Early life stress, kangaroo care, parenting behavior and secure attachment predict executive functioning in 2 year olds born preterm

Self-regulation and executive functioning are known key predictors of future cognitive development and mental health. We examined the effect of early life neonatal stress, maternal perinatal stress, kangaroo care, maternal parenting behavior and secure child attachment on executive function at 2 years corrected age (CA) in children born preterm (i.e. < 34 weeks of gestation and/or < 1500 g birth weight). Neonatal child characteristics were recorded at the Neonatal Intensive Care Unit (NICU). We examined self-reported perinatal maternal stress during NICU stay, maternal emotional availability at 4 months CA, and child attachment security at 14 months CA. The executive function battery at 2 years CA was completed by 97 children. Low birth weight, a high number of skin breaking procedures and high level of maternal stress predicted lower executive function scores. Kangaroo care, non-intrusive maternal parenting behavior and secure attachment were associated with higher executive function scores. Even after controlling for background factors, modifiable factors such as neonatal child and mother stress, kangaroo care, parenting style, and child attachment style uniquely predict later executive functioning development, indicating that preventive interventions need to integrate multiple aspects of neuroprotective care, including supporting the child-parent bond, both at the NICU and beyond.