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Psychological development of prematurely born children
  1. D Wolke
  1. University of Hertfordshire, Department of Psychology, College Lane, Hatfield, Hertfordshire AL10 9AB, UK
  1. Professor Wolke.

https://doi.org/10.1136/adc.78.6.567

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    Improvements in antenatal care and advances in neonatal medicine have resulted in increased survival of infants, in particular those of very low birthweight (VLBW) (< 1500 g) and extremely low birthweight (ELBW) (< 1000 g). If simple gain in life years is taken as a standard, then neonatal care is the most successful discipline in medicine today.1 The psychological development and quality of life of VLBW and ELBW children has become an increasing focus of recent research.2

    Key messages

    • Approximately a quarter of VLBW children have severe or multiple psychological problems and a further quarter have moderate to mild problems

    • Lowered IQ, attention deficit, and schooling problems are the most prevalent psychological difficulties of VLBW children

    • Larger preterm infants (LBW) are only at a slightly increased risk for long term psychological deficits

    • Postdischarge environment can often reduce or compensate for neonatal risk in LBW children. Evidence for compensatory processes in VLBW infants after discharge from a neonatal intensive care unit are much more limited and disappointing

    Domains of psychological development

    The psychological development of the preterm child has been considered in four main domains: (a) cognitive development (for example, intelligence, memory, language); (b) behavioural and emotional status ranging from individual differences such as temperament to behavioural problems such as hyperactivity, phobias, or enuresis; (c) social functioning—that is, the ability to form and maintain social relationships with adults and peers and to reflect on these relationships (for example, self concept); and (d) school adaptation and failure.

    Follow up research methods

    To provide reliable, valid, and generalisable information on the psychological developmental outcome of VLBW infants the ideal study should: (a) be prospective; (b) be based on large populations (geographical, epidemiological, or multicentre studies); (c) have few infants lost to follow up or good documentation of the dropouts; (d) include full term control groups for cohort specific comparisons; (e) be long term …

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