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Marie C. McCormick, MD, ScD; Jeanne Brooks-Gunn, PhD; Kathryn Workman-Daniels, PhD; JoAnna Turner; George J. Peckham, MD

JAMA. 1992;267(16):2204-2208.

Abstract
Objective.
—To assess the effect of improved survival of increasingly premature infants by examining the outcomes at school age of a large group of children born at different birth weights.

Design.
—Inception cohort.

Setting/Participants.
—Participants were selected from two previously studied multisite cohorts: very low—birth-weight (1500 g) children referred to participating intensive care units and heavier birth-weight children drawn from a stratified random sample of births in geographically defined regions. Follow-up at 8 to 10 years of age was by a combination of telephone interview and home/clinic visits for 65.1% (1868) of those eligible.

Main Outcome Measures.
—The presence or absence of 17 specific conditions, limitations in activities of daily living due to health, mental health (affective health, behavior problems), and, for a subset, IQ scores.

Results.
—Decreasing birth weight was associated with an increased morbidity for all measures except affective health; those with birth weights of 1500 g or less were more likely to experience multiple health problems. Maternal educational attainment did not influence the association of birth weight with morbidity except for IQ among children whose birth weight was above 1000 g, for which socioeconomic disadvantage worsened the status of all children irrespective of birth weight.

Conclusions.
—Children born at lower birth weights experience increased morbidity at early school age. These results reinforce the importance of postdischarge, early intervention programs to reduce the risk of these later health problems.

(JAMA. 1992;267:2204-2208)

Author Affiliations
From the Department of Maternal and Child Health, Harvard School of Public Health (Dr McCormick), and Joint Program in Neonatology, Department of Pediatrics, Harvard Medical School (Drs McCormick and Workman-Daniels), Boston, Mass; Columbia University, New York, NY (Dr Brooks-Gunn); and Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia (Pa) (Ms Turner and Dr Peckham). Dr McCormick was formerly with the Division of General Pediatrics, Children's Hospital of Philadelphia.

Footnotes
The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the US government.

Reprint requests to Department of Maternal and Child Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (Dr McCormick).

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