Other Medical Issues
While neurological issues delays are primarily responsible for the functional developmental delays in children other complications can also affect the development of a preterm child. These problems include: cardiovascular complications; respiratory problems such as respiratory distress syndrome or chronic lung disease; a number of severe metabolic and gastrointestinal problems that can result in delayed growth and other problems; immune system problems, such as susceptibility to infections or diseases like pneumonia; and hematologic complications (Saigal & Doyle, 2008).
Neurodevelopmental Sequelae
Cerebral Palsy
Cerebral palsy is a heterogeneous group of neurologically-related disorders that can involve central nervous system functions as well as other functions such as leaning, movement, vision, hearing, and cognitive speed (Saigal & Doyle, 2008). As a result there are several variations of cerebral palsy including dyskinetic (mixed tone in the muscles that leads to difficulties with posture and movement), spastic (increased muscle tone leading to stiff and jerky movements), ataxic (poor coordination and loose/low muscle tone leading to floppy movements), and mixed (two or more of the other types are present).
Across most studies the incidence of cerebral palsy in preterm children is negatively related to weeks of gestation, although some studies indicate curvilinear trends (Saigal & Doyle, 2008). Therefore, both the prevalence and severity of cerebral palsy in preterm infants will general ly vary depending on the time to birth. For instance, Sagial and Doyle (2008) report the results of some Swedish studies that indicated that the rates of cerebral palsy were 14%, 19%, and 3% for infants born at 23-24, 25-26, and 27 weeks of gestation respectively. .
A significant number of children who are born preterm develop cerebral palsy. Many of these children have moderate to severe motor disabilities. These disabilities obviously lead to delays in motor and even sensory development (Marlow, Wolke, Bracewell, & Samara, 2005; Sagial & Doyle, 2008). Children with either moderate or severely disabling cerebral palsy are significantly more likely to display cognitive impairments when compared to age-matched normal peers as well as children with other motor problems (Sagial & Doyle, 2008). Marlow, Wolke, Bracewell, & Samara (2005) performed a large and often cited study of very early preterm infants who were six years of age and compared them to their full term peers on their performances over several cognitive measures. Overall performance was significantly lower for children with cerebral palsy for children without neurological abnormalities. Moreover, the cognitive scores of the very preterm children who later display cerebral palsy are typically poorer than those who are born preterm but at a longer weeks of gestation. Forty six percent of children born between 22 and 25 weeks of gestation had severe or moderate disabilities such as cerebral palsy, vision or hearing loss, and learning problems.
Mental Retardation
Mental retardation is not uncommon for preterm infants. Like cerebral palsy there is an inverse relationship between the weeks of gestation to birth and the prevalence and severity of mental retardation in preterm infants (Sagial & Doyle, 2008). Using the United States criteria for mental retardation (IQ < 70) Neubauer, Voss, and Kattner (2008) found a high proportion of mental retardation in a cohort of preterm infants that had been treated at a neonatal intensive care unit and followed up to age ten. The researchers defined a major impairment present in the child if the child had one or more of the following: cerebral palsy, intellectual disability, blindness, deafness, and/or intractable epilepsy. In the cohort of 135 children 24 had major impairment as defined by the researchers and of those 24 children 19 (79%) had mental retardation. The researchers did not delineate the various IQ scores of this subset of children so there is no way of knowing the range of mental impairment observed in the cohort; however, they did report that earlier preterm infants were more likely to have more severe deficits.
Given the aforementioned discussion concerning the role of the thyroid in assisting with cerebral development the finding of high levels of mental retardation in this group is not surprising.
Other Motor and Sensory Disabilities
Although individual differences can vary significantly among both full term and preterm children regarding their capacity to respond to environmental stimuli, preterm infants demonstrate some rather striking differences. Preterm infants have been observed to spend less time in a state of awareness than full term infants. They sleep more than full term infants and when they are alert they often experience difficulty maintaining states of alertness or wakefulness...
" (2008) There are stated to be a wide range of toxic chemical sin the environment that are linked to neurodevelopmental disabilities which affect approximately three to eight percent of the total 4 million babies born in the U.S. every year. Exposure to toxic chemicals may be through industrial accidents, occupational exposure, suicide attempts and accidental poisonings. The number of toxic chemicals that cause neurotoxicity is stated to exceed 1000. (Gupta,
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