Long-term outcomes of preterm birth: risk and resilience

The project ran from October 2012 to August 2014.

The aims of this project were to:

• examine very preterm (gestational age at birth <32 weeks) and/or very low birth weight (birth weight <1500 g: VP/VLBW) adults' personality and risk taking when compared with term controls at 26 years of age.
• investigate whether there are differences in attachment security and disorganisation between (VP/VLBW) and full-term born children; and whether the pathways to disorganised attachment differ between them at the age of 18 months. 
• investigate the impact of gestational age at birth and SGA, birth on child attention problems at six and eight years of age.
• test if adverse effects of preterm birth on attention regulation and academic achievement are mediated by children’s early delay gratification abilities at age of eight.
• examine general intelligence (IQ) and executive functioning (EF) of adults born VP/VLBW in comparison to term controls at 26 years.

• VP/VLBW birth is a significant risk for a global withdrawn personality, as indicated by being less socially engaged (introversion), low in taking risks, poor in communication (autistic features) and easily worried (neuroticism).
• A third of VP/VLBW children are found to have disorganised attachment type.
• A non-linear relationship was found between attention and gestational age at birth; whereas being small for gestational age at birth was an additional risk factor for poorer attention in childhood across the full spectrum of gestation.
• The impact of preterm birth on attention problems was partially mediated by children’s ability to delay instant gratification.
• Cognitive problems were observed in VP/VLBW born adults despite many receiving special education support; and low family socio-economic status had an additive adverse effect.

The results of this study confirm the significant impact of preterm birth on individuals’ psycho-social and cognitive outcomes longitudinally. This study also shows the additive effect of low socio-economic status on development of preterm children. This confirms that inequalities are stark not only in survival rates of preterm neonates but also in their wellbeing and adjustment lifelong. Further research will aim to understand in detail the impact of social disadvantage on preterm children’s development taking a resilience perspective, such as exploring the ways to tackle some of the risk factors. These studies will inform resilience building practices for individuals born preterm.

Suna Eryigit-Madzwamuse collaborated with Diane Putnick, Marc Bornstein and Dieter Wolke on an investigation into whether children born very preterm, moderate-late preterm, and term differ in their average level and individual-difference stability in language performance over time.

Language was assessed at five and 20 months and four, six, and eight years of age in 204 very preterm (<32 weeks' gestation), 276 moderate-late preterm (32-36 weeks' gestation), and 268 term (37-41 weeks' gestation) children from the Bavarian Longitudinal Study.

Very preterm children consistently performed worse than term-born children, and moderate-late preterm children scored in between. Language performance was stable from five months through eight years in all gestation groups combined, and stability increased between each succeeding wave. Stability was stronger between five months and four years in very preterm than moderate-late preterm and term groups, but this differential stability attenuated when covariates (child nonverbal intelligence and family socioeconomic status) were controlled.

The team concluded that preterm children, even moderate-late preterm, are at risk for poorer language performance than term-born children. Because individual differences in language performance are increasingly stable from 20 months to eight years in all gestation groups, pediatricians who attend to preterm children and observe language delays should refer them to language intervention at the earliest age seen.