The paradox of prematurity: The behavioral vulnerability of late preterm infants and the cognitive susceptibility of very preterm infants at 36 months post-term

We explored associations among preterm status (very preterm infant (VPI: <30 weeks), moderate preterm (MPI: 30-336/7 weeks), late preterm (LPI: 34–366/7 weeks), parenting, and 3-year cognitive and behavioral outcomes. We hypothesized that LPIs would demonstrate better health and neurobehavioral outcomes compared with more premature infants, and that preterm status would moderate the association between parenting quality and 3-year outcomes. Sample included 123 preterm infants (gestation <37 weeks) and their mothers from a larger study of high-risk infants with measures of neonatal and socioeconomic risks at hospital discharge; maternal vocabulary at 9-months, child IQ and behavior at 36 months, and maternal depressive symptoms and parenting at all timepoints. Group differences were explored using MANOVAs while predictors of child outcomes were explored using hierarchical regression analyses. MANOVAs indicated that LPIs had more optimal neonatal health during the hospital stay, yet more externalizing (p = .043), aggressive (p = .006) and oppositional behaviors (p = .008) at 3 years compared with VPIs. There were no IQ differences between VPIs, MPIs and LPIs. However, preterm infants who experienced less negative parenting had higher IQs at 36 months (β = −3.245, p = .017), with the greatest effects seen in VPIs (β = 0.406, p = .01) compared with LPIs (β = 0.148, p = .381). LPIs manifested similar IQ, but more externalizing, oppositional and aggressive behavior symptoms compared to VPIs. VPIs appeared to be differentially susceptible to parenting effects, with VPIs demonstrating the highest cognitive scores in the context of more positive parenting.

► 36-month outcomes in preterm infants vary by degree of prematurity and parenting.
► Late preterms exhibit more behavior problems compared to very preterm infants (VPI).
► Very preterm infants are differentially susceptible to the quality of parenting.
► VPIs exhibit lower IQ with more negative parenting and higher IQ with more positive.
► Late preterms demonstrate similar cognition regardless of early parenting quality.