Eleven percent of all births worldwide are preterm, happening before 37 weeks of pregnancy. Preterm-related issues account for a high percentage of infant deaths and neurological disabilities.
An initiative by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and other efforts aim to reduce elective deliveries before 39 weeks of pregnancy. Two new longitudinal studies that appear in the journal Child Development provide insights on decreasing the potential problems of premature birth.
Funded by Israel Foundations Trustees, the first study enabled researchers in Israel to discover that early positive caregiving can reduce risks associated with preterm birth. Conducted in the Child Development & Family Relationship Lab, directed by Dr. Naama Atzaba-Poria of the Department of Psychology at Ben-Gurion University and Soroka University Medical Center, the study is part of a larger study Dr. Atzaba-Poria is conducting.
A second study was funded by the Northern Regional Health Authority in Norway. Researchers at the University Hospital of North Norway and the Arctic University of Norway, Tromosø, identified an intervention associated with better outcomes for preterm babies in later childhood.
Preterm children are at increased risk for poor cognitive and social outcomes throughout childhood. Environmental factors such as parenting could affect this risk. The Israeli researchers studied 150 two-parent, low- to middle-income families of infants, about half of whom were born preterm with no significant medical complications and half of whom were full-term. At the age of 6 months, parents completed questionnaires assessing emotional distress, and family warmth and cooperation were assessed via videotaped interactions of the parents and infants playing together. At the age of 12 months, the babies' cognitive and social competences were assessed.
Preterm infants were more strongly affected by the quality of their caregiving environment than their full-term counterparts. Infants born prematurely and exposed to high levels of emotional stress from their mothers and tense, uncooperative relationships within their families demonstrated worse cognitive and social outcomes than full-term infants. Infants born prematurely, exposed to low levels of maternal distress and warm, cooperative family relationships had similar cognitive outcomes and even better social abilities than infants born full term. Mothers' emotional distress and the quality of family relationships appeared not to affect full-term infants' cognitive and social development. Researchers concluded that preterm infants were more affected by their caregiving environment within the normal range of environmental functioning.
According to Noa Gueron-Sela, postdoctoral fellow at the University of North Carolina at Chapel Hill, who led the study when she was at BGU, "We found that preterm infants are particularly sensitive to both negative and positive effects of parenting on development. While stressful parenting environments predicted low developmental outcomes, positive caregiving experiences buffered the negative effects of prematurity on babies' cognitive development and promoted their social communication competencies. The study's findings can inform the types of medical surveillance and care provided for preterm infants. Specifically, routine health surveillance could include monitoring for symptoms of mothers' emotional distress and could promote cooperative, positive relationships among family members.
In Norway study, researchers attempted to determine whether a brief intervention during the neonatal period could address the behavioral development of children born prematurely. About 40 percent of children born before 37 weeks have attention and adaptive problems throughout elementary school, often requiring specialized educational and psychiatric services.
Researchers gave the parents of 72 children born preterm an early, brief intervention in the four weeks after birth to promote more sensitive and positive parent-child interactions, and enhance parents' enthusiasm for their children and sense of empowerment as parents. The Mother Infant Transaction Program (MITP) involves 11 one-hour sessions during which parents could talk about their experiences related to the pregnancy and delivery with support from a nurse, and learn about how to interpret their children's strengths and limitations.
Afterwards, researchers received reports from parents and teachers about the children's behavior through age 9. The behavioral development of the 72 children born prematurely was compared with a control group of 74 children born prematurely and a control group of 75 children who were born full term. The children born prematurely weighed less than 4 pounds, 6.5 ounces at birth.
At ages 7 and 9, the children whose parents took part in the intervention had significantly fewer attention problems than the children born preterm whose parents did not, and they adapted more successfully to school. At age 9, teachers and parents of the children born preterm whose parents took part in MITP assessed the behavioral problems and social and academic competencies of these children as similar to those of full-term children. Preterm children not involved in the intervention had more difficulties that those who were, and their parents sought more outside help.
As explained by Inger Pauline Landsem, a doctoral student at University Hospital of North Norway and at the Arctic University of Norway, who led the study, "Our findings suggest that early intervention works for parents and children who experience a preterm birth. With the help of the MITP intervention, children born preterm can overcome the difficulties most frequently reported in their early school years."