A test of differential susceptibility in behavior trajectories of preterm infants from preschool to adulthood.
Michelle M Kelly, Kimberly Arcoleo, Amy L D'Agata and 1 others
PMID 36316209WHAT IT FOUND
After accounting for sex, socioeconomic status, cognition and maternal depression, medical risk and early protective home environment did not predict child behavior scores.
Unadjusted means showed lower scores with protective homes, but this does not prove benefit.
Key findings
01After controlling for sex, socioeconomic status, cognition and maternal depression, neither medical risk nor proximal protective index showed statistically significant differences in internalizing or externalizing behavior.
02Internalizing behavior changed significantly over time in both preterm and full-term groups, and male sex predicted higher externalizing behavior in the preterm group.
03Unadjusted mean scores showed lower internalizing and externalizing behavior in preterm children with highly protective early home environments compared with full-term children with similar protection at several ages.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a secondary analysis of existing cohort data, so the measures were limited to what was collected and cannot be updated or clarified. The proximal protective environment was measured only through age 4, so later home environment was not considered. The analysis did not explore distal environment, social determinants, diversity or health equity. Family characteristics not assessed could have influenced outcomes. The cohort included a wide range of gestational ages, birth weights and medical risk profiles, so findings may differ in narrower preterm groups. The adjusted analyses found no significant differences by medical risk or proximal protective index, so unadjusted mean differences cannot be treated as tested effects. Some participants did not have all five behavioral assessments; 86.5% had at least three externalizing assessments and 86.4% had at least three internalizing assessments.
Declared interests
The paper reports NIH extramural research support. No other conflicts of interest statement is included in the supplied text.
The easy way to misread this
Do not conclude that a protective home environment reduces behavior problems or that medical risk has no effect. The adjusted analyses found no significant differences by medical risk or proximal protective index, and the study did not test an intervention.