Transition of Extremely Low-Birth-Weight Infants From Adolescence to Young Adulthood: Comparison With Normal Birth-Weight Controls

Abstract

Survival of extremely low-birth-weight (ELBW) infants weighing less than 1000 g has improved impressively, but as children and adolescents, they continue to have problems in cognition, achievement at school, behavior, and social adaptation. Only recently have survivors from the early era of postneonatal intensive care reached their young adult years. The investigators report a prospective population-based study carried out in Ontario, Canada, that enrolled 166 ELBW subjects weighing 501 to 1000 g at birth who presently were 22 to 25 years of age. The comparison group consisted of 145 normal-birth-weight (NBW) young adults. Face-to-face interviews were conducted without knowledge of the interviewee's status. Complete data were available for 149 of the ELBW participants and 133 of the NBW group at mean ages of 23.3 and 23.6 years, respectively. Neurosensory impairment of various types had been documented in 27% of the ELBW group and 2% of the NBW group. Average total years of education were significantly fewer in the ELBW group (13.9 vs 14.5 years). The proportion of each group who graduated high school was comparable to that for the overall Canadian population, but ELBW subjects were less likely to have completed the advanced course needed for entering the university (36% vs 57%). Half of the 22 ELBW participants with less than a high school education had neurosensory impairments. Approximately 5% could not be enrolled in special resource classes. Males were overrepresented among ELBW participants with the least education, and they were less likely than females to be enrolled in-or graduated from-a college or university. Rates of permanent employment were 48% for ELBW participants and 57% for the NBW group, both figures being comparable to Canadian norms. A higher proportion of the ELBW group was not in school or employed. More of the ELBW group was unemployed because of either chronic illness or permanent disability (46% vs 15%). Overall living arrangements did not differ, and there were no significant group differences, overall or by gender, in marital status. Contrary to what many have expected, a significant majority of young adults in this study who had been ELBW newborn infants have made a generally successful transition from adolescence to young adulthood, even when those with neurosensory impairment are taken into account. Many of them have overcome earlier problems to become functioning members of society. Parents of ELBW children are entitled to hope that, in the longer term, their children will do as well as NBW children.