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Towards a Social Model of Prematurity: Understanding the Social Impact of Prematurity and the Role of Inclusive Parenting Practices in Neonatal Intensive Care Units: Comparison
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Please note this is a comparison between Version 2 by Jessie Wu and Version 1 by Chrysoula A Moscholouri.

Prematurity, defined as a birth before 37 weeks of gestation, affects approximately 15 million infants worldwide yearly. Beyond the Neonatal Intensive Care Unit and the possibility of long-term developmental challenges affecting children’s quality of life, prematurity influences family dynamics, including parental mental health, financial stability, employment, and daily life. On a broader scale, research highlights the significant socioeconomic consequences of preterm birth that influence public healthcare policies, healthcare systems, and long-term costs. Addressing these challenges requires a multidisciplinary approach, beginning in the NICUs, with parental inclusion as a key component. The shift toward parental inclusion in the NICU may represent a fundamental transition from a medical to a social model of prematurity. The concept of a social model of prematurity parallels the social model of disability, from disability studies, focusing on premature babies, strengthening their abilities and nurturing early caregiver—infant relationships. It highlights how societal structures, such as accessibility and support systems, shape developmental outcomes and inclusion of premature infants, rather than framing prematurity solely in terms of survival and treatment.

  • medical model of disability
  • medical model of prematurity
  • parental inclusion prematurity
  • social model of disability
  • social model of prematurity
Every infant delivered before the 37th week of gestational age is considered premature. Each year, approximately 15 million babies are born preterm (1 in 10 newborns). These babies survive thanks to advances in neonatology and perinatal medicine at Neonatal Intensive Care Units [NICUs] [1]. However, prematurity may lead to long-term neuro-developmental and health challenges affecting premature infants’ quality of life [2]. Furthermore, admission of a preterm infant to the NICU can be highly stressful for parents [3]. Consequently, prematurity is considered a significant medical and social issue with profound global implications [4,5][4][5]. However, prematurity is more than a medical condition. Premature babies should not be considered incomplete full-term infants. On the contrary, they appear to be well-equipped and adequately adapted “fetuses”. Fetuses, who strive to regain the levels of developmental capacity in the incubator, within the NICU environment [6].
This perspective views preterm infants as competent and capable of communication rather than passive patients. NICUs, though a lifesaving environment, often present sensory and emotional stressors [6,7,8][6][7][8]. Preterm infants demonstrate physiological and behavioral competencies aligned with their gestational age, competently adapted to the unique demands of extra-uterine life. Their autonomic system, while immature, shows functional regulation attempts appropriate to their gestational age. Behavioral responses—such as organized sleep–wake states, motor patterns, and sensory processing—are not deficient; rather, they represent developmental stages. These stages are appropriate for their current neural maturation and reflect their ongoing developmental capacities rather than deficits [9,10][9][10]. Premature babies’ brains also exhibit significant neuroplasticity, allowing for adaptive growth when supported by enriched and responsive care environments [11]. Furthermore, their early emotional and social engagement, such as recognizing voices and responding to touch, indicates innate capacities for relational connection [12,13][12][13].
Challenging the traditional deficit-based views on prematurity, early foundational work by Brazelton [10], Prechtl [14], and Als [9] laid the foundation for understanding and assessing both term and preterm infants. They emphasize that infants possess organized behavioral systems, capable of self-regulation, interaction, and meaningful responses to their environment through body signs, gestures, and spontaneous movement. Research findings argue that preterm infants are active participants in their own developmental trajectory, with complex and dynamic interactions within it, leading to unexpected nonlinear developmental outcomes [15,16][15][16]. Furthermore, assessment tools like the Neonatal Behavioral Assessment Scale [13] have revealed the nuanced competencies of preterm infants, including their ability to engage, respond, and regulate in interaction with caregivers. From a social perspective, recognizing preterm infants as competent individuals with intrinsic value may promote family involvement, reduce stigma, and enhance caregiving quality [17,18][17][18]. Collectively, these findings may challenge the view that preterm infants are “deficient” full-term infants. They may reframe prematurity from a narrative of deficit to one of adaptation and potential, urging both clinical and developmental frameworks to support individualized, strength-based care.

References

  1. World Health Organization (WHO). WHO Recommendations on Interventions to Improve Preterm Birth Outcomes; World Health Organization: Geneva, Switzerland, 2015. Available online: https://www.ncbi.nlm.nih.gov/books/NBK321160/ (accessed on 10 May 2025).
  2. Petrou, S.; Yiu, H.H.; Kwon, J. Economic Consequences of Preterm Birth: A Systematic Review of the Recent Literature (2009–2017). Arch. Dis. Child. 2019, 104, 456–465.
  3. Konukbay, D.; Vural, M.; Yildiz, D. Parental Stress and Nurse-Parent Support in the Neonatal Intensive Care Unit: A Cross-Sectional Study. BMC Nurs. 2024, 23, 820.
  4. Khurana, S.; Kane, A.E.; Brown, S.E.; Tarver, T.; Dusing, S.C. Effect of Neonatal Therapy on the Motor, Cognitive, and Behavioral Development of Infants Born Preterm: A Systematic Review. Dev. Med. Child Neurol. 2020, 62, 684–692.
  5. Paul, P.; Pais, M.; Kamath, S.; Pai, M.V.; Lewis, L.; Bhat, R. Perceived Maternal Parenting Self-Efficacy and Parent Coping among Mothers of Preterm Infants—A Cross-Sectional Survey. Manipal J. Med. Sci. 2018, 18, 40.
  6. Als, H.; Butler, S.; Kosta, S.; McAnulty, G. The Assessment of Preterm Infants’ Behavior (APIB): Furthering the Understanding and Measurement of Neurodevelopmental Competence in Preterm and Full-Term Infants. Ment. Retard. Dev. Disabil. Res. Rev. 2005, 11, 94–102.
  7. Lawhon, G.; Hedlund, R.E. Newborn Individualized Developmental Care and Assessment Program Training and Education. J. Perinat. Neonatal Nurs. 2008, 22, 133–146.
  8. Pineda, R.G.; Neil, J.; Dierker, D.; Smyser, C.D.; Wallendorf, M.; Kidokoro, H.; Reynolds, L.C.; Walker, S.; Rogers, C.; Mathur, A.M.; et al. Alterations in Brain Structure and Neurodevelopmental Outcome in Preterm Infants Hospitalized in Different Neonatal Intensive Care Unit Environments. J. Pediatr. 2014, 164, 52–60.e2.
  9. Als, H. Toward a Synactive Theory of Development: Promise for the Assessment and Support of Infant Individuality. Infant Ment. Health J. 1982, 3, 229–243.
  10. Brazelton, T.B. The Remarkable Talents of the Newborn. Birth Fam. J. 1978, 5, 187–191.
  11. Smyser, C.D.; Inder, T.E.; Shimony, J.S.; Hill, J.E.; Degnan, A.J.; Snyder, A.Z.; Neil, J.J. Longitudinal Analysis of Neural Network Development in Preterm Infants. Cereb. Cortex 2010, 20, 2852–2862.
  12. Als, H. The Newborn Communicates. J. Commun. 1977, 27, 66–73.
  13. Brazelton, T.B.; Nugent, J.K. The Neonatal Behavioral Assessment Scale, 4th ed.; Mac Keith Press: Cambridge, UK, 2011.
  14. Prechtl, H.F.R. Motor Behaviour in Relation to Brain Structure. In Normal and Abnormal Development of Brain and Behaviour; Stoelinga, G.B.A., Van Der Werff Ten Bosch, J.J., Eds.; Boerhaave Series for Postgraduate Medical Education; Springer: Dordrecht, The Netherlands, 1971; Volume 6, pp. 133–147.
  15. Blair, C.; Raver, C.C. Individual Development and Evolution: Experiential Canalization of Self-Regulation. Dev. Psychol. 2012, 48, 647–657.
  16. Silva, N.F.; Linhares, M.B.M.; Gaspardo, C.M. Stress and Self-Regulation Behaviors in Preterm Neonates Hospitalized at Open-Bay and Single-Family Room Neonatal Intensive Care Unit. Infant Behav. Dev. 2024, 76, 101951.
  17. Blanchard, Y.; Mouradian, L. Integrating Neurobehavioral Concepts into Early Intervention Eligibility Evaluation. Infants Young Child. 2000, 13, 41–50.
  18. Stefana, A.; Lavelli, M. Parental Engagement and Early Interactions with Preterm Infants during the Stay in the Neonatal Intensive Care Unit: Protocol of a Mixed-Method and Longitudinal Study. BMJ Open 2017, 7, e013824.
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