Cognitive and educational outcomes in early adulthood for infants weighing 1000 grams or less at birth

Background: The Neonatal Intensive Care Unit (NICU) can be ethically charged, which can create challenges for health-care workers.Objective: To determine the frequency with which nurses and residents have experienced ethical confrontations and what factors are associated with increased frequency.Design/Methods: An anonymous questionnaire was distributed to nurses in a university center, a high-risk obstetric service, a maternity hospital NICU with 85% in-born patients and an outborn NICU, most of whose preterm admissions are those with surgical complications. Obstetric and pediatric residents in the four universities of the province also received the questionnaire, which included demographics, opinions regarding the gestational age threshold at which resuscitation of a premature infant with bradycardia was appropriate, knowledge of cerebral palsy (CP) outcomes (as an indicator of knowledge about long-term sequelae of prematurity) and questions about ethical confrontation in the NICU.Results: Two hundred and seventy-nine caregivers participated (115 full time nurses and 164 residents). All the distributed questionnaires were completed. Frequent ethical confrontation was reported by 35% of the nurses and 19% of the residents. Among the nurses, moral distress differed significantly between work environments. Nurses working in an out-born NICU and obstetric nurses were more likely to overestimate CP prevalence (P<0.05). Nurses who overestimated CP rates had higher thresholds for resuscitation and were more likely to experience ethical confrontations. Of the residents, 60% were pediatric and 40% obstetric. All groups of residents frequently overestimated the prevalence of CP, and knowledge differed significantly by residency program (P<0.05). The residents who overestimated CP rates had higher thresholds for resuscitation, had more incorrect answers regarding prematurity outcomes and were less likely to have ethical confrontations.Conclusions: A large proportion of nurses and residents report frequent ethical confrontations. Many residents and nurses have limited knowledge of outcomes and high threshold for resuscitation. Ethical confrontation is more common among nurses with poor knowledge about outcomes, and less common in residents with poor knowledge about outcomes.

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“…[8][9][10] We accepted 10 and 15% as reasonable responses. Therefore, 50% of the answers were considered acceptable).…”

Section: Cp Prevalencementioning

confidence: 92%

Moral distress in the neonatal intensive care unit: caregiver's experience

et al. 2007

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“…33 The population-linkage studies have reported rates of CP in term adults of 0.19% in Denmark 6 and 0.13% in Norway. 4 Rates of other sensory impairments are higher in EP subjects than in controls and are generally higher in ELBW cohorts than in VLBW cohorts; bilateral blindness ranged from 7.4% in an ELBW cohort 33 33,34 although in 1 study there was 1 case of deafness of 233 controls (0.4%). 35 In addition to blindness, more survivors of extreme prematurity require prescription glasses than do controls (64% vs 37% in 1 study 29 ).…”

Section: Neurosensory Impairmentsmentioning

confidence: 98%

“…32 Reported rates of CP in adulthood are consistent with these observations and are a little higher in cohorts of those who were either of Ͻ1001 g birth weight or Ͻ28 or Ͻ29 weeks' gestation (13.4% 33 or 7.2% 34 in ELBW cohorts, 9.1% at 23-27 weeks' gestation, 4 or 8.7% at either Ͻ29 weeks' gestation or Ͻ1001 g birth weight 23 ) compared with rates in VLBW cohorts (6.9%, 5 6.6%, 35 4.7%, 36 or 8.5% 37 on self-report), or 4.1% in those born at Ͻ33 weeks' gestation in a population-linkage study. 6 Rates of CP in controls are typically low and mostly zero in cohort studies with concurrent controls, 23,34,35,37 because the sample sizes are relatively small compared with the expected frequency of Ͻ1 in 500. 32 There was, however, 1 case of CP in 133 (0.8%) controls in 1 study.…”

Section: Neurosensory Impairmentsmentioning

confidence: 99%

Adult Outcome of Extremely Preterm Infants

2010

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Survival rates for extremely preterm (<28 weeks’ gestational age) infants have increased and are approaching 3 in 4 with the advent of modern perinatal and neonatal intensive care. In contrast with some children with chronic diseases such as cystic fibrosis, most survivors of extreme prematurity have no ongoing health issues. However, as a group, they do have higher rates of adverse health outcomes, and more of them will present to pediatricians over time and, ultimately, to adult physicians as they grow older. Pediatricians can aid the transition to adult health care by being aware of the nutritional, cardiovascular, respiratory, motor, cognitive, psychiatric, and functional outcomes into adulthood of survivors of extreme prematurity.

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“…These deficits are evident by school entry, persist throughout the school-age years, and are costly to treat (Chaikind and Corman, 1991;Saigal et al, 2000;Pharoah et al, 2003;Roth et al, 2004;Lefebvre et al, 2005). Many survivors have relatively selective impairments in academic skills, possibly related to specific neuropsychological weaknesses (Litt et al, 2005).…”

mentioning

confidence: 99%

Mathematics deficiencies in children with very low birth weight or very preterm birth

Taylor

Espy

Anderson

2009

Dev Disabil Res Revs

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Children with very low birth weight (VLBW, <1500 g) or very preterm birth (VPTB, <32 weeks gestational age or GA) have more mathematics disabilities or deficiencies (MD) and higher rates of mathematics learning disabilities (MLD) than normal birth weight term‐born children (NBW, >2500 g and >36 weeks GA). MD are found even in children without global disorders in cognition or neurosensory status and when IQ is controlled, and they are associated with other learning problems and weaknesses in perceptual motor abilities and executive function. Factors related to poorer mathematics outcomes include lower birth weight and GA, neonatal complications, and possible abnormalities in brain structure. While little is known about the nature of MD in these children, studies of MLD in other neurodevelopmental disorders and in children with learning disabilities provide useful models for further investigation. Further investigation of the neuropsychological and neuropathological correlates of distinct types of mathematics difficulties is also needed. Studies along these lines will yield information about the unique features of MD in children with VLBW/VPTB and about the nature and origins of poor mathematics achievement more generally. © 2009 Wiley‐Liss, Inc. Dev Disabil Res Rev 2009;15:52–59.

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Cognitive and educational outcomes in early adulthood for infants weighing 1000 grams or less at birth

Abstract: ELBW subjects had a mean adult IQ in the normal range; however, it was one standard deviation below that of NBW subjects and they had more school failures. Despite this, more than half of ELBW subjects aged 18 y or more had obtained their secondary school diploma.

Cited by 48 publications

References 21 publications

Moral distress in the neonatal intensive care unit: caregiver's experience

Moral distress in the neonatal intensive care unit: caregiver's experience

Adult Outcome of Extremely Preterm Infants

Mathematics deficiencies in children with very low birth weight or very preterm birth

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