The Tiniest Preemies May Struggle with School and Adult Life


Although extremely preterm birth is no longer the death sentence it once was, many of the tiniest preemies still struggle in school and have a harder time as adults, two new studies suggest.

One study focused on the most vulnerable subset of preemies: those born at no more than 28 weeks gestation. More than half of these infants went on to have moderate to severe cognitive deficits and had academic test scores well below average.

The second study looked at babies born before 32 weeks gestation. By the time they reached adolescence and adulthood, these individuals were more likely than their peers born full term to think that health problems lowered their quality of life.

“In terms of extremely preterm infants, there are multiple reasons why we are seeing deficits and poor performance later,” said Dr. Margaret Kern, a researcher at the University of Melbourne who wasn’t involved in the studies.

“Biologically, there is a lot of key development that occurs across the cycle, and when that is cut off very early it raises risk—like an uncooked cake, there isn’t enough time for things to come together fully.”

Kern added that some of the same things that may have contributed to their early arrival may also make it harder for preemies to get help in overcoming developmental deficits.

“There are a whole host of related issues involved, including less knowledge and education by the mother and father, if involved in the life at all, which often is not the case, and poor nutrition and other health behaviors,” Kern said.

Soon after birth, premature infants often have difficulty breathing and digesting food. Some preemies also encounter longer-term challenges such as impaired vision, hearing, and cognitive skills as well as social and behavioral problems.

“The life-saving medical care these infants receive in neonatal intensive care units can contribute to developmental deficits, said Jill Zwicker, a pediatrics researcher at the University of British Columbia.

“At this time of rapid brain development, these infants are exposed to procedures for their medical care, such as heel pokes to draw blood, tube insertions to help them breathe, medications etc.,” Zwicker said. “Exposure to these invasive procedures is associated with slower brain development and poorer cognitive outcomes.”

Joseph added that it’s possible that inflammation may increase the risk of developmental problems, and scientists are working to understand how these things are connected and develop treatments to address the effects of inflammation after birth. However. the studies published in Pediatrics were not designed to prove cause and effect.

By adulthood, lower quality of life can be influenced by economic and social factors, independent of whether people were preemies or not, noted Dr. Dieter Wolke, a psychology researcher at the University of Warwick in the U.K. and senior author of the paper on teen and adult quality of life.

“Sometimes, people think health issues diminish their quality of life even when this isn’t the case,” Wolke said.

I have known and taught many mothers of premature babies, and just for the “other side of the glass,” I would like to share a letter I received fairly early in my infant massage classes:

    Dear Vimala,
            I wanted to personally write and thank you for the invaluable contribution you made to my children.
My son was born addicted to a drug that I had been given to stop seizures from toxemia and premature labor. Additionally, I was treated several times with other intravenous drugs. Throughout the pregnancy, repeated physicians scolded me and my husband for continuing the pregnancy. We were assured that our baby would be handicapped, a “vegetable,” and so on. We fought hard and well as he survived to thirty-eight weeks gestation, born at a robust eight pounds, fifteen ounces. It was soon obvious that his nervous system was badly affected by the drugs and stress.
           He cried endlessly or slept nonstop, missing feedings. If he was startled, his little arms and legs would jut out and shake uncontrollably. The doctors suggested more drugs to calm him. They again asserted that his nervous system (and probably brain) were irreparably harmed. A wonderful neighbor and breastfeeding professional came to our rescue. She taught me your methods of infant massage to calm him and showed me how to swaddle him to prevent jarring his sensitive nervous system. To make a long story a tad bit shorter, he grew to be an inquisitive and absolutely delightful toddler. The shaking subsided, and a brilliant intellect came forth combined with an energy that was tiring to us poor adults. Today, my supposedly “handicapped” child is in college, a National Merit Scholar, a recognized leader, a wonderful volunteer worker, and engaged to be married to a dynamic and equally bright young woman. He was nationally recognized as a teen and was offered more than $375,000 in scholarships. He works with severely handicapped adults and plans on being a physician.
           My second son was also the product of a terribly high-risk pregnancy. Drug therapies were a bit more advanced and, with the help of diet, controlled the toxemia. He was born with noted neurological deficits. By the age of five months, we were cautioned that he had begun to show the symptoms of autism. He was highly irritable and, to put it simply, a challenging baby.
           I once again drew on my experience with massage. The tension in his little limbs would melt away, and he remained in contact with the world. I kept him close to me, leaving him only with caregivers for short periods of time who were willing to comfort him as needed, to hold him, massage him. Though still plagued with a few problems, he is a very bright and caring sixteen-year-old. He is already doing computer design for toy and software companies.
           Without the help of my neighbor who had studied your techniques, I do not believe that either of these young men would be where they are today. I believe that their intellectual, physical, and emotional development is attributable to the comfort they received as infants. How can I ever thank you? Please know that this mother will be in your debt forever.
                                A grateful mother