Developmental Trajectories of Late Preterm Infants Using an Ecological Framework

University Of Michigan At Ann Arbor, Ann Arbor MI

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Abstract

? DESCRIPTION (provided by applicant): Candidate/Environment: Dr. Shah is a board-certified Developmental-Behavioral Pediatrician who is committed to engaging in research that bridges the fields of Developmental Pediatrics and Infant Mental Health. She has received training in medical and behavioral sciences and was supported by an early career development award (K12 HD041648) which provided her with introductory training in statistics, resulting in a Master's of Clinical Research. She has develope a programmatic research focus on social-emotional outcomes of infants at developmental risk, with a special focus on these processes in preterm infants. This mentored career development award will allow her to continue her programmatic development in an emerging area of research (outcomes of late preterm infants (LPIs)). She has identified a comprehensive mentoring team at the University of Michigan Center for Human Growth and Development, an interdisciplinary child development research center, to provide methodological and content expertise, including Pamela Davis-Kean, PhD (Associate Professor of Psychology and Center Director: Institute for Social Research); Niko Kaciroti, PhD (Research Scientist of Biostatistics); John Barks, MD (Professor of Neonatology); Brenda Volling, PhD, (Professor and Chair, Developmental Psychology) and Julie Lumeng, MD (Associate Professor of Pediatrics). The University of Michigan has demonstrated a commitment to her career development. She has also Identified additional faculty members with specialized expertise in the areas of early brain development (Hannah Glass, MDCM, UCSF), late preterm infants (Lucky Jain, MD, Emory University), and neuropsychological assessment (Seth Warschausky, PhD, University of Michigan) who will provide additional training experiences that will integrate with her future career goals focused on understanding the mechanisms in the perinatal and postnatal environments associated with increased developmental risk in LPIs. Training and Career Goals: Dr. Shah's career goal is to improve outcomes for late preterm infants by better understanding the mechanisms in the perinatal and post-natal environments that are associated with increased developmental risk. Her career goals will focus on answering the following questions: (1) What features of the perinatal period are associated with increased developmental risk; (2) How do differences in parenting and the quality of the early caregiving environment modify the developmental trajectories of these infants; (3) Which late preterm infants are most likely to benefit from the provision of early intervention services; and (4) What are the key developmental time periods when intervention effects are most robust, and should be implemented? To prepare her to address these questions, Dr. Shah has identified 5 key training goals which she will achieve during this 4-year K-award: [1] Develop skills in conducting longitudinal data analysis; [2] Develop knowledge of the biologic mechanisms by which features of the perinatal period may contribute to developmental vulnerabilities in LPIs; [3] Develop increased content expertise and skills in the measurement of family systems and parenting behavior in infancy; [4] Develop skills in primary data collection; and [5] Develop familiarity with neuropsychological tools to assess neurocognitive functioning. These training goals are overseen by an integrated mentoring team, and will facilitate her ability to develop refined hypotheses regarding how features of the perinatal environment may be associated with neurodevelopmental outcomes in late preterm infants. Research: Late preterm infants (LPIs) (infants born between 34-36 weeks gestation) account for 75% of infants born prematurely. LPIs manifest increased developmental vulnerabilities compared to full term infants, though reasons for their developmental vulnerability remain largely under-researched. Understanding the biological vulnerabilities and the potential modifiable factors associated with suboptimal development in this population has the potential to inform the clinical management of LPIs in the peri- and postnatal environments. Using a nationally representative sample containing over 1100 late preterm infants, this investigation will address 3 specific aims: SA-1: Examine how variations in brain development characterized by differences in gestational age, neonatal risk and intrauterine growth status are associated with cognitive trajectories of LPIs from 9mo-kindergarten. SA-2: Examine how variations in the proximal (e.g., parenting) and distal environments (e.g., early intervention enrollment and socioeconomic status) are associated with differences in cognitive trajectories of late preterm infants. SA-3: Examine how specific sequelae in the immediate perinatal period and proximal neurocognitive processes (e.g., self-regulation) are associated with differences in cognitive outcomes of late preterm infants. Future Implications: This research can elucidate the perinatal biological and environmental factors associated with developmental vulnerability in late preterm infants. Results can inform practice regarding care in the immediate post-partum period and shape policy recommendations for developmental surveillance for LPIs who account for >400,000 preterms born each year and who currently receive no specialized follow-up care.