Resilience and vulnerability in very preterm 4-year-olds

Area of Science:

• Developmental Pediatrics
• Neonatal Follow-up
• Child Psychology

Background:

• Very preterm (VPT) birth is associated with increased risk for developmental challenges.
• Adaptive competence, or resilience, is crucial for positive child development.
• Understanding factors influencing adaptive competence in VPT children is essential for targeted interventions.

Purpose of the Study:

• To determine the prevalence of adaptive competence in 4-year-old very preterm (VPT) children compared to term-born (Term) children.
• To identify correlates of adaptive competence within the VPT group and compare adaptively competent VPT children to their maladaptive counterparts and to adaptively competent Term children.
• To explore family factors associated with adaptive competence independent of birth status.

Main Methods:

• Study included 51 very preterm (VPT, gestational age ≤30 weeks) and 35 term-born (Term) 4-year-old children.
• Adaptive competence was defined by age-appropriate literacy/numeracy scores and absence of clinical behavioral/developmental problems.
• Analyses compared adaptive competence prevalence between groups and examined cognitive, executive function, and family factors.

Main Results:

• Significantly fewer VPT children (31%) demonstrated adaptive competence compared to Term children (71%) (p = .026), after controlling for sociodemographics.
• Adaptively competent VPT children exhibited higher cognitive scores and better executive function/self-regulation ratings than their maladaptive VPT peers.
• While sharing similarities, adaptively competent VPT children had some domain-specific weaknesses compared to adaptively competent Term children; higher home stimulation and lower parent distress correlated with competence.

Conclusions:

• A notable minority of VPT children achieve adaptive competence, but they may still face cognitive and executive functioning challenges.
• Supportive home learning environments and reduced parental distress are associated with better adaptive competence in VPT children.
• Early family interventions focusing on home stimulation and parental well-being may enhance developmental outcomes for very preterm infants.