Grant: CIHR Fellowship

Children born very preterm are at high risk for behavior problems including inattention and social difficulties, placing enormous burdens on family, school and community. Wide variation is seen in behavior outcomes and problem severity, even in children born at the same range of prematurity but we do not know why. How adverse clinical factors during neonatal intensive care contribute to outcomes and the extent to which parenting after discharge mitigates these neurobehavioral problems is unclear. Longitudinal investigation of developmental pathways from birth through to school age to examine relationships between early-life brain development, stress (cortisol) regulation and behavior problems, together with the role of parenting, is urgently needed. AIMS: I will examine longitudinal developmental pathways to understand why some very preterm children do well and others poorly: 1. Characterise the behavioral phenotype of children born very preterm at school age (8 years) 2. Examine how neonatal factors, early-life brain dysmaturation, and stress regulation (cortisol levels) across childhood alters: a) trajectories of behavior problems across ages 1.5, 3, 4.5 to 8 years; b) the preterm behavioral phenotype at 8 years; c) pathways differently for boys and girls 3. Characterize specific parent interactions during semi-structured teaching tasks that ameliorate effects of early-life stress and brain dysmaturation from infancy through school-age, in boys and girls To address these aims I will use Drs. Grunau & Miller's internationally unique longitudinal very preterm cohort that includes quantitative brain imaging twice in early life, serial cortisol measures, filmed parent interaction and developmental follow-up at ages 1.5, 3, 4.5 and 8 years. In Neonatal Follow-up, parents of very preterm children express that behavior problems are challenging and seek advice. My research will identify parent interactions that improve behavior, to provide tangible benefits for families.