In Reply We thank Provenzi et al for their insightful suggestions with regard to using prospective longitudinal studies, such as ours,1 to examine the effects of preterm birth and neonatal intensive care unit–related stress on the programming of health and disease in later life.
We agree that the risks associated with preterm birth are not simply limited to those associated with their intrauterine environment and delivery. Indeed, these pathways are complex and undoubtedly involve early postnatal stresses including those that infants experience in the neonatal intensive care unit. These include adverse environmental and complex medical and pain pathways that are under study by many investigators for their role in the development of later mental and chronic health conditions in former premature infants. It is also important to note that the physiological and psychological stresses that contribute to risk and resilience in preterm survivors likely continue beyond the neonatal intensive care unit.2 Our work in 2016 has shown that later postnatal exposures, such as exposure to bullying,3 increase the risk of psychiatric problems in adulthood, while other factors that might be expected to be linked to elevated risk (eg, motor coordination problems) do not.4 Such findings not only highlight the complexity of these pathways but also that intervening on certain modifiable exposures could have the potential to improve the health and well-being of these individuals across the lifespan.
Saigal S, Van Lieshout RJ, Schmidt LA. Why Are Prospective Longitudinal Studies Needed in Preterm Behavioral Epigenetic Research?—Reply. JAMA Pediatr. 2017;171(1):92-93. doi:10.1001/jamapediatrics.2016.2467