Key Takeaways:  

• National Institute of Child Health and Human Development awards $2.8 million to the University of Houston to lead the first clinical trial evaluating the remotely delivered PALS parenting program to support healthy brain development in infants born preterm.  

• Researchers will examine whether online support after NICU discharge strengthens brain development linked to emotional and mental health.  

• Research advances UH Health’s mission to improve lifelong health through interdisciplinary research and innovative care. 

HOUSTON, July 29, 2026 — A University of Houston psychologist has received a $2.8 million grant from the National Institute of Child Health and Human Development to lead the first randomized clinical trial testing whether a remotely delivered parenting program can improve healthy infant brain development to support long-term mental health outcomes for babies born prematurely.  

Researchers will examine whether providing parents with web-based support during the critical weeks and months after premature infants leave the hospital strengthens early brain development linked to emotional and mental health. 

In the United States, more than one in 10 babies are born prematurely each year and the rate of mental health disorders among youth and adults born preterm is rising, posing substantial burden to individuals, families and society. Texas has some of the highest rates of preterm birth in the country.  

While advances in neonatal medicine have dramatically improved survival rates, babies born prematurely remain at greater risk for developmental and mental health disorders.  

The scalable intervention could transform how families receive support after discharge from the neonatal intensive care unit, bringing evidence-based support into the home. The research aligns with UH Health’s mission to advance innovative, accessible solutions that improve health outcomes and reduce disparities for vulnerable populations. 

Johanna Bick, associate professor of psychology and director of the Laboratory of Early Experience and Development at UH, will lead the trial of a remotely delivered version of Play and Learning Strategies (PALS), a parenting program that has been adapted for parents of prematurely born infants. PALS is an evidence-based parenting intervention program designed to strengthen parent-child bonds and stimulate early cognitive, language and social-emotional development. 

“The field is beginning to understand how preterm birth can alter the development of neural circuits that underlie long-term mental health,” said Bick. “This study will allow us to test whether increased support during one of the most sensitive periods of brain development can help place infants on a more typical developmental trajectory.” 

Many effective parenting programs end when babies leave the NICU, missing a critical period when parents need support most and babies’ brains are developing rapidly. Because the program is delivered online, it has the potential to reach families regardless of where they live while engaging multiple caregivers during this critical period. 

Parents or caretakers of prematurely born infants will be randomly assigned to either the remotely delivered PALS program or a comparison program. Researchers will evaluate how the intervention affects parental responsiveness, infant social and emotional development, emotion regulation and brain development using behavioral assessments and advanced neuroimaging and neurophysiological measures. 

The study zeroes in on the window of late childhood, a critical period characterized by intensive brain maturation and cognitive skill refinement. The authors, led by Acosta-Rodriguez et al., employed advanced magnetic resonance imaging (MRI) protocols to analyze structural and functional brain markers associated with cognition. Their interest was specifically targeted toward children born between 32 and 36 weeks of gestation, a group historically understudied relative to extremely preterm infants. This nuanced focus allows researchers to decipher the more subtle neurodevelopmental alterations that might not be evident in infancy but emerge with increasing cognitive demands.

One of the most striking aspects of the study is its comprehensive approach combining cognitive assessments with high-resolution neuroimaging. The researchers utilized diffusion tensor imaging (DTI), resting-state functional MRI (rs-fMRI), and volumetric analyses to chart alterations in white matter integrity, connectivity patterns, and regional brain volumes. These multi-modal imaging strategies enable a holistic interpretation of the brain’s architecture and function, critical to understanding how premature birth influences neurological substrates that underpin learning and memory.

The results elucidate a pattern of altered neurodevelopment in MLP children that, while less severe than in extremely preterm infants, nonetheless reveals significant disparities compared to full-term controls. Notably, the integrity of specific white matter tracts, such as the arcuate fasciculus and the superior longitudinal fasciculus—key pathways supporting language and executive function—showed reduced microstructural organization correlating with diminished performance in standardized cognitive tests. This finding highlights the importance of white matter maturation in the context of prematurity-related cognitive challenges.

Moreover, the study highlights intriguing variations in functional connectivity within networks implicated in attention and cognitive control. Resting-state fMRI revealed that MLP children exhibited less synchronized activity between prefrontal and parietal cortices, suggesting a potential neural basis for commonly reported attentional difficulties and executive dysfunction in this population. These disrupted network dynamics may reflect subtle delays in the maturation of neuronal circuits crucial for higher-order cognitive processes.

Simultaneously, volumetric analyses uncovered region-specific reductions in gray matter volume, particularly within the prefrontal cortex and hippocampus—structures integrally involved in working memory, decision-making, and learning. These morphological differences provide a tangible neural correlate for observed neuropsychological deficits, underscoring how even modest degrees of prematurity can affect cerebral growth trajectories.

A crucial component of this investigation is its emphasis on late childhood as a critical evaluation period. Previous research often concentrated on infancy or early childhood, potentially overlooking complications that consolidate or emerge later as cognitive demands increase. By focusing on a later developmental stage, this study reveals that neurodevelopmental vulnerabilities associated with MLP birth are not transient but persist, potentially influencing academic achievement and psychosocial adaptation during pivotal stages of child development.

The findings bear significant implications for medical and educational interventions. Early identification of neurodevelopmental divergence via neuroimaging could facilitate targeted support that caters to the specific cognitive domains affected in MLP children. This precision medicine approach might enable clinicians and educators to tailor therapies and learning environments that mitigate risks of long-term difficulties, thereby enhancing life trajectories.

Importantly, the study also recognizes the heterogeneity within the MLP group, underscoring that prematurity is not a monolithic risk factor. Variability in perinatal health, socioeconomic status, and postnatal experiences contribute to divergent neurocognitive outcomes. Future research may thus benefit from integrating genetic and environmental data to comprehensively map factors that modulate vulnerability and resilience following moderate to late preterm birth.

Methodologically, the research exemplifies the growing power of neuroimaging biomarkers as objective, quantifiable indices of brain health and cognition in pediatric populations. The fusion of structural, functional, and microstructural metrics offers a powerful framework for charting developmental trajectories and identifying atypical patterns that may predict neurodevelopmental disorders or learning disabilities well before clinical symptoms become evident.

The study’s revelations also open doors for longitudinal research trajectories. By tracking this cohort into adolescence and adulthood, scientists can map the evolution of brain-cognition relationships and determine critical periods where interventions may be most efficacious. Such longitudinal insights will be instrumental in unraveling the plasticity and recovery potential of the developing brain after early-life insult such as prematurity.

Beyond clinical and educational spheres, these neuroimaging findings contribute to fundamental neuroscience by illuminating how gestational age modulates the maturation of brain networks underpinning cognition. The observed alterations in white matter connectivity and cortical volumes elucidate biological pathways through which preterm birth disrupts normative brain maturation, advancing our grasp of neurodevelopmental processes at a systems level.

Intriguingly, this line of research prompts further investigation into potential neurobiological mechanisms driving these alterations, including disruptions in oligodendrocyte development, synaptic pruning, and neuroinflammation associated with perinatal stressors. Understanding these intracellular and molecular underpinnings is critical for devising therapeutic strategies that could promote optimal neural repair or plasticity during sensitive developmental windows.

Furthermore, the study invites a revisitation of how clinical definitions of prematurity incorporate neurodevelopmental risk. While extremely preterm birth is widely recognized for its adverse neurocognitive sequelae, moderate to late preterm birth accounts for a far larger portion of preterm deliveries and thus impacts public health on a broader scale. This research underscores the need for heightened surveillance and support for this broader cohort.

In the current era of precision pediatrics, such comprehensive neuroimaging work represents a paradigm shift from purely behavioral assessments toward personalized brain-based evaluations. These methodologies could ultimately refine diagnostic criteria, predict individual prognosis, and tailor interventions that holistically consider the neural bases of cognitive strengths and vulnerabilities.

As the scientific world digests these findings, the hope is that we move beyond viewing MLP birth as a benign clinical category. Instead, this research urges recognition of its latent but tangible effects on neurodevelopment, encouraging health providers, educators, and families to adopt a proactive stance in optimizing developmental outcomes for these children.

The study by Acosta-Rodriguez and colleagues, therefore, marks a pivotal contribution to contemporary pediatric neuroscience, leveraging cutting-edge neuroimaging to illuminate how relatively common early-life experiences shape the architecture and function of the growing brain. It signals a call to action: to recognize, understand, and address the subtle cognitive footprints left by moderate to late prematurity in pursuit of healthier futures.

Subject of Research: Neurodevelopmental associations and cognitive outcomes in children born moderate to late preterm (MLP) during late childhood.

Article Title: Neuroimaging markers of cognition in late childhood associated with moderate to late preterm birth.

Article References:
Acosta-Rodriguez, H., Bobba, P., Zeevi, T. et al. Neuroimaging markers of cognition in late childhood associated with moderate to late preterm birth. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04286-5

Image Credits: AI Generated

DOI: https://doi.org/10.1038/s41390-025-04286-5

The study meticulously investigated how meeting recommended macronutrient intakes through targeted feeding approaches could influence brain size and morphology at term gestational age. For preterm infants, measuring outcomes beyond mere survival rates is critical. Cognitive functioning and brain development are essential metrics of health and quality of life. Naseh et al. provided a strong argument that appropriate nutritional interventions can lead to favorable neurodevelopmental results at the two-year mark.

One of the key takeaways from this study is the emphasis on the administration of early parenteral nutrition. This strategy allows for the immediate delivery of essential nutrients directly into the bloodstream, thus bypassing the gastrointestinal tract, which may be underdeveloped in preterm infants. By utilizing parenteral nutrition in the initial days of life, caregivers can help prevent nutrient deficiencies that could impede growth and development during this crucial window.

Moreover, alongside parenteral nutrition, the implementation of enteral feeding has proven invaluable. By progressively introducing enteral feeds composed of supplemented maternal and donor milk, the study participants received a balanced array of nutrients that are vital for optimal growth. This combination of early interventions not only supports physical growth but also enhances the likelihood of adequate cognitive development, as crucial nutrients associated with brain health are introduced early in life.

However, the study’s authors acknowledge a notable limitation: the lack of detailed data regarding individual infant growth rates and nutrition assessments over the study duration. By elucidating growth rates and providing a more granular analysis of how different feeding approaches impacted individual infants, future research could further elucidate the complex relationship between nutritional strategies and developmental outcomes. This would allow for a more comprehensive understanding of how distinct feeding protocols can be tailored to meet the nuanced needs of each infant.

The outcomes presented in this study are particularly timely, as guidelines for preterm infant nutrition evolve based on recent advances in neonatal science. Enhanced understanding of the necessary macronutrient composition in infant diets can pave the way for innovative feeding strategies. In the future, implementing such guidelines could become a standard protocol in neonatal intensive care units (NICUs) worldwide, ultimately improving outcomes for preterm infants.

In addition to focusing on nutrition, consideration must also be given to external factors influencing cognitive and physical growth. For example, establishing an enriching environment during hospitalization can play a vital role in development. Consistent stimulation, along with proper nutrition, supports both cognitive and sensorimotor advancements, further embedding the importance of a holistic approach to neonatal care.

Ongoing studies that expand on the findings of Naseh et al. will be crucial for refining nutritional guidelines tailored to preterm infants. With a growing body of evidence supporting early and adequate macronutrient intake, healthcare providers are increasingly equipped to make informed decisions regarding patient care. Future research could explore the effects of variations in macronutrient compositions and feeding techniques on long-term outcomes, potentially leading to new paradigms in neonatal nutrition.

As the landscape of neonatal research evolves, attention to longitudinal studies examining the sustained impact of nutritional interventions on cognitive and developmental outcomes will be vital. Innovative research methodologies utilizing advanced imaging and assessment techniques can provide further insights into how early dietary interventions affect brain structure and function over time.

Ultimately, the findings presented by Naseh et al. underscore the necessity for continual investigation into the nutritional needs of preterm infants. While strides have been made, there remains a significant need for further studies that explore the long-term effects of early nutritional interventions on both physiological and cognitive development.

As the medical community continues to grapple with the challenges posed by premature birth, the focus on nutrition as a cornerstone of neonatal care becomes ever more critical. By fostering a deeper understanding of nutritional interventions and their impact on developmental trajectories, researchers and practitioners can work towards improving the life outcomes of preterm infants.

The progress made thus far offers a beacon of hope for many families navigating the complexities of premature birth. As more studies emerge, the quest to develop best practices for preterm infant nutrition will rely heavily on the insights gained from rigorous clinical investigation, ensuring that future generations of infants receive the best possible start in life.

In light of these findings, it is evident that addressing nutritional needs during the early stages of life can significantly influence outcomes. Ongoing collaboration among clinicians, researchers, and policymakers will be crucial in translating such research into actionable guidelines and practices that can be uniformly applied in NICUs across the globe.

The commitment to learning from past research while embracing new methodologies will empower healthcare providers to strengthen their approaches to the care of preterm infants. Building on the work of Naseh et al., there is ample opportunity to reshape neonatal nutrition practices for the benefit of this vulnerable population.

Subject of Research: The impact of early parenteral and enteral nutrition on the cognitive and developmental outcomes of extremely to very preterm infants.

Article Title: Recommended nutrition for preterm infants—on track, but more research is needed.

Article References:

Hay, W.W. Recommended nutrition for preterm infants—on track, but more research is needed.
Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04062-5

Image Credits: AI Generated

DOI: 10.1038/s41390-025-04062-5

Keywords: preterm infants, nutrition, early parenteral nutrition, enteral feeding, cognitive outcomes, brain development, neonatal care