The continuing effects of low birth weight

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CNNTINUIIIIG _EFFECTS

LOl|,| BIRTH },|EI6HT

A Tnesls Sus,mrrrED To rrre UnTvERSITy _oF Auct<r-nnto [N FururrlumeNT CI rHE ReoutREMENT$

FoR THE DeeRrr or Docron

sr

PHILosopFty

BAF{ION

A.

MacARTI{UR.

.

L97'7

flhe h.i,s&.org af, mten fo'r ^{&ke nilme nonfrha} preeeding lt^i.s b,i,.tth uowld., probablg, be

fan ^move dntepeab,i,.ng' and eombaf;n etewta

af

^grea*efr ffiatft€t&* tha'n aL|; the *k:ree-aGa?€

err,d ten gaa#s

that fottaw

4t.

$arnueL Taylor Coleridge 1772-t 834)

'ltLgce-llanies, Aesthet{c ^{and f,.,itera} tr'

4750 4500 4250 4000 3750 3500 3250 3000

?750

2500 2250

2000 1750 1500 1250 1000 750

500

NEWBOBN CLASSIFICATION AND NEONATAL MOBTALITY RISK

BY BIRTH WEIGHT AND CESTATIONAL AGE

29 30 31

32

33

U

35 36

37

38 39 40 ⁴¹

PRE-TERM I

I ^renvr

WEEKS OF GESTATION

Interpolated data irased on mathematical ^f it ^f rom origirral data UniversitV of Coloraclo Medical Center newltorns. 111158'711169

Lufrchenc.j, L.O., SeJrls. D.T., ancl Brazte, J.V., Jl. of Fediat.,

8r:1, ^pp 814.822 (Oci) 1972, C,V. Mostty Co., Sl. LoL|s. Mo.

Distribirted bv Mead Jolrn:;ort Laboratories Evansvrlle, lrrdrana 47721 LJ.S.A

42

I

28 43 44 45 ⁴⁶

POST.TERM 24 25 26 27

TNSTRLICTIONS

At the time of adrnission to the hur erv. the infant's birth weight and gestatlonal _agF are plotted on the Chart by the nurse, using thd estimat€d age caloula:ted frorn the flrst day of the last menstrual period.

The method dessribcd in the reprint _Brov'ides a convenignt means; sf defining PrdTerm; Teirn, and ^Post-Term infants. And, the rnprtatlty, risk makes possible,a drrcl3ion as to type of rnursery care needed for an

individual infar,rt. In addhion, all iLnfants who harre any'significant ilinicat ^problom, re,gardles of classifieation, stpqld be admitted to a high-risk nurseny.

The advar,rtagee of setting up such a routinG qn a nurdery servie are considerable. First, it en ures that all infants in a high Neonatal

Mortallty Rate,gfoup l.vill be sbeerved closely. Secondly, it makes it a great deal more oonvonient for house staff or attending staff to identify srnalhfor-gpstational-age and large'for-gestati'onal-age infants . . . partic-

ularly in seBarating emall-for"g*tational-age Term infants frorn appropriate-for:gestatlonal-age Fre.Term ^ri nfents.

Battaglia, F. C.,. Lubchencs, L. O,. J, Pediat.., 71:169; 1967

Lubdrenccr. L. O.. Searl8., D. T.r Lubchencor L. O,, J" Pediat,. 8l:814, 19.'12

Date oi Frrnths:

"*'"*"-{rrl

ACKNOI,TLEDGEMENTS

It is important that the assistance of so many

who contributed to this study shourd be recognised. Not

only did their efforts make the work possible but they

also demonstrated both ttre possibilities and the benefits of multidisciplinary _research.

First I would like to thank professor _R. Winterbourn

for his patient and meticulous supervision and Associate Professor R.N. Howie for the many hours he has contributed to the work over the years as med.ical consultant.

Grateful thanks are also due to Dr. A. Warren of National ^{Inlomen I} s llospita1 and his staf f for their co-

operation, to Professor D. ^Bonham for his interest, and

to Special Duties Sisters 1"1. Barnes, S. Coenraadts, A.

Dezoete and M. Tretheway for their conscientiousness and

to Mrs. P. Fulrjames for her assistance with clerical work.

f would like to express my thanks to Miss E. ^Leaming for assistance with retrieval of research literature.

In my orvn Department I would. like to express my

appreciation to Mrs. M. Klippel for assistance in ana}ysis and proof reading and to Dr. Arvidson and Mr. Gill for their help with statistics and computer analysis.

For the typing of the thesis and her patience I ^am grateful to Mrs. B. McKenzie.

To these may be ^added the mothers of the children in the study, headmasters and teachers and all those who

helpecl with the arrangement of visits, the tracing of

subjects, the translation of articles and rnany other tasks.

i-v

ABSTRACT

Perinatal associations of low birth weight and its long term sequelae were surveyed and the resulting

hypotheses examined in a study of zLa children classified by birth weight, gestational age and sex.

Subjects were placed in small for gestational dg€,

pre-term.appropriate for gestational a9€, controlr pr€- term small for gestational age, Iow birth weight with gastroenteritis and very low birth weight groups.

Assessment was blind. and, where necessary, ^groups were randomry selectecl. Data r.rere gathered from four stages of the subjects'd.evelopment; the ^pregnancy, the ^newborn period, pre*school and school age.

Analysis of ^pregnancy data showed that some aspects

of the intrauterine environrnent provided by a number of mothers was less than optimal.

In the neonatal per5.od, the low birth ^we j-ght _groups were at some disad.vantage and, further, there were aspects where there was some evidence that either the treatment or

the conCition for which it was required could possiblq influence subsequent development. J

The pre-school period was marked by sex differences, particularly in cognitive functioning. Disadvantage in all instances was confined to the low birth weight male

groups. Some events in the prenatal, perinatal and.

neonatal periods aBpeared

to

be associated,

with

_trroorer

perf,orrnanee on intell,igence

test8

rnore than

four

^y.ears l,ater.

Among these inf:luences were rnothers' smoking

habitss, ternlleraturen duratJ.on

of

tube feedi.r,rg and

gastroen

,eritis while in

hospi,tal..

Assesl,sraent

at

school revealed

the

sane Battern

of

cognitiv'e develoSmrent among

the

subgrouBs

that

had b-een apparellt

at

ttre pre-schsol _stage-

The pre-term mdles found adjustnrent

to

school

diffi.oult

and rnade srow prrogress

in

reading

in

comparis.on

with the

feurares b-eLongi.ng

to the

same

group.

At, thi,s age

the

ter:m

*

_small

for

gestational _age grolrp was

stir.l

laEging behind

in

phlrslcal deveJ.opment.

trt was eonc'l.uded

that

Lhe Lorr bLrth weight maLes

consti.tu'tect

a

^group who were !,at rj,shr because

of

^sn-ower

coEniti.ve development, _Thls was

particurarly

evi.denb

in

eo

far

as the pre-terrn males r+rere con,c,erned.

TABLTE 0F coNTENTS

Ac ^k lrow I ed,gfemer r t 6

List, ,ot Figuree Chapter One IbilI'RODUCTTON

Chapter Tua

REVTEW OF EHE TTTERAtrT'RE

Ilypotheses Chapter T,lwee RESEARCII PROCEDURES

Fopulation

CrLteria

for

establ$.shing _Eroups Exglusions

Sel"ecti.on of, strbjects

Description

of

research procedures Assessment instrumeRts eryloyed

.

Socio-econodiie status

StatisticaL

,methods

Chaptev _Eour SIIE PREGtilAlilCY

-

^REgttI,TS

Chapten E',f;te

1TIHE PBEGNAI$CY - ^DISEUSSTON

Surnmary

iv ix

Bev,iew

of

^.Ehe ernpirie.al"

iiterature

Causes

of

low

birth

weight and, prematurity

v

7 51 75

1,8

78

8I

95

.1J-2

IJ.5

1r7

131.

138

143

232 255

vii

rHE

THE

ITIIE

TITE

fHE

TI{E

ehaP'ten ^gda

NEOhIATE

-

^RESUTTS

Ch,apter S,epen NEONATE _ _DTSEUBSION

Summary

Chapten Eight

FRE-SCHOO& C$ILD

-

^RESUIJtss

Medieal ancl pftysicaL _faertors Maternal factors

Social dev,eloprnent

Cogait_ive eveLopment

Aesoqiation

of

eerbaln events during the p.renatal, perinaLal _{and neoniiaL}

perC.ods wi.th eognitive d,evelopment Chapten _Nine

FRE-SCHOOL C-HILD

-

TDISCUS,SION

Sununary ^.

Ahapter Een

SCHOOL CHII,D

-

^RESULTS

Phlrsi.ca1 developrnent. and health Cognilive clevelopment

School adJustrnent and! aeadernia progress Chap.t.et _Eletsan

SCHOQI, CHTI,D

-

^DISCUSSION

Srlnrnary

Cl+aptex Taalue

259

3I0

340

344 344 365 392 394

410

50.3

503 513.

5:18

533 547

550 582 674

Iimited

448 496

CONCI,USTONS

App.endices References

NorE:

sr:bhead-ings

in

the Tabre

of

contents are

to

major areas only.

vii.:i

LIST OF FIGURE.S

2.1

IntelLectual

ability at

,age 5

to

? ^year,s

by ^s,o:ci,a1 grade an:d. bLrth

r+eight

3g

8..1

IntelJ-igence

test results for

males at

age 4 years ₉

rnonths

_39g

8.2 Intelligence test results for

females

at

agie 4 _Xrears 9

rnonths

400

8.3 Frostig

Test

sf

^{Vis-ueL perception}

re'su1ts

for

rnales

at

a,ge 4 _Srears 9 rngnths. 405

8.4

_Frostig Test,

of

Visual ^perception

results for

fenrales

at

age 4 years

t

,ooOn"n',

tro.I

Wo..rd Reading Te,s,t

results

aft,er ^olre _}r€&r

at schooL

S,ZT

Lx