LAUSR

Preterm birth remains an important public health challenge for improving the quality of immediate and long-term care of the child and their family. Nearly 1 in 10 live births worldwide are preterm, with higher rates in marginalized populations and developing countries. 1 Advances in medical intensive care of these infants mean more infants born very preterm and extremely preterm are surviving. The preponderance of research on children born very preterm has revealed the linkages between numerous risks and acute and long-term adverse health and developmental outcomes for the children, and social and psychological challenges for the families. 2 Although children born earlier in gestation are at increased risk for poor outcomes, there is wide variability, with many children doing well. Therefore, research that can identify the protective factors or identify who, when, or under what circumstance some preterm children thrive is essential for informing interventions to assist those preterm children who are at risk of ongoing emotional problems. Very preterm (<32 weeks’ gestational age) and very low birth weight (<1500 g) children are more at risk than their full-term peers for developing internalizing symptoms (eg, anxiety and/or depression). Emerging evidence suggests that maternal sensitivity is a long-term resilience factor in the development of internalizing problems in early adolescence in very preterm children. 3 McLean et al 4 further that supportive parenting of infants born very preterm is associated with more optimal emotional outcomes across early and middle childhood. They report the findings from a prospective, longitudinal cohort study of 186 very preterm neonates (24-32 weeks’ gestational age) recruited from the level III neonatal intensive care unit (NICU) at BC Women’s HospitalinVancouver,Canada.Thisreportaimedtoinvestigatewhetherneonatalpain-relatedstress experienced by neonates in the NICU was associated with trajectories of internalizing behaviors at ages 1.5 (159 children), 3.0 (169 children), 4.5 (162 children), and 8.0 (153 children) years and whether supportive parenting behaviors and lower self-reported parental stress at ages 1.5 and 3 years attenuated this association. Cumulative pain and stress was defined as the number of invasive procedures performed in the NICU. The main outcome was parent reports of child internalizing behaviors measured with the Child Behavior Checklist at every follow-up. At ages 1.5 and 3 years, parental stress was obtained from the Parenting Stress Index, and parent-child interactions were obtained from videotapes of a 5-minute teaching task coded by independent examiners using the Emotional Availability Scale–IV. After accounting for gestational age at birth and neonatal clinical factors, greater exposure to neonatal pain-related stress, related to invasive procedures from birth to NICU discharge, was associated with increased internalizing symptoms across follow-up. At 1.5 years, internalizing behaviors were within the normative range; however, by age 8 years, parent reports indicated that 24 of 153 children (16%) had symptoms that put them in the clinical range for internalizing behaviors. Latent profile analyses of parenting behaviors observed in parent-child interactions at ages 1.5 and 3 years and parenting stress at 3 years identified 3 profiles: average support with average stress, high support with low stress, and low support with high stress. Higher parenting stress at 1.5 years contributed to parent reports of greater internalizing problems across development to age 8 years. At age 3 years, the profile of high support and lower stress was associated with a reduction in the development of parent reports of internalizing behavior across development to age 8 years. Parents in this group demonstrated more behaviors that were characterized as sensitive, nonhostile, and nonintrusive and provided more structure in parent-child interactions.