Objective: To assess the extent to which social and family factors explain variability in cognitive, language, and motor development among very preterm (VPT; <30 weeks of gestation) children from 2 to 5 years of age. Study design: As part of a longitudinal study, VPT children recruited as neonates were assessed at 2 (n=87) and 5 (n=83) years using standardized tests of cognitive, language, and motor ability alongside demographically-matched full term (FT) children (n=63). For VPT children, developmental change scores were calculated for each domain to assess within-individual variability to 5 years of age. Multivariate regression and mixed-effect models examined social risk index, parenting stress, family functioning, and maternal intellectual ability as predictors of developmental variation among VPT children. Results: VPT children demonstrated poorer cognitive, language, and motor abilities than FT children at 2 (P ≤ .001) and 5 (p<.002) years of age. Social adversity was associated with cognitive (p<.001) and language (p<.001) outcomes at both ages, with parenting stress also related to cognitive outcomes (p=.03). Infant medical risk was associated with motor outcome at 5 years (p=.01). VPT children showed considerable within-individual variation between assessments. Among VPT children, neonatal white matter abnormalities predicted worsening cognitive (p=.04) and motor development (p=.01). Social risk index predicted worsening language development (p=.04), but this association was subsequently explained by dysfunctional maternal affective involvement (p=.01) and lower maternal intellectual ability (p=.05). Conclusions: Both clinical and socioenvironmental factors are associated with cognitive, language and motor developmental variation among VPT children from infancy to early school age.

Opinion statement Purpose of review Parents of infants admitted to the Neonatal Intensive Care Unit (NICU) experience psychological distress, loss of the parenting role, and disruptions to parent-infant bonding. The inclusion of evidence-based practices to address these challenges in the NICU has largely been based upon short-term improvements in parent and infant functioning. However, less is known regarding the extent to which family-based interventions may also be associated with longer-term parenting behaviors and children’s neurobehavioral outcomes. Recent findings Comprehensive family-based NICU interventions demonstrate consistent links with later parental mental wellbeing, sensitive parenting behaviors, and children’s cognitive and socioemotional development. Dyadic co-regulation activities implemented inconsistently and/or in isolation to other components of NICU interventions show mixed associations with outcomes, highlighting the need for multifaceted wrap-around care. Further research is needed to delineate associations between NICU interventions and children’s neurological and language development, with follow-up beyond very early childhood in larger samples. Summary Long-term associations may reflect the stability of early parental responses to NICU interventions and the extent to which parents continue to implement mental health and sensitive parenting techniques in the home. However, the transition of parental psychiatric care from hospital to community-based services upon NICU discharge remains a pertinent need for high-risk families. Remaining issues also concern the extent to which NICU interventions incorporate sociodemographic differences across families, and whether interventions are generalizable or feasible across hospitals. Despite variation across interventions and NICUs; supporting, educating, and partnering with parents is crucial to strengthen longer-term family functioning and alter the developmental trajectories of high-risk infants.

Background Very preterm (VPT; <30 weeks gestation) children are a heterogeneous group, yet the co‐occurrence of psychiatric and neurodevelopmental impairments remains unclear. Moreover, the clinical and socio‐environmental factors that promote resilient developmental outcomes among VPT children are poorly understood. Methods One hundred and twenty five children (85 VPT and 40 full‐term) underwent neurodevelopmental evaluation at age 5‐years. Parents and teachers completed measures of internalizing, externalizing, attention‐deficit/hyperactivity (ADHD), and autism symptoms. Psychiatric and neurodevelopmental measures were analyzed using Latent Profile Analysis. Multinomial regression examined the extent that infant, sociodemographic, and family factors, collected prospectively from birth to follow‐up, independently differentiated resilient and impaired children. Results Four latent profiles were identified, including a Typically Developing Group which represented 27.1% of the VPT group and 65.0% of the full‐term group, an At‐Risk Group with mild psychiatric and neurodevelopmental problems (VPT 44.7%, full‐term 22.5%), a Psychiatric Group with moderate‐to‐severe psychiatric ratings (VPT 12.9%, full‐term 10.0%), and a school‐based Inattentive/Hyperactive Group (VPT 15.3%, full‐term 2.5%). Clinical diagnoses were highest among the Psychiatric Group (80%). Factors that differentiated resilient and impaired subgroups of VPT children included prolonged exposure to maternal psychosocial distress (p ≤ .04), current family dysfunction (p ≤ .05), and maternal ADHD symptoms (p ≤ .02), whereas social risk index scores differentiated resilient and impaired full‐term children (p < .03). Conclusions Lower levels of maternal distress, family dysfunction, and maternal ADHD symptoms were associated with resilience among VPT children. Maternal distress and family dysfunction are modifiable factors to be targeted as part of psychiatric interventions embedded in the long‐term care of VPT children.

Objective: Previous studies suggest that maternal postpartum mental health issues may impact parenting and child development in preterm infants, but have often not measured symptomatology in the Neonatal Intensive Care Unit (NICU) nor followed families through early childhood. This study examines how maternal depressive symptoms and stress in the NICU are related to parenting behaviors at age 5 years, in mothers of children born very preterm (≤30 weeks gestation).Method: This longitudinal study followed a diverse sample of 74 very preterm children and their mothers. Maternal depression and stress were assessed in the NICU. At age 5, mother-child dyads were observed and coded for maternal intrusiveness, negativity, sensitivity, and positivity. Other covariates, including maternal and child intelligence, maternal education, income-to-needs ratio, maternal depression at age 5 years, and child sex were included in multivariate analyses.

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