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It starts in the neonatal intensive care unit (NICU): Why promoting best outcomes for babies born very preterm must include a focus on parents

When a baby is born two or more months too early – less than 32 weeks’ gestation – they are considered to be in the group of more than 5000 babies born very preterm in Australia every year. Babies born very preterm have an increased risk of significant challenges with cognitive development (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses), school work, and mental health outcomes by early school age.

These challenges have an associated cost to these babies, their families, and to society. Intervention with children in the early years is one of the most cost-effective strategies to improve future outcomes, so this means we need to understand the best way do this.  

The initial focus after premature birth is helping the baby survive and grow. But many Neonatal Intensive Care Units (NICUs) and hospitals have moved towards family-centred care. This means parents are actively involved in decision-making and caring for their baby. This recognition of the need for parents to be involved right from the start is important.

Parents have the strongest external influence on child development in the early years. One way this happens is through the parent-child relationship. Our research supports this by showing that sensitive and warm parenting, where the parent and child share emotions and attention, has a positive relationship with the development of children born very preterm. We have also found a higher-quality home environment is associated with better cognitive outcomes for children born very preterm, regardless of how long the baby spent in hospital initially.

Studies show early intervention programs for babies born very preterm, starting when the baby is in hospital or early post-discharge, have a positive effect on cognitive development in infancy and preschool. Importantly, bigger improvements are seen when early intervention programs work with the parent-child relationship instead of trying only to improve child development or only supporting parents.

Involving parents is also important because research suggests parents of babies born very preterm are considerably distressed after preterm birth. This distress does not seem to disappear after babies are discharged from hospital. Studies have found up to 63 per cent of mothers of babies born prematurely report symptoms of depression in the first few months after the birth. Our research has shown that, compared with parents of full-term babies, parents of babies born very preterm show higher rates of psychological distress two years after the birth (26 per cent very preterm, 12 per cent full term), and higher rates of anxiety and depression seven years after the birth. Twenty per cent of very preterm mothers reported significant anxiety compared to eight per cent of mothers of full-term babies.

Intervention for parents with anxiety and depression is critical because of the impact on the parents and their already at-risk children. Encouragingly, hospital and home-based intervention programs after preterm birth that include a focus on parents have shown early improvements in parent anxiety, depression and parenting self-efficacy – the belief in one’s ability to succeed.

So not only does involving parents in early intervention for babies born very preterm help the babies, it seems to help the parents too. Now we need to build on these previous intervention studies, identify the best ways to intervene, and find a way to make early intervention accessible to the thousands of families with new babies born very preterm across Australia every year. 

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