Extreme preemies disadvantaged in employment, income, self-esteem, marriage and more by their 30s

Published today in the scientific journal JAMA Pediatrics, the findings come from a longitudinal study that has followed a cohort of ELBW survivors since their birth between 1977 and 1982.

Dr. Saroj Saigal is the principal author of the study and a professor of pediatrics for McMaster's Michael G. DeGroote School of Medicine, with collaborators from the departments of psychology, and psychiatry and behavioural neurosciences. She is also a pediatrician with Hamilton Health Sciences.

Her study compared 100 ELBW survivors -- born at less than 2.2 pounds (1000 grams) -- to 89 control subjects of normal birth weight (NBW) -- born at more than 5.5 pounds (2500 grams) and more than 38 weeks of gestation. The participants, now aged between 29 and 36, answered a series of questions on a broad range of medical, social and psychiatric outcomes tailored to young adulthood.

On the positive side, the results of the survey showed that in their early 30s, the ELBW survivors have the same levels of education, family and partner relationships and report fewer risky behaviours compared to their normal birth weight peers.

Otherwise, the ELBW group is less likely than NBW peers to be employed (80% versus 92% of NBW), less likely to have a full-time job (62% versus 77%), and they have an average of $20,000 less in personal income. More of the ELBW survivors are single (51% versus 35%), more have never had sexual intercourse (21% versus 2%), and fewer have children (20% versus 33%).

One in five ELBW survivors suffer from neurosensory impairments such as blindness and cerebral palsy, and when these individuals were taken out of the survey's results, the differences in employment, marital status and children are no longer significant.

However, excluding ELBW survivors with impairments, there remain significant differences in personal income, lower self-esteem, alcohol abuse over their lifetime, learning disability, ever having sexual intercourse, mental illness, vision problems and chronic illness between the ELBW survivors and their NBW peers.

Saigal said the findings are departures from the survey results a decade ago of the ELBWs in their early-to-mid 20s, but the results are not entirely unexpected.

"We didn't see any major differences between the ELBWs and NBWs then, but they were still very young and just transitioning into adulthood," said Saigal. "But now, they are older and are facing a competitive labour market where jobs are scarce. Also, the high proportion with neurosensory impairments accounted for many of the differences between the groups."

Nevertheless a significant proportion of ELBW adults are employed and living independently and contributing well to society, Saigal said, adding that her team plans to continue to track the outcomes of the ELBW survivors.

"To our knowledge, this is the first longitudinal study of ELBW infants followed from birth into their fourth decade of life, and this is going to have wide-reaching application moving forward. We've learned a lot since then, and as a result of better nutrition and technological advances, survival of ELBW infants has now nearly doubled."

She added: "It is difficult to predict what the future will hold for these ELBW adults as they reach middle age. We also need similar studies on newer ELBW survivors to obtain a better understanding of the most pressing issues and to develop effective intervention strategies."

This study was funded by a Canadian Institutes of Health Research (CIHR) team grant.