Impact of Very Low Birth Weight on IQ and School Performance

Very low birth weight affected some neurocognitive abilities and need for remedial education, but not grade average or level of educational attainment in a case-control study. In this case-control study, the authors examined the effects of very low birth weight (VLBW), prematurity, and intrauterine growth restriction on IQ, neurocognitive abilities, and history of school performance in young adults. The 103 VLBW patients weighed <1500 g at birth, had a mean gestational age of 29.3 weeks, and were treated in a single university hospital neonatal intensive care unit in Finland between 1978 and 1985. Sixty-six had a birth weight appropriate for their gestational age (AGA); 37 were small for gestational age (SGA) a marker for intrauterine growth restriction. Individuals with neurosensory impairments (cerebral palsy, developmental disabilities, or blindness) were excluded. The 105 control participants were born at term and were matched to case patients for sex, age, and birth hospital. At a mean age of 25 years, participants underwent neurocognitive testing. Mean estimated IQ was significantly lower in the VLBW group (102.2) than in the control group (110.6). Adjusting for parental education and head circumference slightly attenuated the IQ difference. IQ did not differ significantly between the AGA and SGA groups (mean IQs, 103.2 and 100.4, respectively). Some measures of neurocognitive ability were lower in the VLBW group than in controls. Although the VLBW group was significantly more likely than controls to have needed remedial education (fully adjusted odds ratio, 2.66), grade-point averages and education level attained were no different. Comment: Although this 2-decade follow-up of individuals born at VLBW found a lower mean IQ and more remedial education compared with those born at term with normal birth weight, it is clinically significant that the average IQ of the VLBW group was within the normal range. In addition, grade-point average and years of completed education did not differ from those of controls. Hence, whether the differences have any functional impact is unclear. The exclusion of those with neurosensory impairments or developmental disabilities limits the usefulness of these findings in early counseling of parents with VLBW children, as such impairments may not be apparent in the first few years of life. However, clinicians can counsel families of children similar to those in the study that, although their child may be more likely to need extra help in school, we expect the child's IQ to be in the normal range and that their child's academic performance will be similar to that of their full-term peers. Amy Gelfand, MD Dr. Gelfand is Clinical Instructor, Department of Neurology, Division of Child Neurology, University of California, San Francisco. Published in Journal Watch Neurology January 10, 2012

REACTION: