KIDS
September 1, 2009

No Place Like Home

Premature infants face a variety of medical challenges. They may have difficulty breathing and may require extra oxygen or a respirator. They may develop serious infections because of their immature immune systems. They may have abnormalities of their underdeveloped hearts, circulatory systems, or kidneys or they may develop bleeding in their brains. They may have difficulty taking in and absorbing enough nutrition orally and may require special intravenous nutritional solutions.

Both the medical complications of being born too early and the treatments that are used to combat these problems carry short and long−term risks. Normal physical, mental, and emotional development can be threatened and many former premies have learning disabilities as well as physical disabilities.

The greatest risk for decreased school readiness was not past or current medical history, but low socioeconomic status.

By the time children reach school age, they need to have developed certain skills to be prepared to learn to read and write, follow directions, interact socially with their classmates, and to be able to feed and relieve themselves in order to be successful in the classroom setting.

What are the best ways to help preemies “catch up” to their full−term peers? A recent study in the July issue of the journal Pediatrics looked at the factors which negatively and positively impacted school readiness in 135 premature infants' medical and social histories. (1) All the infants in the study had required ventilator support and medication to help their breathing. Their medical records from infancy were reviewed for information about how early they were born, their birth weights, what types of medical problems they had in the nursery and what treatments were needed, and what chronic medical problems and treatments they required when they went home When they were 5−6 years old, their caretakers provided information about their special education needs, their current health problems, and their ongoing need for medications or special equipment for feeding, breathing etc.

The children underwent neurodevelopment and school readiness testing and assessment of their health. Their families' socioeconomic status was determined by obtaining the head of household's highest educational attainment and their current occupation. Of the 135 premies, one−third were not ready for age−appropriate school. Of the group that was ready for school, 15% required special education services.

The researchers found that being male, having a non−white mother, and having a lower birth weight were negative factors in neurodevelopmental outcome. Boys were twice as likely to have lower school readiness than girls. Lower socioeconomic status was linked to decreased thinking and reasoning skills when the children were tested at two years, and at entry into kindergarten.

Many of the children received Early Intervention (EI) services. While socioeconomic status did not influence whether a child received these services, children who were more socially advantaged and had Early Intervention were more likely to be ready for school than those EI participants who were less socially advantaged.

The researchers found the greatest risk for decreased school readiness was not past or current medical history, but low socioeconomic status. They thought perhaps this was because families with lower SES had social/family environments that did not contain as much stimulation, developmentally appropriate interactions with caregivers, and exposure to oral language, books, toys, and other materials that stimulate the development of thinking skills. They also speculated that other problems of having lower socioeconomic status, such as poor nutrition, decreased access to community resources, single−parent household, and increased psychological stress in the family might contribute to the poorer developmental outcome of the preemie.

The researchers concluded that excellent medical management early in life, while of course important, is not enough alone to give preemies the support they needed for normal or near−normal development. The child's home environment plays a major role in influencing the long term mental and physical development of premature infants.

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