A new study suggests that a preterm infant’s home and family environment has more of an impact on the child’s psychiatric health than medical challenges at birth.
The findings are published in The Journal of Child Psychology and Psychiatry.
In general, babies who are born at least 10 weeks before their due dates are at greater risk for developing psychiatric issues such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder and anxiety disorders.
They are also at greater risk for other neurodevelopmental problems, including cognitive and language difficulties, and motor delays.
In the study, researchers from Washington University School of Medicine in St. Louis discovered that the children who were most likely to overcome the complications of being born so early, and who showed normal psychiatric and neurodevelopmental outcomes, were those with healthier, more nurturing mothers and more stable home lives.
“Home environment is what really differentiated these kids,” said first author Rachel E. Lean, Ph.D., a postdoctoral research associate in child psychiatry.
“Preterm children who did the best had mothers who reported lower levels of depression and parenting stress. These children received more cognitive stimulation in the home, with parents who read to them and did other learning-type activities with their children.”
“There also tended to be more stability in their families. That suggests to us that modifiable factors in the home life of a child could lead to positive outcomes for these very preterm infants.”
The researchers evaluated 125 children at age 5. Of these, 85 had been born at least 10 weeks before their due dates. The other 40 children in the study were born full term, at 40 weeks’ gestation.
The 5-year-olds completed standardized tests to assess their cognitive, language and motor skills. Parents and teachers were asked to complete checklists to help determine whether a child might have issues indicative of ADHD or autism spectrum disorder, as well as social or emotional problems or behavioral issues.
Among all the children who had been born at 30 weeks of gestation or sooner (very preterm), 27% were found to be particularly resilient.
“They had cognitive, language and motor skills in the normal range, the range we would expect for children their age, and they tended not to have psychiatric issues,” Lean said.
Another 45% of the very preterm children, although within the normal range, tended to be at the low end of normal. “They were healthy, but they weren’t doing quite as well as the more resilient kids in the first group,” said Lean.
The rest of the children had clear psychiatric issues such as ADHD, autism spectrum disorder or anxiety with about 13% having moderate-to-severe psychiatric problems. About 15% displayed a combination of problems with inattention and hyperactive and impulsive behavior, according to surveys from teachers.
The children with psychiatric problems weren’t markedly different from other kids in the study in terms of cognitive, language and motor skills, but they had higher rates of ADHD, autism spectrum disorder and other problems.
“The children with psychiatric problems also came from homes with mothers who experienced more ADHD symptoms, higher levels of psychosocial stress, high parenting stress, just more family dysfunction in general,” said senior investigator Cynthia E. Rogers, M.D., an associate professor of child psychiatry.
“The mothers’ issues and the characteristics of the family environment were likely to be factors for children in these groups with significant impairment. In our clinical programs, we screen mothers for depression and other mental health issues while their babies still are patients in the NICU.”
The researchers believe the findings may indicate good news because maternal psychiatric health and family environment may be flexible factors that can be targeted with interventions that have the potential to improve long-term outcomes for children who are born prematurely.
“Our results show that it wasn’t necessarily the clinical characteristics infants faced in the NICU that put them at risk for problems later on,” Rogers said.
“It was what happened after a baby went home from the NICU. Many people have thought that babies who are born extremely preterm will be the most impaired, but we really didn’t see that in our data.”
“What that means is in addition to focusing on babies’ health in the NICU, we need also to focus on maternal and family functioning if we want to promote optimal development.”
The researchers are continuing to follow the children from the study.