Open research questions in Infant Development and Preterm Care

What the literature leaves open

• As larger study samples, controlled design, blinded assessment, and longer follow-up periods are recommended, future research is warranted in order to draw evidence-based conclusions regarding integrated physiotherapy-KMC treatment protocols for LBW preterm infants.

  Potential Impact of Kangaroo Mother Care Combined With Structured Physiotherapy on Neurodevelopmental Outcomes in a Low-Birth-Weight Infant: A Case Report · 2026 · DOI

• for ISSHP classification, international practice. 62. Erez, O. et al. Preeclampsia and eclampsia: the conceptual evolution of a syn- drome. Am. J. Obstet. Gynecol. 226, 786–S803 (2022). 63. Lees, C. C. et al. ISUOG practice guidelines: diagnosis and management of small- for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet. Gynecol. 56, 298–312 (2020). 64. Jensen, E. A. et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants. An evidence-based approach. Am. J. Respir. Crit. Care Med. 200, 751–759 (2019). 65. Papile, L. A., Burstein, J., Burstein, R. & Koffler, H.

  Risk profiles of motor deficits in preterm infants: a cluster analysis approach · 2026 · DOI

• Replication of the identified risk profiles in larger, multicenter cohorts is needed to validate their structure and examine generalizability across diverse populations, health systems, and socio-economic contexts. Longitudinal follow-up into preschool age and beyond will help clarify the stability of these early risk profiles and their predictive value for cognitive, motor, and socio- emotional outcomes. Further research should also explore how access to and engagement with early intervention services—such as physiotherapy and occupational therapy and structured follow- L. Middendorf et al. 8 up programs—modifies developmental trajectories within specific risk profiles. Taken together, our findings highlight the need for comprehen- sive, individualized follow-up strategies for preterm infants. Risk assessment should move beyond neonatal factors alone and incorporate maternal and socio-economic variables to more effectively support early development and reduce health inequities. DATA AVAILABILITY The data that support the findings of this study are available in aggregated form upon reasonable request from the corresponding author. The data is not publicly available due to privacy and ethical restrictions. REFERENCES 1. Ohuma, E. O. et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet 402, 1261–1271 (2023). 2. Vos, T. et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet 396, 1204–1222 (2020). 3. Pierrat, V. et al. Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study. BMJ 358, j3448 (2017). 4. Fernández de Gamarra-Oca, L. et al. Long-term neurodevelopmental outcomes after moderate and late preterm birth: a systematic review. J. Pediatr. 237, 168–176 (2021). 5. Sarda, S. P., Sarri, G. & Siffel, C. Global prevalence of long-term neurodevelop- impairment following extremely preterm birth: a systematic literature mental review. J. Int. Med. Res. 49, 1–21 (2021). 6. DeMaster, D. et al. Nurturing the preterm infant brain: leveraging neuroplasticity to improve neurobehavioral outcomes. Pediatr. Res. 85, 166–175 (2019). 7. Libertus, K. & Hauf, P. Editorial: motor skills and their foundational role for per- ceptual, social, and cognitive development. Front. Psychol. 8, 301 (2017). 8. Jackman, M. et al. The predictive validity of Hine, Bayley, general movements and Mos-R in infancy. Early Hum. Dev. 203, 106226 (2025). 9. Li, S.-J. et al. Cognitive and motor development in preterm children from 6 to 36 months of age: trajectories, risk factors and predictability. Early Hum. Dev. 172, 105634 (2022). 10. Einspieler, C. & Prechtl, H. F. Prechtl’s assessment of general movements: a diagnostic tool for the functional assessment of the young nervous system. Ment. Retard Dev.

  Risk profiles of motor deficits in preterm infants: a cluster analysis approach · 2026 · DOI

• IntroductionInfant neurodevelopment is associated with maternal nutritional status, yet few studies have evaluated the effects of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation.

  Effect of fortified balanced energy-protein supplementation during pregnancy and lactation on infant neurodevelopment: a community-based randomized controlled trial in rural Nepal · 2026 · DOI

• While the benefits of RS for parent-child dyads are well documented, its efficacy has not been evaluated in parent-child dyads facing significant relational stressors, such as those experienced in post-NICU contexts.

  Increasing Parental Well‐Being After the Neonatal Intensive Care Unit Through Relational Savoring · 2026 · DOI

• There are some limitations in the study. First, all participants were recruited from a single provincial tertiary hospital in China, with a relatively small sample size. This restricted our ability to fully examine potential differences in parental activation patterns between fathers and mothers, as well as their associated influencing factors. Second, data were collected at a hospital with a fixed weekly visitation schedule allowing only 30 min per visit. It is therefore uncertain whether our findings can be generalized to hospitals with more open, flexible visitation policies or those with fully restricted access. Future research should from hospitals with diverse visitation policies to validate the cross-context robustness of our results. Furthermore, the study failed to distinguish clearly between primary and secondary caregivers, with all respondents categorized merely as parents. Since paternal and maternal caregivers can differ systematically in caregiving behaviours, this interaction undifferentiated grouping may compromise the precision of the research conclusions. Third, causality between the independent and dependent variables cannot be established due to the crosssectional nature of this study.

  Classification and influencing factors of parent activation among parents of preterm infants at a NICU in China: a latent profile analysis · 2026 · DOI

• The paper documents that maternal voice benefits have been shown in neonatal ICU, pediatric ICU, perioperative, and diagnostic settings, but its effect on postoperative sleep following cardiac surgery has not been systematically examined. A randomized controlled trial specifically measuring sleep quality metrics (sleep onset latency, sleep efficiency, total sleep time) in the cardiac surgery population is needed to fill this evidence gap.

  Effect of maternal voice on sleep quality in children following cardiac surgery: protocol for a randomized controlled trial · 2026 · DOI

• The observed effects may reflect combined influences of auditory stimulation, structured intervention exposure, and attention-related effects rather than maternal voice specifically. Future studies must incorporate attention-matched control groups and unfamiliar voice comparators to isolate the unique therapeutic contribution of maternal voice from general auditory intervention and attention effects in postoperative sleep outcomes.

  Effect of maternal voice on sleep quality in children following cardiac surgery: protocol for a randomized controlled trial · 2026 · DOI

• The study assessed primary outcomes only during the first three postoperative nights with no long-term follow-up data. Future research should extend evaluation periods beyond the immediate postoperative phase to determine whether maternal voice intervention produces sustained improvements in sleep quality at 1 week, 1 month, and 3 months post-discharge in children with congenital heart disease.

  Effect of maternal voice on sleep quality in children following cardiac surgery: protocol for a randomized controlled trial · 2026 · DOI

• While actigraphy is used for sleep assessment, it cannot capture sleep architecture with the same comprehensiveness as polysomnography (PSG). Future studies should employ PSG alongside actigraphy to provide a more detailed characterization of sleep stages, sleep cycles, and microarousals in children following cardiac surgery exposed to maternal voice intervention.

  Effect of maternal voice on sleep quality in children following cardiac surgery: protocol for a randomized controlled trial · 2026 · DOI

• This paper attempts to address these gaps in knowledge by exploring the relations between caregiver education, household stimulation, and early childhood development in a sample of infants and toddlers aged birth to three using data on 9,099 caregiver-child dyads from eight under-represented Majority World sites: Brazil, Guatemala, India, Jordan, Lebanon, Pakistan, the Philippines, and Zambia.

  The Relations Between Caregiver Education, Home Stimulation, and Children’s Developmental Outcomes: Research in Majority World Countries · 2024 · DOI

• Eighteen of 40 studies on maternal behavior found less favorable behavior, including decreased sensitivity and more intrusiveness in mothers of preterm infants, seven studies found the opposite, four studies found mixed results, and 11 studies found no differences.

  Preterm infant mental health in the neonatal intensive care unit: A review of research on NICU parent‐infant interactions and maternal sensitivity · 2023 · DOI

• Participatory learning and action cycles with women’s groups have been recommended by the WHO to promote maternal and newborn health, but few studies have tested its feasibility and acceptability in mobile health (mHealth) interventions among mothers of toddlers.

  A WhatsApp-Based Intervention to Improve Maternal Social Support and Maternal–Child Health in Southern Brazil: The Text-Message Intervention to Enhance Social Support (TIES) Feasibility Study · 2021 · DOI

• Music therapy (MT) may support maternal-infant bonding during this critical period, but studies measuring impact across the infant's first year are lacking.

  Longitudinal Study of Music Therapy’s Effectiveness for Premature Infants and Their Caregivers (LongSTEP): Feasibility Study With a Norwegian Cohort · 2021 · DOI

• ” The wide heterogeneity in the number and type of diagnostic conditions listed across states should be further investigated as it may represent imbalances in children with diagnosed conditions gaining access to Part C evaluations and individualized family service plans and potentially the services themselves across states.

  State Variability in Diagnosed Conditions for IDEA Part C Eligibility · 2019 · DOI

• The present study was designed to address this gap in research, predicting frontal EEG asymmetry response in the context of the Still Face procedure (SFP), examining mother–infant interaction quality and infant temperament attributes as potential contributors.

  Frontal electroencephalogram (EEG) asymmetry reactivity: Exploring changes from baseline to still face procedure response · 2019 · DOI

• Given that one secure attachment has been shown to promote healthy development in important ways and that it remains unknown at birth which parent will best generate that attachment, it is wise to provide each parent enough time with the child to foster attachment, including children whose parents do not live together.

  Safe and secure: Suggestions for sharing care of babies and toddlers · 2018 · DOI

• The literature about connecting children to Part C early intervention (EI) is sparse and fragmented; few studies document the full process from community monitoring to service receipt.

  A Systematic Review of Part C Early Identification Studies · 2016 · DOI

• BACKGROUND AND OBJECTIVE: The initial years of life are critical for physical growth and broader cognitive, motor, and socioemotional development, but the magnitude of the link between these processes remains unclear.

  Linear Growth and Child Development in Low- and Middle-Income Countries: A Meta-Analysis · 2015 · DOI

• Although a large body of literature exists on how different types of child care arrangements affect a child's subsequent health and sociocognitive development, little is known about the relationship between birth health and subsequent decisions regarding type of nonparental child care as well as how this relationship might be influenced by maternal employment.

  Associations between Birth Health, Maternal Employment, and Child Care Arrangement among a Community Sample of Mothers with Young Children · 2013 · DOI

• Conclusions: The greater overall dysregulation in VLBW toddlers compared with premature/LBW toddlers suggests that early screening for such difficulties among VLBW toddlers is warranted, and this study provides preliminary evidence that the ITSEA Dysregulation Domain may be an appropriate screening measure.

  Screening for Dysregulation Among Toddlers Born Very Low Birth Weight · 2013 · DOI

• However, very little is known about how parents perceive different types of medical technology products commonly used in the neonatal intensive care unit (NICU) as barriers to their wish to interact with their infants.

  Parental interaction with infants treated with medical technology · 2012 · DOI

• CONCLUSION: Further research is needed to understand the reasons for the adverse findings of this study and identify potentially changeable factors contributing to adverse pregnancy and birth outcomes for women with ID and/or self-reported learning difficulties and their children.

  Women with intellectual disability at risk of adverse pregnancy and birth outcomes · 2008 · DOI

• Future research is warranted to determine how these findings relate to infants' stress reactions in naturalistic settings and if relationship-focused interventions may reverse infant negative emotionality, enhance positive emotionality, and thereby improve self-regulation and longer term social and cognitive developmental outcomes in medically at-risk infants.

  The role of maternal responsiveness in predicting infant affect during the still face paradigm with infants born very low birth weight · 2008 · DOI

• BACKGROUND: A great deal of attention has focused on understanding preterm infant feeding behaviors and on strategies to support the preterm infant during this period; however, comprehensive descriptions of the feeding behavior of preterm infants that incorporate an examination of multiple subsystem levels are lacking.

  Multiple Factors Related to Bottle-Feeding Performance in Preterm Infants · 2007 · DOI

Most-cited papers in Infant Development and Preterm Care

• The Avon Longitudinal Study of Parents and Children (ALSPAC): an update on the enrolled sample of index children in 2019 · Wellcome Open Research · 2019 · 626 citations
• Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis · PEDIATRICS · 2015 · 488 citations
• Linear Growth and Child Development in Low- and Middle-Income Countries: A Meta-Analysis · PEDIATRICS · 2015 · 346 citations
• Maternal responsiveness to young children at three ages: Longitudinal analysis of a multidimensional, modular, and specific parenting construct. · Developmental Psychology · 2008 · 309 citations
• The Stockholm Neonatal Family Centered Care Study: Effects on Length of Stay and Infant Morbidity · PEDIATRICS · 2010 · 305 citations
• Neurodevelopmental Outcome at 5 Years of Age of a National Cohort of Extremely Low Birth Weight Infants Who Were Born in 1996–1997 · PEDIATRICS · 2005 · 273 citations
• Expectancies for social contingency in 2‐month‐olds · Developmental Science · 1999 · 247 citations
• From alienation to familiarity: experiences of mothers and fathers of preterm infants · Journal of Advanced Nursing · 2003 · 209 citations
• Measuring neonatal intensive care unit‐related parental stress · Journal of Advanced Nursing · 2005 · 206 citations
• Do early father–infant interactions predict the onset of externalising behaviours in young children? Findings from a longitudinal cohort study · Journal of Child Psychology and Psychiatry · 2012 · 185 citations

Most recent work

• Effects and feasibility of expressive writing intervention on coping among mothers of preterm newborns hospitalised in the neonatal intensive care unit: Insights from a convergent parallel mixed-methods study · Journal of Neonatal Nursing · 2026
• Electronic Health Record Monitoring Dashboard and Developmental Screening in Pediatric Patients · JAMA Network Open · 2026
• High Risk Follow-Up of NICU Graduates – A Quality Improvement Study at a Tertiary Care Centre · The Indian Journal of Pediatrics · 2026
• Parents' experiences during their child's stay in the NICU or PICU: A scoping review · Journal of Pediatric Nursing · 2026
• Reimagining walkable cities: exploring the experience of mothers of premature babies · Town Planning Review · 2026
• Effect of maternal voice on sleep quality in children following cardiac surgery: protocol for a randomized controlled trial · Frontiers in Medicine · 2026
• Exploring factors influencing mother-infant interaction trajectories post-NICU discharge in low-birth-weight infants during COVID-19 in China: a longitudinal qualitative study · BMC Pregnancy and Childbirth · 2026
• Latent profiles and associated factors of mother-infant bonding among mothers of preterm infants: a cross-sectional study · BMC Pregnancy and Childbirth · 2026
• Beyond survival: Thriving with advanced maternal and neonatal care · Sri Lanka Journal of Perinatal Medicine · 2026
• Early-life painful and stressful exposures and neurodevelopment in preterm infants · Frontiers in Pediatrics · 2026

Related topics in Medicine