Article summary of Preterm birth: Educational and mental health outcomes by O'Nions et al. - 2021 - Chapter

What are the consequences of preterm birth?

Preterm birth is defined as a birth at less than 37 week's gestation. It is common and responsible for global child mortality. Researchers have become interested in the long-term outcomes of preterm birth and found some interesting links between preterm birth and cognitive and psychological outcomes. On average, children born preterm were found to experience poorer mental health and educational outcomes compared to their term-born peers. Pre-term birth is also associated with lower IQ scores. Difficulties with executive functioning, processing speed, verbal fluency, cognitive flexibility and working memory may underlie the poorer cognitive and academic performance of individuals who were born preterm. These cognitive outcomes appear to be rather stable over life. Especially problems with mathematics have been linked to preterm birth. Preterm birth also increases the likelihood of neurodevelopmental and certain mental health difficulties. Children born very preterm have, on average, poorer attention and more social- communication difficulties, peer problems, and internalising symptoms than their term-born peers. Links between preterm birth and depression during childhood are less clear. However, cohort study data for young adults born at extremely low birth-weights (

How does the brain of children who were born preterm develop?

For individuals born preterm, brain maturation outside of the uterine milieu, common medical complications, plus separation from parents due to hospitalisation may contribute to lasting changes in brain and autonomic development. The period between the current threshold of viability (22– 24 weeks) and term (40 weeks) is a stage when the brain is developing rapidly. In infants born preterm, this part of brain development in an atypical extra-uterine biological milieu. This leads to alterations in cortical development.

The impact of preterm birth on brain development may actually persists into adulthood. Studies have identified structural differences, including reduced cortical gyrification, alterations in network connectivity and changes in the trajectory of cerebral development. Daily skin-to-skin care, during which the infant is placed unclothed on the mother’s or father’s chest, improves child autonomic and circadian development, maternal attachment behaviour, and mother-infant synchrony compared to standard incubator care. At age 10, babies who received kangaroo care show bet- ter resilience to social and emotional stress, better sleep organisation and better executive function- ing compared to incubator care controls. Facilitating parental presence in the NICU may therefore promote better long-term outcomes for preterm babies. 

How does psychosocial development across the lifespan take place for children who were born preterm?

Psychosocial factors, from socioeconomic status to parenting, peer relationships, and bullying victimisation have a significant impact on long-term outcomes for preterm-born children. Parental sensitivity appears to be a key factor linked to positive developmental outcomes. Responsive and involved parenting of babies in the NICU has also been linked to higher IQ scores in adults born very preterm. Children born preterm appear to be particularly susceptible to certain forms of psychosocial adversity. The detrimental impact of low parental sensitivity appears to be greater in preterm compared to term-born children. Cohort study data also suggest that adults born extremely preterm are more susceptible than term born adults to mental health problems when they have experienced psychosocial adversity. Children born very or extremely preterm are at least three times as likely to be chronically bullied during childhood compared to their term-born counterparts. 

Difficulties with working memory in preterm-born children may lead to problems with mental arithmetic, and deficits across a range of executive functions have been shown to mediate the relationship between preterm birth and attainment at school. Cognitive and learning difficulties may form part of a cascade leading to poorer educational outcomes.

What recommendations for the future can we distinguish?

In conclusion, preterm birth appears to have a lasting impact on child educational and mental health outcomes. Parent-led organisations have started advocating for greater recognition of and research into the ongoing impact of preterm birth. More work is needed to identify fruitful interventions or support strategies to ensure that preterm-born children achieve their potential. Affecting nearly 15 million children born annually worldwide, preterm birth deserves more attention as a significant and potentially modifiable risk factor for poorer educational and mental health outcomes.