Development of (moderately) preterm infants: regulation skills, parent-infant interaction and parental emotions.

Moderate preterm birth constitutes an insult for the still immature brain of
the infant. At 34 weeks gestational age the overall brain weight is only 65%
of term weight and dendritic arborization is still poor (Kinney, 2006). Despite
these risk factors and the large number of infants involved (6,2% is born
between 32 and 36.6 weeks in the Netherlands, around 11.000 infants per year),
information on developmental outcome of moderate preterm infants is scarce.
Research in our own region in The Netherlands was done on a group of 377
moderately preterm children (M=34.7, SD=1.2 weeks), without need for neonatal
intensive care, no dysmaturity and no congenital malformations, assessed around
8 years of age and compared with 183 term children concerning school situation,
IQ, concentration, behavior problems, ADHD and fear characteristics (Van Baar,
Knots et al., 2008 en Van Baar, Couturier et al., 2008). Results showed that
7,6% of the preterm group needs special education compared to 2,9% in the Dutch
population, and 19,5% versus 8,3% of the comparison children repeated a class.
Of the 76 preterm children with school problems (defined as special education
or grade retention), 65% were boys, their parents had a lower education level,
and they had a 100 grams lower mean birth weight than the preterm children
without school problems.
It was concluded that regulation difficulties are found in moderate preterm
children at school age. Further study should focus upon the early (interaction)
processes that shape regulative capacities during infancy, in relation to
parental characteristics, including maternal anxiety (Zelkowitz et al., 2007).
A structured follow up programme for moderately preterm children might be
necessary.
Comparisons of the outcome in moderately preterm children with term born
children, as well as with extreme preterm born children are important in view
of differences in brain maturation at birth, as well as differences in the
amount of parental stress and anxiety.

The main question in the study is
How do moderately preterm infants and their parents differ from term, as well
as extreme preterm infants in (a) development and self regulation skills of the
infants, (b) interaction patterns and relationship between parent-infant dyads,
and (c) health and personality of their parents. A second question concerns the
groups differences that are found when the infants are 6-7 months of age
(corrected for prematurity); will these differences become stronger or weaker
when the children are older, at 18 - 23 months of age.

Two cohorts of 6-7 and 18 -23 months old children will be studied cross
sectionally using parent questionnaires concerning the development and
behaviour of the children and their own health and personality characteristics,
as well as and interview and an oberservation of parent child interaction. By
following up the youngest group also a longitudinal study of their development
is possible. The study aims to include 300 moderatly prterm children, 50
extreme preterm children and 150 term children.

The burden of this research is limited to answering questionnaires and
cooperating with a video recording of an interview, as well as cooperation of
mother and child with an observation during a daily routine. Parents are free
to stop participation if they decide to do so. If parents or children feel that
they need further support, couseling ot treatment, possibities for referral
will be checked within the network of cooperating hospitals.