 |
Additional Information
|
|
Even Moderately Premature Birth Poses
Risk for Developmental Delays
Contrary to current assumptions, being born just two to four
weeks premature can put a child at risk for minor delays in
development, according to a study by researchers at the National
Institute of Child Health and Human Development (NICHD) and
the Health Resources and Services Administration. Although
these delays, by themselves, are not likely to convey any
long-term consequences for a child, pregnant women and their
physicians should take them into consideration when deciding
whether or not to induce labor early or perform an early C-section.
If inducing labor early is unavoidable, the researchers cautioned,
physicians should counsel parents to have these children followed
through early childhood to see if they will require any medical
services to assist their development.
Publishing in the January issue of Paediatric and Perinatal
Epidemiology, the researchers also reported that infants born
even moderately undersize for their age are also likely to
experience developmental delays.
"Physicians commonly induce labor early in cases where
the mother has a condition that threatens her health or the
health of her unborn baby, and it is commonly thought that
this practice carries few or no risks to a child's later development,"
said NICHD Director, Duane Alexander, M.D. "This finding
suggests that women and their physicians should balance the
risks of moderate prematurity against the risks of continuing
the pregnancy before deciding whether to induce early labor."
Specifically, the researchers found that infants who were
from 1 to 4 weeks premature-from the 33rd through the 36th
week of pregnancy-were likely to experience a delay in one
or two developmental milestones for a given age category,
from birth through 47 months of age. Physicians consider a
child to be full term when he or she is born in the 37th week
of pregnancy or later.
The researchers also found that children who were smaller
than normal for their age at birth were also likely to experience
a delay in one developmental milestone in each age category.
Early induction of labor and, sometimes, cesarean section,
are conducted for such complications as pregnancy-induced
hypertension, gestational diabetes, and the life-threatening
condition known as preeclampsia, explained the study's first
author, Mary L. Hediger, Ph.D., a researcher with NICHD's
Division of Epidemiology, Statistics and Prevention Research.
In fact, she said, the number of infants born moderately preterm
after induced labor has nearly doubled, from 9.1 percent in
1989 to 17.1 percent in 1996.
Dr. Hediger explained that the developmental delays the children
experienced were very minor, such as failing to pick up small
objects before 3 months of age, failing to crawl before six
months of age, or failing to say two words other than "mama"
or "dada" by 12 months. In all probability, the
children will reach such developmental milestones when they
are slightly older and not experience any long-term effects
from the delay.
"Inducing labor early is thought to be more acceptable
than allowing the fetus to remain inside the womb when the
mother's or fetal health is affected by a disorder of pregnancy,"
she said.
She added, however, that a cumulative effect may result when
a child who faces other risks for developmental delays is
born prematurely.
"Being born to an older mother, being the youngest child
in a large family, being born in poverty, being born to a
family with a low educational level are all risk factors for
developmental delays," Dr. Hediger said. "A combination
of these risk factors, together with the developmental risks
of moderate prematurity, might have a noticeable affect on
development and might hinder a child's academic and other
achievements."
Still, Dr. Hediger pointed out that in many cases inducing
labor early might be absolutely necessary. For example, if
ultrasound tests show that the fetus is failing to grow at
a normal rate, the safest course for both mother and child
may be to induce labor early. It is possible, she said, that
a condition complicating pregnancy, such as gestional diabetes
or preeclampsia, may have an adverse effect on the fetus that
causes these mild developmental delays.
"We have no way of knowing whether or not these mild
developmental delays might be worse if the pregnancy were
not ended early," she said.
The main message, she added, is that physicians and caregivers
should be on the alert for developmental lags in this group
of children.
"If a child is born moderately premature, caregivers
should know that minor delays are likely and can check when
the child is older to see if he or she needs any early childhood
educational services."
Similarly, parents and physicians might wish to observe low
birth weight infants to see if they reach their developmental
milestones. Low birth weight is usually defined as less than
5 ½ lbs.
To conduct their research, Dr. Hediger and her coworkers
reviewed information from the third National Health and Nutrition
Examination Survey, conducted by the National Center for Health
Statistics. In all, researchers examined the records of 4621
children born in single births, who were from 2 to 24 months
of age when the survey was taken. The records included birth
certificates and tests of children's motor and social development
(MSD).
Records were available from children up to three months old,
from four to six months, from seven to nine months, from ten
to 12 months, from 13 to 15 months, from 16 to 18 months,
from 19 to 21 months, and from 22 to 47 months.
To view this excellent article on premature births, produced
by the National Institutes of Health, please click here: http://www.nih.gov/news/pr/jan2002/nichd-15.htm
|
Additional
Information