Life Course Health Development Outcomes After Prematurity: Developing a Community, Clinical, and Translational Research Agenda to Optimize Health, Behavior, and Functioning

Long-term survival for infants born extremely prematurely (<28 weeks of gestation) and extremely low birth weight (<1000 g) has increased dramatically due to obstetrical and neonatal advances. However, poverty, inequality, and resulting health disparities are significant contributors to women who give birth to preterm infants and also impact their children’s healthy development and education. While the vast majority of survivors of extreme prematurity do not have the most severe forms of neurodevelopmental disability (i.e., cerebral palsy, blindness, sensorineural hearing loss >55 dB, and intellectual disability), half of survivors can be expected to require special education services at kindergarten entry and during their school years. In addition, there are also high rates of health disparities in the prevalence of preterm birth across the spectrum of gestations including very preterm (28–31 weeks), moderate preterm (32–33 weeks), and late preterm births (34–36 weeks). Life course health development offers a valuable framework for examining how complex medical and social adversities that impact a mother’s health can also impact their child’s health and developmental trajectories. A better understanding of the cumulative impact of protective factors and other buffers that can support prenatal and postnatal parental and child health will provide important insights into how to promote greater resiliency and optimal health development. This population-based information can provide ongoing data for thriving developmental health trajectories for vulnerable preterm survivors with respect to physical, behavioral, and social health outcomes. Though premature infants who receive comprehensive early intervention and preschool educational supportive services have improved outcomes at kindergarten entry, school-age survivors, even those escaping major neurodevelopmental diagnoses, have challenges which impact attention, behavioral regulation, academic achievement, and social skills compared to their full-term peers. Unfortunately, many essential services that can contribute to better outcomes are unnecessarily fragmented and not systematically implemented to provide preventive interventions that optimize health, learning, executive function, social, and adaptive competencies. These cumulative medical, developmental, and social risks among preterm survivors adversely impact long-term adult physical and behavioral health, educational attainment, and social participation. In order to address these disparities, more precise, population-based, health development interventions aimed at optimizing physical and behavioral health, educational achievement, and adaptive competencies will be required. We recommend research strategies to inform our efforts for improving life course outcomes.