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UAMS Scientists Confirm Link
between Premature Birth and Later Learning, Behavioral Problems
| 08-16-02
(Little Rock) Scientists at the University of Arkansas for Medical
Sciences (UAMS) reported in the Journal of the American Medical
Association (JAMA) today [8-14-02] that premature babies are
more likely to have significant learning and behavioral problems
after the age of five years than babies born full-term.
Using sophisticated statistical
methodology to analyze 20 years of research around the world, the
scientists at UAMS confirmed that children born prematurely have
much lower cognitive scores, with lower-than-average learning
ability, and more behavioral problems after the age of five years
than children born full-term.
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Dr. K. S. "Sunny" Anand
(Arkansas Children's Hospital)
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The scientists call for "concerted efforts of clinicians and
neuroscientists to [study] the biological, environmental, and
psychosocial mechanisms responsible for these cognitive and
behavioral differences."
Children born prematurely have been found in numerous studies to
have "huge differences" in cognitive scores, and to be
aggressive or withdrawn or suffer from attention deficit
hyperactivity disorder. However, researchers who conducted the
other studies over the years used a variety of population groups
and research methods, making the body of knowledge about the
effects of pre-maturity questionable.
K. S. "Sunny" Anand, MBBS, D.Phil., FAAP, FCCM, FRCPCH,
led the study, called a meta-analysis. Dr. Anand is the Morris and
Hettie Oakley Chair in Critical Care Medicine in the Department of
Pediatrics in the UAMS College of Medicine and chief of critical
care at Arkansas Children’s Hospital. The National Institute for
Child Health and Human Development and the Blowitz-Ridgeway
Foundation provided research funding to the Arkansas Children’s
Hospital Research Institute for the study.
The scientists analyzed 227 studies, eliminating studies that had
methodological problems, before drawing conclusions from the
remaining studies. Their analysis should "eliminate
controversies" about the importance of pre-maturity for
long-range outcomes.
While the relationship between pre-maturity and later learning and
behavioral problems is now clearer, the actual causes of those
problems in children born prematurely are not yet clear.
The UAMS investigators speculate in JAMA that the medical
complications of pre-maturity; the painful medical procedures that
many premature babies experience in hospitals; and prolonged
separation from their mothers all may contribute to
lower-than-average brain development and thus to later learning
and behavioral problems. They also point to the stress and
depression that having a premature baby can cause for parents,
particularly mothers, as a potential factor in the children’s
later developmental problems.
Dr. Anand commented recently that the increasing survival rate for
extremely low birth weight and premature babies means that "a
larger and larger pool of children" will have developmental
problems "as times goes on … and the incremental costs of
educating these children are likely to be astronomical."
"With an improved understanding of the underlying biological
mechanisms, we can begin to develop more focused therapeutic
interventions to decrease or prevent these long-term impairments
following survival after pre-term birth," the scientists
conclude in JAMA.
The following investigators, all with UAMS, collaborated
with Anand: Adnan T. Bhutta, MBBS, FAAP, assistant professor of
pediatrics; Mario A. Cleves, Ph.D., associate professor of
pediatrics and senior bio-statistician, Arkansas Center for Birth
Defects Research and Prevention; Patrick H. Casey, M.D., FAAP, the
Harvey and Bernice Jones Professor of Developmental Pediatrics;
and Mary M. Cradock, Ph.D., assistant professor of pediatrics. The
researchers formulated a novel method for assessing the quality of
observational studies which other scientists will now be able to
use.
Anand also is conducting multiple studies of the relationship of
pain to brain development in premature infants. By observing the
progress of premature infants who receive pain medication in
conjunction with painful medical procedures, and through
laboratory experiments, he has formed the hypothesis that
repetitive pain in the first weeks of life causes the death
or damage of certain brain cells and may consequently reduce
learning ability and alter behavioral development. As part of this
research, Anand is participating in a nationwide study of the use
of pain medication to reduce or eliminate pain during essential
medical procedures for premature infants. The National Institutes
of Health are sponsoring the study at 11 centers around the nation
and four hospitals in Europe.
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08/16/02 |
