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Life Course Translational Research Network (LCT-RN) Prematurity Node leaders Jonathan Litt and Susan Hintz have co-edited a Special Issue of Children that considers the life-course implications of preterm birth on physical, mental and behavioral health, functional abilities and wellbeing  of children and their families.  This collection of twelve manuscripts explores both the experience of premature birth, and care after birth from a life course perspective, incorporating the reports of parents, family members and professionals from disciplines including psychology, child health, public health, nursing and doula care. 

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While survival rates after premature birth have improved dramatically over the past three decades, outcomes vary by infant and maternal health at birth, experiences during the neonatal hospitalization, and the family and social context in which the child lives. It is this familial and community environment which has not received adequate attention in the literature, yet provides the vital ‘scaffolding’ that will support each child’s subsequent growth and development long after they leave the NICU. The life course health development approach recognizes that children and families exist within a dynamic, multilayered ecosystem of community, social, educational and economic environments that can either pose a threat, or serve to support and optimize children’s health development trajectories. This collection of papers considers new ways to optimize that developmental ecosystem to support optimal outcomes for children and their families.

In the framing article, Jonathan Litt and colleagues explore how applying a Life Course Health Development (LCHD) Approach to care after prematurity could help to ensure optimal outcomes.  The existing system of high-risk infant follow up has a number of shortcomings, including unclear goals, inadequate support for infants, parents and families and an artificially foreshortened time horizon. Mapping life course concepts such as health development, unfolding, complexity, timing, plasticity, thriving and harmony to key components of follow-up care could result in a more effective approach leading to optimal functional outcomes. The impact of prematurity is not limited to the first few years, but rather constitutes an interrelated cascade of vulnerabilities that can pose ongoing challenges to the typical processes of developmental unfolding and opportunities for resilience.  Addressing these issues requires multi-level supports that are responsive to the child’s social and developmental environments, multilevel in scope, and integrated across health, education and social services as well as community-based resources and organizations. 

In the two articles that follow Jessica DiBari and LaToshia Rouse write from the Parents Perspective on Considerations for Changing the NICU Culture and Considerations for the Transition Home. In addition to each being parents of premature infants, Jessica and LaToshia have professional roles in maternal and child health, and have been able to bring this intersection of lived and professional experience to make valuable suggestions for improving the family experience after prematurity, and for improving health outcomes. Applying the Life Course Health Development Framework (LCHD) they highlight how each child’s health development trajectory is shaped by their family and community ecosystems and make the case for the need for much greater attention to the family’s health and well-being as this is a major contributor to the child’s ability to thrive. Psychological distress, trauma and grief are common family experiences in the NICU, yet are often left unaddressed with the risk of negatively impacting parent-child bonding.  Family well-being can be improved by setting a positive tone in the NICU, creating a nurturing personalized environment, addressing the social determinants of health, adopting a growth mindset, building trust and establishing collaborative models of care.  Peer support, doulas and community health workers can play a vital role in facilitating the early interactions that are crucial to child and family healing. 

All Articles

Litt J, Hintz S (eds) The Implications of Preterm Birth for Health and Wellbeing Across the Life Course. Children (ISSN 2227-9067) 2023; 10 (11).

Disclaimer

This Special Issue was supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under award UA6MC32492, the Life Course Intervention Research Network, and award U9DMC49250, The Life Course Translational Research Network. The information, content and/or conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.