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About 8% of infants born in the United States each year are low birthweight (Martin et al., 2013). Low-birthweight infants may be preterm, or premature (born before their due date), or small for date, who are full term but have experienced slow growth and are smaller than expected for their gestational age. Infants are classified as low birthweight when they weigh less than 2,500 grams (5.5 pounds) at birth; very low birthweight refers to a weight less than 1,500 grams (3.5 pounds), and extremely low birthweight refers to a weight less than 750 grams (1 lb., 10 oz.). Infants who are born with low birthweight are at risk for a variety of developmental difficulties. Indeed, their very survival is far from certain; the Centers for Disease Control and Prevention lists prematurity and low birthweight among the leading causes of infant mortality, accounting for 35% of mortality cases in infancy (Mathews & MacDorman, 2013). Infants most at risk for developmental challenges, handicaps, and difficulty surviving are those with extremely low birthweight. As shown in Figure 3.10, women of color are disproportionately likely to give birth to low-birthweight infants. The socioeconomic inequalities that influence women’s ability to seek early prenatal care also influence birth outcomes. Unfortunately, poor access to health care can prevent low-birthweight infants from getting the help that they need to overcome the formidable challenges ahead of them.

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.

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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.