There appears to be a higher risk for psychiatric disturbance in the childhood and young adult years in babies with low birth-weight, in comparison with those of normal birth-weight, according to a report released on September 1, 2008 in the Archives of General Psychiatry, one of the JAMA/Archives journals. This correlation appeared to be greater for children in urban communities than those in suburbia.

Advances in medical care have allowed lower weighing newborns to survive into childhood. According to the article: “Advances in neonatal medicine have raised the survivorship of low-birth-weight infants (2,500 grams [about 5.5 pounds] or less), especially very low-birth-weight infants (1,500 grams [about 3.3 pounds] or less) and extremely low-birth-weight infants (1,000 grams [2.2 pounds] or less).” Previously, studies have shown that lower birth-weight children have an increased risk of internalizing, externalizing, and attention problems.

To investigate this association further in a long-term study, Kipling M. Bohnert, and Naomi Breslau, PhD, of Michigan State University, East Lansing, examined 823 children in the Detroit area. Of these, 413 children came from a socially disadvantaged community while 410 lived in a middle-class suburb. Each child was evaluated by mothers and teachers at 6, 11, and 17 years old. Any psychiatric disturbances were classified in one of three ways: externalizing (including delinquent and aggressive behavior), internalizing (including acting withdrawn or signs of anxiety/depression), and attention (including symptoms of ADHD, like an inability to pay attention or to follow directions).

Externalizing and internalizing problems were more likely in low birth-weight children than in normal birth-weight children in the same community. The authors note: “An increased risk of attention problems was associated with low birth weight only in the urban community and was greater among very low-birth-weight children (weighing 1,500 grams or less) than heavier low-birth-weight children (weighing 1,501 grams to 2,500 grams).” They continue, commenting on the other exposures: “In the suburban community, there was no increased risk for attention problems associated with low birth weight. Psychiatric outcomes of low birth weight did not vary across ages of assessments.”

The authors conclude, with hopes that identification of this risk factor could impact children’s early lives. “Attention problems at the start of schooling predict lower academic achievement later, controlling for key factors that contribute to academic test scores, which in turn predicts termination of schooling and curtailed educational attainment,” they say. “Attention problems influence academic performance by reducing the time that students devote to class learning and homework assignments and hinder organization and work habits.”

They finally indicate a need for intervention: “Early interventions to improve attention skills in urban low-birth-weight children might yield better outcomes later.”

Stability of Psychiatric Outcomes of Low Birth Weight: A Longitudinal Investigation
Kipling M. Bohnert, BA; Naomi Breslau, PhD
Arch Gen Psychiatry. 2008;65(9):1080-1086.
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Written by Anna Sophia McKenney