQ), subjects with very low birth weight still had lower rates of alcohol use (68 percent vs. 83 percent, P=0.001) and illicit-drug use (36 percent vs. 49 percent, P=0.009) than normal-birth-weight subjects. Among men, the rates of contact with police for offenses related to drugs or alcohol were 14 percent and 28 percent, respectively (P=0.04).
Tasman asks about visual impairment. Four very-low-birth-weight subjects (1.7 percent) had blindness due to retinopathy of prematurity (bilateral in one subject and unilateral in three).
We agree with Zach that many of the very-low-birth-weight subjects had normal IQs in young adulthood. However, as we noted in the discussion, our results are applicable only to current survivors of neonatal intensive care with birth weights between 1000 g and 1500 g. We have serious concern about children born during the 1990s weighing less than 1000 g, who may not function well as young adults.2,3
In Table 3 of our article, the total number of normal-birth-weight men with postsecondary study should have been 56 rather than 57.
Maureen Hack, M.B., Ch.B.
Nancy Klein, Ph.D.
Daniel J. Flannery, Ph.D.
University Hospitals of Cleveland
Cleveland, OH 44106
mxh7{at}po.cwru.edu
References
To the Editor: Ms. Harrison offers an alternative hypothesis for the relative absence of risk-taking behavior observed in the group of young adults studied by Hack et al. Both our somewhat more optimistic hypothesis of resilience and hers of social isolation are testable in follow-up studies of very-low-birth-weight children now approaching adulthood. Her letter underscores the importance of not simply reporting on the outcomes of these vulnerable children, but also exploring the mechanisms that cause them, as we have argued elsewhere.1 Well-targeted interventions have been demonstrated to effect changes in preschool cognitive and behavioral outcomes in very-low-birth-weight children.2 Understanding the mechanisms behind other adverse outcomes could lead to the development of strategies for amelioration.
Marie C. McCormick, M.D., Sc.D.
Harvard School of Public Health
Boston, MA 02115
mmccormi{at}hsph.harvard.edu
Douglas K. Richardson, M.D., M.B.A.
Beth Israel Deaconess Medical Center
Boston, MA 02215
References
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