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CHILDHOOD BEHAVIOURAL PROBLEMS ASSOCIATED WITH LOW BIRTHWEIGHT (p 1641)

May 23, 2001

Low birthweight may be associated with the behavioural problems of attention, thought, and social difficulties in childhood which is unrelated to the cultural environment, conclude authors of a study in this week's issue of THE LANCET.

The increased survival chances of extremely low-birthweight (ELBW) infants (weighing 1000 g or less at birth) has led to concern about their behavioural outcome in childhood. In reports from several countries with different assessments at various ages, investigators have noted a higher frequency of behavioural problems in such infants, but cross-cultural comparisons are lacking. Elysée Hille from TNO Prevention and Health, Netherlands, and colleagues aimed to compare behavioural problems in ELBW children of similar ages from four countries.

408 ELBW children from the USA, Canada, Netherlands, and Germany aged 8-10 years were prospectively studied. Parents completed the child behaviour checklist. This measure provides a total problem score consisting of eight narrow-band scales: anxious, somatic, and withdrawn behaviour (these three give an internalising score); aggressive and delinquent behaviour (giving an external score); and social, thought, and attention difficulties. Scores for ELBW children were compared with control groups of children in all four settings.

ELBW children had higher total problem scores than control children, but this increase was only significant in European countries. Narrow-band scores were raised only for the social, thought, and attention difficulty scales, which were 0·5-1·2 SD higher in ELBW children than in others. Except for the increase in internalising scores recorded for one population, ELBW children did not differ from control children on internalising or externalising scales.

Elysée Hille comments: "Despite cultural differences, types of behavioural problems seen in ELBW children were very similar in the four countries. This finding suggests that biological mechanisms contribute to behavioural problems of ELBW children. Medical advances could result in increased survival of extremely immature and sick babies with a high risk for cerebral problems. Children born with an ELBW, irrespective of culture, are at risk of attention, social, and thought difficulties. Prospective monitoring of these children for development of behavioural problems is advisable to prevent subsequent learning and social integration difficulties".

Contact: Dr Elysée T M Hille, TNO Prevention and Health, Child Health Division, PO Box 2215, 2301 CE Leiden, Netherlands; T) +31 71 518 1671; F) +31 71 518 1920; E) Et.hille@pg.tno.nl

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