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Testing proximal and distal protective processes in preterm high-risk children
Margaret M McGrath1, Mary Sullivan
1University of Rhode Island, College of Nursing, Kingston, Rhode Island, USA. risc@etal.uri.edu
Insights
Cumulative medical risk and protective factors significantly impact preterm children's school-age outcomes. Understanding these combined effects is crucial for enhancing cognitive, academic, and socioemotional development in high-risk populations.
Area of Science:
- Developmental Psychology
- Pediatric Medicine
- Public Health
Background:
- Preterm birth is associated with increased medical risk.
- Early life medical risk can impact long-term child development and competency.
- Protective factors may mitigate risks associated with preterm birth.
Purpose of the Study:
- To examine a model of cumulative medical risk and protective processes in preterm children.
- To assess the impact of these factors on school-age outcomes: cognition, academic achievement, and socioemotional well-being.
- To understand the interplay of risk and protection in high-risk children.
Main Methods:
- Prospective longitudinal study of 151 preterm and 39 full-term infants followed to age 8.
- Construction of indexes for cumulative medical risk, distal protective, and proximal maternal protective processes.
- Hierarchical multiple regression analysis to test effects on competency outcomes.
Main Results:
- Significant main effects of cumulative medical risk and protective processes were found for all competency outcomes.
- Protective processes showed a small to moderate (6%-18%) yet clinically significant effect.
- The study supported hypotheses regarding the influence of risk and protection.
Conclusions:
- A cumulative risk and protection model effectively explains school-age outcomes in preterm children.
- Protective factors play a clinically significant role in moderating the impact of medical risk.
- Understanding the joint occurrence of individual and contextual processes is vital for high-risk children's competence.
Abstract:
The purpose was to examine a model that incorporates cumulative medical risk at age 4 and distal and protective processes at age 8 to assess school-age competency outcomes of cognition, school achievement, and socioemotional well-being in a sample of preterm children born at various degrees of medical risk. Cumulative medical risk and distal protective and proximal maternal protective processes were constructed into indexes. Hierarchical multiple regression analysis were performed entering the cumulative medical risk index first, followed by distal and proximal protective processes in the next two steps to test the effect on cognitive, academic, and socioemotional competence. For participants, 151 preterm and 39 full-term infants were recruited at birth into a prospective longitudinal study and followed until age 8 with a 97% retention rate. Children were stratified by birth weight and socioeconomic status. The hypotheses were supported. Significant main effects for cumulative medical risk and distal and proximal protective processes in all competency outcome models are key findings. The addition of protective processes was small to moderate in effect (6%-18%) yet clinically significant. These findings illustrate the advantage of applying cumulative medical risk and protection approach to better understand school-age outcomes. Multiple risk and protective models emphasize the joint occurrence of individual contextual processes in the understanding of competence outcomes in high-risk children.
