Psychological development of prematurely born children.

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 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) be-havioural and emotional status ranging from individual diVerences 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 (that is, into school age to assess the full spectrum of abilities and behaviours); (f) include diVerential reports of subpopulations (for example, according to social class, small for gestational age v appropriate for gestational age, single v multiple birth, ELBW v VLBW); and (g) be conducted by independent (group blinded) psychology researchers not involved in the neonatal care of the infants under investigation. Unfortunately, most reports to date are single centre studies (mostly regional or university centres of excellence), have inadequate descriptions of study populations and those lost to follow up, most included no same aged comparison children, ended in the preschool years, and were often conducted by those also involved in the neonatal care of the children. 3 These limitations have serious effects on the conclusions reached and usually result in underestimation of the true rate and prevalence of developmental deficits. 4–6 Particular emphasis should be placed on findings from controlled investigations. Cognitive development Uncontrolled studies have reported that VLBW children have intelligence quotients (IQs) in the normal range but up to 0.5 …