Low Birth Weight

LOW BIRTH WEIGHT/PREMATURITY reasons, incidence in African Americans is about twice
that in Whites and Latinos. Advances in prenatal care and

Low birth weight (LBW) infants may be born preterm neonatal care have improved survival and development
(premature), at term but small for gestational age (SGA), of premature and LBW infants but have not reduced the
or both preterm and SGA. LBW, very LBW (VLBW), incidence (March of Dimes, 2011).
extremely LBW (ELBW), and micropremie describe, Although most affected infants develop with few
respectively, those with birth weights of less than 2,500, sequalae, LBW is involved in about 60% of newborns’
1,500, 1,000, or 800 grams (Bernbaum & Batshaw, 1997). deaths and is a major cause of brain damage and devel-
Premature infants are born before 37 completed weeks opmental disabilities (March of Dimes, 2011). The degree
of gestation; late preterm infants (a recently defined cat- of impairment generally is associated with the degree of
egory) are born between 34 and 36 weeks of gestation; low birth weight or prematurity (Bernbaum & Batshaw,
moderately preterm infants are born between 32 and 36 1997). Long-term effects of IUGR include decreased termi-
completed weeks and very preterm infants are born before nal physical growth, developmental delays, decreased IQ,
32 completed weeks of gestation (Taylor, 2010) Of LBW cerebral palsy, learning disabilities, and perhaps cardio-
infants, about 70% are premature. Full-term SGA infants vascular disease as adults (Stevenson & Sunshine, 1997).
generally have suffered from intrauterine growth retarda- Survival rates of VLBW infants have reached 85%. Of
tion (IUGR), suggesting that they have not achieved their survivors, 5%–15% have spastic cerebral palsy and an
full prenatal growth potential. additional 25%–50% have cognitive disorders (Graziani,
1996). Intracranial hemorrhage and periventricular leuko-
malicia are major causes of neurological and developmen-
tal deficits. Although specific abnormalities are correlated
Characteristics
with neurologic sequelae, the severity of eventual handi-
cap is difficult to predict.
Premature infants In the past decade, survival of ELBW and micropremie
1. Lanugo, or fine hair, over entire body (normally infants has increased to about 80%, but such infants are
lost by 38 weeks gestational age) at great risk for serious physical, neurological, and devel-
opmental complications. Few infants born at 23 weeks
2. Reddish skin color owing to thin skin and closeness
gestation survive without serious neurological complica-
of blood vessels to surface
tions (Taylor, 2010).
3. Lack of breast buds and ear cartilage (normally
In terms of prematurity, in 2008, there were 523,033
appear at about 34 weeks gestational age)
preterm births in the United States; representing 12.3%
4. Lack of skin creases in feet (normally appear at of live births. According to the March of Dimes (2011)
about 32 weeks gestational age) between 1998 and 2008, the rate of infants born preterm
5. Decreased muscle tone; flaccidity in the United States increased 6%. During 2006–2008
6. Weak or absent neonatal reflexes, including in the United States, preterm birth rates were highest
sucking for Black infants (18.1%), followed by Native Americans
7. High-pitched aversive cries (14.1%), Hispanics (12.2%), Whites (11.4%), and Asians
(10.8%).
8. Susceptibility to numerous neonatal complications
Preterm infants may develop a variety of conditions.
9. With increasing prematurity, mental retardation,
Breathing disorders include (a) apnea (irregular and non-
cerebral palsy, sensory impairments, seizure dis-
rhythmical breathing); (b) bronchopulmonary dysplasia
orders, and specific learning disabilities
(BPD; damaged lungs requiring supplemental oxygen
and breathing support), and (c) respiratory distress
Nonpremature SGA infants
syndrome (RDS), incomplete development of the lungs
1. Intrauterine growth retardation leading to mal- and lack of surfactant, which prevents lung alveoli from
nourished appearance sticking together during breathing. Artificial surfactant
2. Postnatal growth retardation leading to perma- has reduced considerably adverse consequences of RDS.
nent short stature and low weight Retinopathy of prematurity (ROP) may result in impaired
3. Learning disabilities, attention-deficit/hyperactivity vision or blindness. ROP has many contributing factors,
disorder, and behavior problems including the degree of prematurity, nutritional status,
and exposure to light, in addition to excess oxygen (Spitzer,
1996). Intracranial hemorrhage and other forms of hypoxic
brain damage can have devastating complications.
LBW is the highest-incidence potentially handicapping The long-term effects of prematurity, which are associ-
condition in the United States: About 7% of births are ated with prenatal and postnatal complications and dis-
LBW and an additional 1.3% are VLBW. For unknown ruption of the parent-infant attachment process, include
Encyclopedia of Special Education, edited by Cecil R. Reynolds, Kimberly J. Vannest, and Elaine Fletcher-Janzen.
Copyright C 2013 John Wiley & Sons, Inc.
breathing disorders, visual impairment, increased inci- and reduce abuse. Many survivors will need individualized
dence of SIDS, and neurological impairment leading to support, including physical and speech therapy, adaptive
sensorimotor and developmental delays. Owing to their technology for sensory and motor impairments, and special
general hyporeactivity, hyperactivity to sudden stimula- education services.
tion, and aversive cries, premature infants are at elevated The March of Dimes (2011) is an excellent resource
risk for abuse, particularly by unskilled parents, although for parents who are at high risk for preterm/low birth
few are actually abused. Lack of attachment by the parents weight events. The organization provides preventative
to the infant is more common. information, prepares the parents for the NICU experi-
Diagnosis is at or shortly after birth through phys- ence, provides guidance and coaching for the transfer to
ical and behavioral signs. Determination of the degree home, and supports research. Professionals should confer
of clinical problems should be performed by an expe- with the March of Dimes for local professional resources
rienced neonatalogist. Clinical problems often require and parental support.
intensive team management providing multisystem sup-
port through incubators, ventilators, intravenous fluids, REFERENCES
and physiological monitoring. Such care is best offered in
a regional neonatal intensive care unit (NICU), which has Bernbaum, J. C., & Batshaw, M. L. (1997). Born too soon, born
the staff and equipment needed to deal with unpredictable too small. In M. L. Batshaw (Ed.), Children with disabilities
(4th ed., pp. 115–139). Baltimore, MD: Brookes.
and serious complications.
Infants may be LBW or premature for many reasons, Goldson, E. (1996). The micropremie: Infants with birthweights
although the cause in most individual cases is unknown. less than 800 grams. Infants and Young Children, 8, 1–10.
Causes can be categorized as fetal, maternal, placental, Graziani, L. J. (1996). Intracranial hemorrhage and leukomalacia
and environmental (March of Dimes, 2011; Stevenson & in preterm infants. In A. R. Spitzer (Ed.), Intensive care of the
Sunshine, 1997). Fetal factors include genetic abnormali- fetus and neonate (pp. 696–703). St. Louis, MO: Mosby.
ties and differential susceptibility to drugs and congenital Guralnick, M. J. (Ed.) (1996). The effectiveness of early interven-
infections. Maternal factors, the most common cause, tion. Baltimore, MD: Brookes.
include maternal nutrition, chronic maternal illness, low March of Dimes. (2011). Low birthweight. Retrieved from http://
socioeconomic status, perinatal drug exposure, maternal www.modimes.org/HealthLibrary2/factsheets/Low_Birth
infection (congenital infections, the STORCH [syphilis, weight.htm
toxoplasmosis, other infections, rubella, cytomegalovirus Ramsay, M., & Reynolds, C. R. (2000). Does smoking by pregnant
infections, and herpes simplex] complex), and labor- women influence birthweight, IQ, and developmental disabili-
intensive occupations. Abnormal placental function ties in their infants? A methodological review and multivariate
includes decreased placental size, poor implantation, analysis. Neuropsychology Review, 10, 1–40.
and decreased placental blood flow. Incidence of IUGR Scafidi, F. A., Field, T. M., Schanberg, S. M., Bauer, C. R., & Tucci,
increases with multiple gestation. Environmental factors, K. (1990). Massage stimulates growth in preterm infants: A
generally mediated by the mother, are difficult to separate replication. Infant Behavior and Development, 13, 167–188.
from maternal factors. Although cigarette smoking is Spitzer, A. R. (Ed.). (1996). Intensive care of the fetus and neonate.
a commonly accepted cause of LBW, careful research St. Louis, MO: Mosby.
questions its role (e.g., Ramsay & Reynolds, 2000). Stevenson, D. K., & Sunshine, P. (Eds.). (1997). Fetal and neona-
Early intervention may reduce later complications. tal brain injury: Mechanisms, management, and the risks of
Improved infant formulas and increased support of breast- practice (2nd ed.). Oxford, England: Oxford University Press.
feeding have improved growth. Control of light and noise, Taylor, G. T. (2010). Children with very low birthweight and or
positioning that provides support, and strategies that very preterm birth. In K. O. Yeates, M. D. Ris, G. T. Taylor, &
avoid overstimulation encourage normal growth and devel- B. F. Pennington (Eds.), Pediatric neuropsychology (pp. 26–70).
opment. Carefully monitored physical massage improves New York, NY: Guilford Press.
development and reduces length of initial hospital stays
(e.g., March of Dimes, 2011; Scafidi, Field, Schanberg, BRENDA MELVIN
Bauer, & Tucci, 1990; Taylor, 2010). Regular develop- ROBERT T. BROWN
University of North Carolina,
mental assessment to detect delays is important to allow
Wilmington
for early intervention. Evidence (e.g., Guralnick, 1996)
indicates that intervention beginning at discharge from
ELAINE FLETCHER-JANZEN
hospital and continuing to at least age 3 improves later The Chicago School of
cognitive performance, particularly of mildly LBW infants. Professional Psychology
Helping parents to deal with their infants’ difficult physi- Fourth edition
cal and behavioral characteristics may foster attachment

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LOW BIRTH WEIGHT/PREMATURITY reasons, incidence in African Americans is about twice

that in Whites and Latinos. Advances in prenatal care and

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