Constipation in Very-Low-Birth-Weight Children at 10 to 14 Years of Age Carin Cunningham, H. Gerry Taylor, Nori Mercuri Minich, and Maureen Hack Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, U.S.A. ABSTRACT Background: The authors documented that very-low-birth- weight children (less than 750-g) when compared with 750- to 1,499-g birth-weight and normal-birth-weight–matched con- trols have higher than normal rates of neurosensory and cog- nitive impairments at school age. In this population, the authors found a higher rate of constipation than expected among 19 of 59 (32%) less-than-750-g-birth-weight children. The authors therefore wanted to evaluate in greater detail the problem of constipation and associated toileting problems in this popula- tion. Methods: Nineteen less-than-750-g-birth-weight children with constipation were matched to the next less than 750-g-birth- weight child of comparable age, sex, and race who did not have constipation. A telephone questionnaire was administered to 15 of 19 parents of the less-than-750-g-birth-weight children who had constipation. Results: The 15 children with constipation had significantly higher rates of neurosensory impairment (7 [47%] vs. 1 [7%]) and lower mean WISC III IQ scores (72 ± 22 vs. 89 ± 13) when compared with birth-weight-matched controls without consti- pation (P < 0.05). The constipated children also had signifi- cantly higher rates of associated toileting problems, including encopresis (8[53%] vs. 1 [7%])and stool withholding (9 [60%] vs. 2 [13%]; P < 0.05). Conclusion: The higher incidence of constipation among less- than-750-g-birth-weight children is associated with neurode- velopment impairment. Awareness of this problem and preven- tive intervention to ensure regular stools could possibly de- crease the high rate of constipation and associated toileting problems. JPGN 33:23–27, 2001. Keywords: Constipation— Very low birth weight—Encopresis. © 2001 Lippincott Willi- ams & Wilkins, Inc. The improved survival of very-low-birth-weight in- fants since the inception of neonatal intensive care has resulted in an increasing number of children who have health and neurodevelopmental problems. We have documented high rates of neurosensory and cognitive impairment in a longitudinal study of less-than-750-g- birth-weight children, born between 1980–1982, from infancy until school age (1,2). A review of the health outcomes of these children at a mean of 11 years of age revealed the rates of constipation to be significantly higher among less-than-750-g-birth-weight children when compared with matched 750- to 1,499-g-birth- weight children and term-born controls (3). This unexpected finding led us to evaluate in greater detail the problem of constipation related toileting prob- lems among less-than-750-g-birth-weight children. We hypothesized that less-than-750-g-birth-weight children with constipation, when compared with nonconstipated birth-weight–matched controls, would have higher rates of neurologic impairment and higher rates of associated toileting problems, such as stool withholding, encopresis, and delayed toilet training. POPULATION AND METHODS The population included a regional cohort of less-than-750- g-birth-weight children born between 1982 and 1986 in the greater Cleveland area who were enrolled in a longitudinal study of health, growth, neurodevelopmental, and school age performance. At 6 years of age, 68 of 73 (93%) less-than-750- g-birth-weight children were available for study. These chil- dren were compared with a group of 750- to 1,499-g-birth- weight children matched for race, sex, and hospital of birth and to a group of normal-birth-weight children matched for race, sex, and school (1). Sixty less-than-750-g-birth-weight chil- dren, 55 750- to 1,499-g-birth-weight children, and 49 normal- birth-weight children were reevaluated at 10 to 14 years of age. Ten (17%) less-than-750-g-birth-weight children had neuro- logic abnormalities compared with 4 (7%) of the 750- 1,499-g group and none of the controls. The less-than-750-g-birth- weight children had significantly lower intelligence scores than the children with birth weights from 750 to 1,499 g and the term-born controls (78.3 ± 19, 89.5 ± 20, and 99.1 ± 18, P < 0.05) (4). In this population, 19 of 59 (32%) parents of the less-than-750-g-birth-weight children identified their children Received August 9, 2000; revised January 30, 2001; accepted Feb- ruary 1, 2001. Address correspondence and reprint requests to Dr. Carin Cunningham, Rainbow Babies and Children’s Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, U.S.A. (e-mail: cxc55@po.cwrn.edu). Journal of Pediatric Gastroenterology and Nutrition 33:23–27 © July 2001 Lippincott Williams & Wilkins, Inc., Philadelphia 23