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The tiniest of premature babies, saved from death by the latest medical procedures, may face severe physical and mental problems that persist when they reach school age, a new study shows.

A team led by Maureen Hack of Case Western Reserve University in Cleveland followed the cases of 68 children who weighed less than 26 ounces at birth.The team compared them with 61 children who were not premature and with another 65 youngsters whose birth weights ranged from 26 ounces to 52 ounces, reports the study in Thursday's New England Journal of Medicine.

The researchers discovered that the extremely premature infants - all born between 1982 and 1986 - tended to be at a disadvantage.

Twenty one percent had IQs lower than 70 - 100 is average - 9 percent suffered from cerebral palsy and 25 percent had a severe visual disability.

Such problems were less likely to be found in the children who were not premature and were larger at birth. The health problems were less common among children in the third group, with higher birth weights.

Children who weigh the least at birth "are at serious disadvantage in every skill required for adequate performance in school," the researchers concluded.

"Twenty-one percent of our sample had subnormal mental abilities and 45 percent required some special education in school," the researchers added.

In an editorial in the New England Journal of Medicine, Dr. Marie McCormick of Harvard Medical School said the picture emerging from the research is not quite as bleak as it might appear.

The youngsters in the Hack study were "born before many of the recent innovations in neonatal care were introduced, a large number of which address the same neonatal complications that are associated with the adverse outcomes reported in this study," McCormick said.

As a result, she said, the problems described in the study may not apply to premature children born today.