The risk of developmental and behavioral problems in many of the 250,000 babies born underweight in the United States each year can be reduced dramatically through early educational, medical and family support, a pioneering new study has found.
The findings, published today by researchers at Stanford University, suggest it may be possible to significantly improve the human potential and quality of life of many of the premature, low-birth-weight infants kept alive through recent advances in medicine.
“We are putting out a population of babies at increased risk over time as our technology gets better,” said Dr. Ruth T. Gross, who headed the study. “It’s extremely important to look at the quality of life for these children and the cost of giving them a decent life.”
“If I were a school superintendent, this is a program that I would go to the barricades for,” said Dr. Julius Richmond, a professor emeritus of health policy at Harvard University and the first director of the Head Start preschool education program.
The nationwide study of 985 premature, low-birth-weight babies found that those enrolled in an early intervention program in the first three years of life scored up to 13 points higher than others on IQ tests and were half as likely to develop behavioral problems.
The program entailed not only regular pediatric care and monitoring but also weekly and biweekly home visits from a trained professional, weekday attendance at a child-development center and support-group meetings for parents.
By the end of the study, the children not enrolled in the program were nearly three times as likely as the others to have IQ scores in the range of mental retardation. They were nearly twice as likely to have the kind of behavioral problems that predict later difficulties.
“I think that tells us we can improve the lot of children who are both biologically and environmentally at risk,” said Dr. Clifford Sells, a professor of pediatrics at the University of Washington in Seattle, who worked on the eight-city study.
“If we don’t take care of these children and provide appropriate programs, the ultimate cost is going to be greater,” he said. “And from the humanistic point of view, I think it’s right that we provide these at-risk kids . . . the best chance to make it in this society.”
Economists at Stanford University have calculated that the cost of such a program, if adopted on a broad scale, would be approximately $8,000 to $10,000 per child per year--the same price tag the federal Government Accounting Office has put on high-quality day care.
No early intervention programs geared to premature, low-birth-weight babies currently exist on a broad scale in the United States, specialists said. There are, however, programs such as Head Start that cater to socially and economically disadvantaged children.
Over the last decade, advances in neonatology have made it possible to save the lives of smaller and smaller babies. But studies suggest that such infants face a higher risk of developmental delays and medical problems than do normally sized babies.
Children born at low birth weight--5.5 pounds or less--tend to score lower in later life on IQ tests. They are more likely than others to have difficulties in behavioral adjustment, learning problems and poor academic achievement.
Some specialists have long suspected that early intervention might help. But studies of the subject have been small. And it has been unclear whether day-care programs designed for normal children might be risky for low-birth-weight children, who are often in poorer health.
Gross, a professor of pediatrics at Stanford, recruited researchers from eight universities, including Harvard, Yale and the University of Arkansas. They then recruited 985 babies born at less than 37 weeks’ gestation and at low birth weight.
One-third of the babies were assigned randomly to take part in the early intervention program. The others received only pediatric care. The study period lasted 36 months, although the researchers are continuing to track many of the participants.
The most striking results were in the area of cognitive development: Children in the intervention group scored 6.6 to 13.2 points higher on IQ tests than the other children. (Those lightest at birth showed less improvement than those who were heavier at birth.)
The behavioral problems covered in the study ranged from shyness and a tendency to withdraw to aggressiveness and acting out. Those tendencies in infants are believed to predict similar tendencies in later life.
The researchers found that the program did no significant harm to the health of the medically vulnerable children. Although it involved group day care, the children experienced only a small increase in minor ailments and no increase in major health problems.
Specialists in childhood development noted that the findings, which they called scientifically solid, come at a time when the federal government has offered states the opportunity to develop early intervention programs for developmentally disabled children.
Under a new federal law, states can receive federal funding to plan preschool programs for handicapped children starting shortly after birth. Such programs can include children believed to be at risk for developmental delays.
“This comes at a time when parent groups and people generally have been pressing for better programs for children at higher risk,” said Richmond, a former U.S. surgeon general. “The data have not always been there, so there is a certain timeliness about this.”