In recent years, the remarkable progress in neonatal care has significantly improved the survival rates of very preterm infants—those born before 32 weeks of gestation. However, with this increasing survival, attention has shifted from mere survival to the quality of life and long-term outcomes for these children. Specifically, neurodevelopmental and socio-emotional challenges have emerged as critical areas of concern, demanding deeper investigation into the underlying physiological and behavioral mechanisms that might contribute to these difficulties. A groundbreaking study recently published in Pediatric Research sheds new light on this issue by examining heart rate variability, skin conductance, and gaze behavior among school-aged children who were born very prematurely.
Understanding the subtle complexities that underpin the neurodevelopmental trajectory of very preterm children requires nuanced assessment methods that bridge physiology and behavior. Previous work has indicated that autonomic nervous system (ANS) dysfunction may play a contributory role to the social and emotional challenges often observed in this population. This new research led by Tang et al. utilizes state-of-the-art methodologies to explore how autonomic regulation—measured through heart rate variability (HRV) and skin conductance responses—and gaze behavior during rest and active social engagement via live eye contact, differ between very preterm and full-term children aged 8 to 12 years.
Heart rate variability is a widely recognized biomarker of autonomic nervous system flexibility and resilience, providing insight into how well individuals adapt to various environmental and emotional stimuli. Reduced HRV often signals diminished parasympathetic output or increased sympathetic dominance, both of which are linked with stress and emotional dysregulation. In this study, the researchers carefully measured HRV at baseline rest conditions as well as during moments of direct social interaction to understand whether and how very preterm children’s autonomic responses diverge from their full-term peers.
Skin conductance, or electrodermal activity, is another critical parameter measuring the sweat gland activity regulated by the sympathetic nervous system, serving as a direct indication of physiological arousal and emotional responsiveness. By recording changes in skin conductance alongside HRV, the researchers provided a multidimensional view of autonomic functioning that captures both the parasympathetic and sympathetic branches. This dual measurement approach allowed unprecedented insights into the possible dysregulation of autonomic balance in the context of social engagement challenges highly relevant to the preterm population.
One of the study’s most innovative aspects lies in coupling these autonomic measures with an analysis of gaze behavior, specifically during live eye contact. Eye contact is a fundamental social signal intricately tied to emotional connection, communication, and cognitive development. Altered patterns in gaze behavior can signal difficulties in social processing that often accompany neurodevelopmental disorders. By using cutting-edge eye-tracking technology in a naturalistic interaction setting, the researchers accurately assessed whether very preterm children show differences in eye contact frequency, duration, and patterns compared to their full-term counterparts.
Analyzing data from 77 children—39 born very prematurely and 38 born full-term—the researchers discovered nuanced yet meaningful differences in autonomic regulation and gaze behavior patterns. Very preterm children exhibited reduced HRV both at rest and during live eye contact situations, suggesting a diminished capacity for adaptive autonomic modulation when faced with social interaction demands. This finding aligns with hypotheses positing that autonomic inflexibility could underlie some of the observed socio-emotional difficulties in this group.
Moreover, the skin conductance data indicated that very preterm children showed heightened sympathetic arousal during eye contact, a state often associated with increased stress or anxiety in social contexts. This heightened physiological reactivity could be a contributing factor to the avoidance or altered engagement patterns reflected in their gaze behavior. The interaction between elevated physiological arousal and gaze behavior is critical, as it may represent a feedback loop where social stress impairs engagement, which in turn limits opportunities for socio-emotional development.
Delving deeper into gaze behavior, the study found that very preterm children demonstrated less direct gaze during live eye-contact trials, spending less time focused on the eye region of the interaction partner. This attenuated gaze toward the eyes could impede crucial social learning opportunities, as eyes convey vital emotional and communicative information. Disrupted gaze behavior has been linked to several neurodevelopmental conditions, and its presence in this cohort highlights a potential shared pathway for social difficulties.
The implications of this research are wide-ranging. From a clinical and educational standpoint, the study underscores the importance of early and ongoing monitoring of autonomic function and social engagement behaviors in children born very prematurely. Identifying biomarkers such as HRV, skin conductance, and gaze parameters could facilitate earlier interventions tailored to improve socio-emotional competencies through biofeedback, behavioral therapies, or targeted social skill training.
Furthermore, the study elevates the conversation about the long-term impact of prematurity by emphasizing the complex interplay between neurophysiological regulation and social behavior, rather than attributing developmental challenges exclusively to cognitive deficits. This integrative perspective advances the field’s understanding and opens promising avenues for multidisciplinary interventions involving pediatricians, psychologists, neurophysiologists, and educators alike.
The methodology employed by Tang and colleagues stands out for its ecological validity, studying children during live interactive conditions rather than artificial task-based environments. This approach acknowledges the dynamic and reciprocal nature of social engagement, capturing real-world complexities often overlooked in laboratory settings. It also reflects the growing trend in neuroscience to use naturalistic paradigms that better represent how brain-body interactions unfold in everyday life.
Overall, the findings provide compelling evidence that very preterm children exhibit distinct patterns of autonomic and gaze behavior regulation during social interaction, contributing to the socio-emotional challenges observed in this vulnerable population. These insights fuel both a call to action and optimism: with improved understanding comes better tools to identify and support those at risk, ultimately fostering improved quality of life and developmental outcomes.
In addition to clinical relevance, this research advances fundamental science by elucidating mechanisms linking early developmental adversity—in this case, extreme prematurity—with alterations in neurophysiological systems critical for social engagement. The results contribute to a growing body of literature on how early environmental and biological disruptions shape lifelong trajectories of social functioning and mental health.
While the current study provides valuable insights, it also raises important questions for future research. For example, longitudinal studies could examine how autonomic and gaze behavior profiles evolve as preterm children enter adolescence and adulthood, potentially revealing critical windows for intervention. Investigations into the underlying neural circuitry governing these autonomic and social behaviors could further refine therapeutic targets.
Moreover, the diversity within the preterm population, including differences in degree of prematurity, medical complications, and environmental exposures, suggests that personalized approaches to intervention will be essential. Parsing these individual differences is a challenging but necessary step toward optimizing support for each child’s unique developmental pathway.
The integration of physiological measures with sophisticated behavioral metrics showcased by this study is emblematic of the cutting-edge research strategies transforming pediatric neuroscience and developmental psychology. It exemplifies the power of multidisciplinary collaboration and technological innovation to tackle complex questions about human development under adversity.
As the global medical community continues to celebrate increased survival rates among very preterm infants, studies like this remind us that survival is but the first step. Ensuring these children thrive requires continued dedication to understanding the intricate biopsychosocial processes underlying their neurodevelopment, particularly in areas as vital and sensitive as social and emotional functioning.
In essence, the work led by Tang et al. represents a critical leap forward in comprehending how early life biological challenges manifest in social behaviors during childhood. It invites a paradigm shift towards more holistic, integrated assessments and interventions that valorize the interconnectedness of body and mind, ultimately aiming to nurture every child’s full potential.
Subject of Research: Neurodevelopment and socio-emotional challenges in very preterm children, focusing on autonomic nervous system function and gaze behavior during social interaction.
Article Title: Heart rate variability, skin conductance, and gaze behavior during rest and during live eye contact in very prematurely born school-aged children
Article References:
Tang, T., Piers, S., Gistelinck, L. et al. Heart rate variability, skin conductance, and gaze behavior during rest and during live eye contact in very prematurely born school-aged children. Pediatr Res (2026). https://doi.org/10.1038/s41390-025-04613-w
Image Credits: AI Generated
DOI: 07 January 2026
