Social Adversity and Cognitive, Language, and Motor Development of Very Preterm Children from 2 to 5 Years of Age

Objective: To assess the extent to which social and family factors explain variability in cognitive, language, and motor development among very preterm (<30 weeks of gestation) children from 2 to 5 years of age. Study design: As part of a longitudinal study, very preterm children recruited as neonates were assessed at 2 (n = 87) and 5 (n = 83) years of age using standardized tests of cognitive, language, and motor ability alongside demographically matched full term (FT) children (n = 63). For very preterm children, developmental change scores were calculated for each domain to assess within-individual variability to 5 years of age. Multivariate regression and mixed-effect models examined social risk index, parenting stress, family functioning, and maternal intellectual ability as predictors of developmental variation among very preterm children. Results: Very preterm children demonstrated poorer cognitive, language, and motor abilities than FT children at 2 (P ≤.001) and 5 (P <.002) years of age. Social adversity was associated with cognitive (P <.001) and language (P <.001) outcomes at both ages, with parenting stress also related to cognitive outcomes (P =.03). Infant medical risk was associated with motor outcome at 5 years (P=.01). Very preterm children showed considerable within-individual variation between assessments. Among very preterm children, neonatal white matter abnormalities predicted worsening cognitive (P=.04) and motor development (P =.01). Social risk index predicted worsening language development (P =.04), but this association was subsequently explained by dysfunctional maternal affective involvement (P =.01) and lower maternal intellectual ability (P =.05). Conclusions: Both clinical and socioenvironmental factors are associated with cognitive, language, and motor developmental variation among very preterm children from infancy to early school age.