Low-birthweight infants require extensive care. They are at risk for poor developmental outcomes and even death.
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Table 3.2
Sources: Prechtl (1974); Wolff (1966).
Low-birthweight infants are at a disadvantage when it comes to adapting to the world outside the womb. At birth, they often experience difficulty breathing and are likely to suffer from respiratory distress syndrome, in which the newborn breathes irregularly and at times may stop breathing. Low-birthweight infants have difficulty maintaining homeostasis, a balance in their biological functioning. Their survival depends on care in neonatal hospital units, where they are confined in isolettes that separate them from the world, regulating their body temperature, aiding their breathing with the use of respirators, and protecting them from infection. Many low-birthweight infants cannot yet suck from a bottle, so are fed intravenously.
Figure 3.10 Very Low and Low Birthweight Rates, by Maternal Race/Ethnicity, 2015
Source: Centers for Disease Control and Prevention, 2018.
The deficits that low-birthweight infants endure range from mild to severe and correspond closely to the infant’s birthweight, with extremely low-birthweight infants suffering the greatest deficits (Hutchinson et al., 2013). Low-birthweight infants are at higher risk for poor growth, cerebral palsy, seizure disorders, neurological difficulties, respiratory problems, and illness (Adams-Chapman et al., 2013; Durkin et al., 2016; Miller et al., 2016). Higher rates of sensory, motor, and cognitive problems mean that low-birthweight children are more likely to require special education and display poor academic achievement in childhood, adolescence, and even adulthood (Eryigit Madzwamuse, Baumann, Jaekel, Bartmann, & Wolke, 2015; Hutchinson et al., 2013; MacKay, Smith, Dobbie, & Pell, 2010). Low-birthweight children often experience difficulty in self-regulation, poor social competence, and poor peer relationships, including peer rejection and victimization in adolescence (Georgsdottir, Haraldsson, & Dagbjartsson, 2013; Ritchie, Bora, & Woodward, 2015; Yau et al., 2013). As adults, low-birthweight individuals tend to be less socially engaged, show poor communication skills, and may score high on measures of anxiety (Eryigit Madzwamuse et al., 2015). Frequently, the risk factors for low birthweight, such as prenatal exposure to substances or maternal illness, also pose challenges for postnatal survival. The Lives in Context feature discusses HIV, a risk factor for neonate development.
Lives in Context
HIV Infection in Newborns
Mother-to-child transmission of HIV has declined as scientists have learned more about HIV. However, it remains a worldwide problem especially in developing nations where cultural, economic, and hygienic reasons prevent mothers from seeking alternatives to breastfeeding, a primary cause of mother-to-child transmission of HIV.
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The rate of mother-to-child transmission of HIV has dropped in recent years as scientists have learned more about HIV. The use of cesarean delivery as well as prescribing anti-HIV drugs to the mother during the second and third trimesters of pregnancy, as well as to the infant for the first 6 weeks of life, has reduced mother-to-child HIV transmission to less than 2% in the United States and Europe (from over 20%) (Torpey, Kabaso, et al., 2010). Aggressive treatment may further reduce the transmission of HIV to newborns, and research suggests that it may even induce remission (National Institute of Allergy and Infectious Diseases, 2014; Pollack & McNeil, 2013; Rainwater-Lovett, Luzuriaga, & Persaud, 2015). However, in developing countries, such interventions are widely unavailable. Worldwide, mother-to-child HIV transmission remains a serious issue. For example, in Zambia, 40,000 infants acquire HIV each year (Torpey, Kasonde, et al., 2010). Treating newborns is critical, although not always possible. Worldwide, 20% to 30% of neonates with HIV develop AIDS during the first year of life and most die in infancy (United Nations Children’s Fund, 2013).
Globally, breastfeeding accounts for 30% to 50% of HIV transmission in newborns (Sullivan, 2003; World Health Organization, 2011). The World Health Organization (2010) recommends providing women who test positive for HIV with information about how HIV may be transmitted to their infants and counseling them not to breastfeed. Yet cultural, economic, and hygienic reasons often prevent mothers in developing nations from seeking alternatives to breastfeeding. For example, the widespread lack of clean water in some countries makes the use of powdered formulas dangerous. Also, in some cultures, women who do not breastfeed may be ostracized from the community (Sullivan, 2003). Balancing cultural values with medical needs is a challenge.
Children with HIV are at high risk for a range of illnesses and health conditions, including chronic bacterial infections; disorders of the central nervous system, heart, gastrointestinal tract, lungs, kidneys, and skin; growth stunting; neurodevelopmental delays, including brain atrophy, which contribute to cognitive and motor impairment; and delays in reaching developmental milestones (Blanchette, Smith, Fernandes-Penney, King, & Read, 2001; Laughton, Cornell, Boivin, & Van Rie, 2013; Sherr, Mueller, & Varrall, 2009).
What Do You Think?
Imagine that you work as an HIV educator with women in an underdeveloped country. What challenges might you face in encouraging women to take steps to reduce the potential for HIV transmission to their infants? How might you help them?
Not only are low-birthweight infants at a physical disadvantage, but they often begin life at an emotional disadvantage because they are at risk for experiencing difficulties in their relationships with parents. Parenting a low-birthweight infant is stressful even in the best of circumstances (Howe, Sheu, Wang, & Hsu, 2014). Such infants tend to be easily overwhelmed by stimulation and difficult to soothe; they smile less and fuss more than their normal-weight counterparts, making caregivers feel unrewarded for their efforts. Often these infants are slow to initiate social interactions and do not attend to caregivers, looking away or otherwise resisting attempts to attract their attention (Eckerman, Hsu, Molitor, Leung, & Goldstein, 1999). Because low-birthweight infants often do not respond to attempts to solicit interaction, they can be frustrating to interact with, can be difficult to soothe, and are at risk for less secure attachment to their parents (Jean & Stack, 2012; Wolke, Eryigit-Madzwamuse, & Gutbrod, 2014). Research also indicates that they may experience higher rates of child abuse (Cicchetti & Toth, 2015).
Parental responses to having a low-birthweight infant influence the child’s long-term health outcomes, independently of perinatal risk, suggesting that the parenting context is an important influence on infant health (Pierrehumbert, Nicole, Muller-Nix, Forcada-Guex, & Ansermet, 2003). When mothers have knowledge about child development and how to foster healthy development, are involved with their children, and create a stimulating home environment, low-birthweight infants tend to have good long-term outcomes (Benasich & Brooks-Gunn, 1996; Jones, Rowe, & Becker, 2009). For example, one study of low-birthweight children showed that those who experienced sensitive parenting showed faster improvements in executive function and were indistinguishable from their normal-weight peers by age 5; however, those who experienced below-average levels of sensitive parenting showed lasting deficits (Camerota, Willoughby, Cox, Greenberg, & the Family Life Project Investigators, 2015). Likewise, exposure to sensitive, positive parenting predicted low-birthweight children’s catching up to their normal-birthweight peers at age 8 in