#354 -🚶‍➡️[Life Course Series] - Do We Really Understand the Life Course after Preterm Birth?

This episode sets the stage for a collection of conversations inspired by a recently published special issue in Children: Implications of Preterm Birth for Health and Well-Being Over the Life Course. Host Dr. Daphna Barbeau is joined by the editors, Dr. Susan Hintz and Dr. Jonathan Litt of Stanford University, to discuss why the concept of “life course” is so critical for understanding the long-term impact of preterm birth.

Dr. Hintz and Dr. Litt explain how survival is only the beginning of the story. Preterm birth often shapes health trajectories well into childhood and adulthood, influenced not only by medical factors but also by family, environment, and community supports. They highlight how the issue’s twelve articles bring together diverse perspectives—from developmental science to family voices—that reveal both the challenges and opportunities faced by preterm infants and their families.

For busy clinicians, this conversation reframes day-to-day NICU care within a broader, lifelong context. It shows how even routine interactions in the NICU can influence resilience, parental well-being, and future outcomes. More than an introduction, this episode is an invitation to think differently about what it means to care for premature infants—not just today, but across their entire life course.

Transcript

Daphna Yasova Barbeau, MD
Hi everybody. Today I am thrilled to say I have two very special guests in the studio with me, Dr. Susan Hintz and Dr. Jonathan Litt. I'll introduce them in just a second.

Today, we are setting the stage for what will be a series on The Incubator in the coming week. We're having this series because a wonderful special issue came out in Children entitled “The Implications of Preterm Birth for Health and Well-Being Over the Life Course.” Drs. Litt and Hintz are the special issue editors. They’re both coming to us from Stanford University. Dr. Jonathan Litt is a neonatologist and Associate Professor of Pediatrics, and Dr. Susan Hintz is also a neonatologist and Professor of Pediatrics. Thank you both for joining me today.

To help people understand the breadth of this project, this was your idea, using a life course framework to talk about what preterm birth means long term for our babies. You’ve brought together a number of experts in the field – a total of 12 articles and contributors from multiple disciplines. I want to give people a little background, so I’ll read a paragraph from your call for submissions. You wrote:

“Dear colleagues, infants born prematurely are surviving in greater numbers, even from the earliest gestational ages. However, preterm birth is associated with ongoing chronic health problems, multi-morbid conditions, developmental challenges, and functional limitations in childhood and beyond. Though common, such outcomes are not a foregone conclusion, varying by infant and maternal health, experiences during hospitalization, and the familial and social context in which the child lives. Therapeutic, material, and psychosocial supports for the infant and family pre- and postnatally and throughout childhood are vital to ensure the best possible outcomes for all. Children and families exist within a dynamic, multi-layered ecosystem of community, social, educational, and economic services, programs, and policies that support growth and development. Such a life course health development perspective is instrumental to identifying, quantifying, and ameliorating the complex, multi-level threats to health and well-being for infants born prematurely.”

So, Dr. Litt, maybe you can tell us a little bit, what is this “life course”? What do we need to know about it before we can really understand where you went with this initiative?

Jonathan Litt
Sure. The life course, to me as a neonatologist and really as a pediatrician, is so central to what we do. If we take a step back and think beyond academia, our job caring for young infants is to understand how the transition from fetal to neonatal life affects their health at that moment and long term. We’re setting babies up for success, for how they grow and develop.

My academic work has delved into how others have thought about this rather magical process of becoming a fully-fledged human being. There are many different concepts and frameworks that inform our understanding, from medicine to psychology to education.

The Life Course Health Development model brings together many of those frameworks: developmental psychology, basic science, how early exposures and experiences affect our bodies long term. It’s a useful lens for both research and clinical care, helping us understand outcomes over time and how we can best support optimal development.

Susan and I are both deeply involved in high-risk infant follow-up, so our perspectives really span from the earliest stages through later development. Life course thinking helps us connect those dots.

Daphna Yasova Barbeau, MD
I love that. Thanks for that introduction. So, Dr. Hintz, I’ll let you give your input too. For our audience, many are busy clinicians in the NICU, focused on the day-to-day management of critically ill babies or getting them home safely and quickly. Why should every neonatologist care about the life course?

Susan Hintz
Thanks for that question, because Jonathan and I have talked about this a lot. As he said, there are many frameworks for thinking about how we can do better for our patients and families. Life course conceptualization is one of them, and it ties into what many people already know about follow-through principles. It can feel overwhelming because neonatologists often say, “I’m focused on the day to day; I’m not the person who’s thinking about the rest of their lives.” But we see it as the opposite — why wouldn’t we think about their lives beyond the NICU?

We’re privileged to be neonatologists. We’re there at the transition from fetal to neonatal life, integrated into the family’s journey for months or years. We have a natural opportunity by virtue of the fact that they are right there in the NICU to identify challenges and resilience factors that that family may have, to understand environmental or societal issues that may be problematic. And then we can help connect them with supports. 

The World Health Organization identifies “building health throughout the life course” as one of its strategic goals. They highlight three main components: first is the longevity effect – because children today, including our patients, are living longer than ever before. The second is the chronicity effect - many of these children live with chronic conditions due to medical advances that allow survival. Lastly is health for development - this focuses on supporting optimal life and well-being, not just preventing disease.

This isn’t about every neonatologist mastering every aspect but about recognizing that we do have a stake in shaping lifelong health, starting in the NICU.

Jonathan Litt
That was so wonderfully said. For me, instead of feeling overwhelmed, the life course perspective is actually centering. It grounds us in our role in this lifelong trajectory. If you think about it, neonatology is one of just a few fields focused on a specific life phase, alongside adolescent medicine and geriatrics. It’s a natural framing for what we do.

Daphna Yasova Barbeau, MD
I love that. I’ll disclose that when you came to us about this, we were maybe nine months into producing this podcast, and I’ve since had the chance to speak with some of the experts. I’ve been thinking about how this changes my own practice. We spend a lot of time with families and hopefully we’re a trusted resource by the end of an admission. But especially in those “feeder-grower” weeks, we have opportunities we often miss, to set families up for success through education or connection to resources. Data shows that families want to talk about these things, but we often don’t make the time. How could we fill that period more meaningfully? What might that look like if we did it effectively?

Susan Hintz
That’s exactly the right way to think about it. Those weeks are a period of opportunity - not that families are “trapped,” but they are present and surrounded by caregivers. From the very beginning, we can create an individualized rhythm of learning. Families can teach us about their needs, experiences, and environments, while we educate and support them.

Many families arrive already carrying trauma - sometimes from before their NICU experience. Understanding that helps us tailor the supports we offer. Sometimes transition to home programs start two weeks before you're going to go home, then all of a sudden we bombard families with all these things that are going to happen. But from the beginning, and ideally even before the baby's born if you're lucky enough to be there, there can be the opportunity for a natural rhythm and flow of education going both ways. The family can educate us about what's going on for them, what their life looks like, where their challenges are, and what their family construct is. We can educate and help build a support system for them that will then move to the next transitions, and hopefully then that process continuing in high-risk infant follow-up programs as well. But it can’t be one-size-fits-all — flexibility is key, especially for preterm infants and their families.

Jonathan Litt
Exactly. Health development is a process - it starts before birth and continues throughout early life. Those “less acute” weeks are also a time for parents to learn how to parent in an abnormal and scary environment. It’s an opportunity for bonding that’s been interrupted by the NICU stay, relationship-building, and supporting parental mental health - which can be deeply affected by the NICU experience. We have a real chance to help families not only prepare for homegoing, but to strengthen those essential relationships.

Daphna Yasova Barbeau, MD
I was struck by what you said about the two-way street. I recall a mother of a very preterm baby, “on the edges” as we say. This was a very stoic family who was coming in every day and were totally engaged. When the baby was almost term, we found out that the mom hadn’t told anyone in her family that her baby had been born, for months. She carried all of this alone. It made me realize how little we sometimes know about what families are holding. If we don’t ask, we don’t know.

Susan Hintz
That’s a great example, Daphna. Everyone has those moments of realization, where you think, “How did we not talk about that sooner?” It changes everything when we understand what families are carrying on their own, and what we can do to reassure them and build support around them.

Daphna Yasova Barbeau, MD
Absolutely. I want to pivot to the special issue itself. Why these articles? Why these experts? How did you narrow it down to 12?

Jonathan Litt
It was hard. There are so many people doing wonderful work in this area. We wanted to highlight, first and foremost, the family voice. We have three articles dedicated to families: two from NICU parents and one from a colleague, Dr. Michael Msall, writing about his sister with special healthcare needs. Then we explored other key themes: the physical and social environments in which families live, early biological aging, and more. Each topic adds another layer of understanding.

Susan Hintz
We could have easily filled twelve volumes instead of twelve articles! The family perspective is central, not only in those three pieces, but infused throughout. We also included articles on parental mental health, uncertainty, and how families cope with it, since every family’s tolerance and strategies differ. This reinforces the need for individualized approaches, which is a core tenet of the life course framework.

Jonathan Litt
Exactly. We wanted to give readers a sense of the breadth of how life course thinking applies to neonatology. It’s everywhere once you start looking.

Susan Hintz
And Jonathan deserves credit. He was the lead author on the kickoff article, which connects the concepts beautifully and shows how they relate to our daily work. This special issue also grew out of our collaboration within the Life Course Intervention Research Network, led by Neal Halfon and Shirley Russ, who co-authored that first paper.

It’s a whole way of thinking about development that I think will really resonate with neonatologists once they explore it.

Daphna Yasova Barbeau, MD
I love that. So, for listeners — we have a whole series of episodes coming up, featuring many of the authors. I hope everyone will also go read the special issue itself.

I don’t know how you can get through these papers and not think, “I should do things a little differently.” There’s so much we can take immediately to the bedside.

Before we wrap up, was there anything unexpected you learned along the way?

Susan Hintz
I’ll just say that I’m always learning. Every single paper taught me something new, and in many cases, moved me deeply. We all need to stay humble and keep learning.

Jonathan Litt
Absolutely. The family perspective pieces especially hit home for me. Reading them in that format, outside the clinical setting, allowed me to reflect differently. And it was a real pleasure to see so many early-career researchers and trainees leading or contributing to these papers. It makes me so excited for the future of our field.

Daphna Yasova Barbeau, MD
I love that. Dr. Susan Hintz, Dr. Jonathan Litt, thank you so much for joining me today, and for this amazing body of work. We look forward to having you back again soon.