How Premature Birth Affects Brain Development (and How to Help)

By: Tyler Hu

Topic: Neonatal Health and Brain Development

Introduction

Every year, approximately 1 in 10 babies in the United States is born prematurely (defined as before 37 weeks of gestation) (Centers for Disease Control and Prevention, 2024). While advances in neonatal care have improved survival rates dramatically, the story doesn’t end at discharge from the NICU. Premature birth can have lasting effects on brain development, influencing learning, behavior, and overall neurological health throughout childhood and potentially into adulthood. However, early interventions and family-centered support can make a significant difference in improving outcomes.

"Vector Illustration of Parents in Neonatal Intensive Care with Newborn Premature Baby" by Wannapik is licensed under CC BY 3.0

The Developing Brain: Why Prematurity Matters

The final weeks of pregnancy are crucial for brain growth. Between 34 and 40 weeks, the fetal brain undergoes rapid expansion, adding billions of new neural connections. When a baby is born prematurely, this development is interrupted, leaving key brain structures, such as the cerebral cortex, white matter tracts, and cerebellum, less mature than in full-term infants. 

Some key developmental impacts include the following:

• White matter vulnerability – Premature infants often show delayed or reduced myelination, the process that insulates nerve fibers and allows for the quick communication between brain regions. As a result of this, difficulties with coordination, attention, and processing speed later in life may arise (Volpe, 2009).

• Cerebral cortex underdevelopment – The cortex is responsible for our thinking, memory, and sensory processing. When it thins and becomes less folded in preterm infants, this may affect cognitive and sensory functions (e.g., taste, touch).

Cerebellar effects – The cerebellum is vital for our body’s motor control and balance, and it develops rapidly in the third trimester. Premature birth can lead to reduced cerebellar volume, potentially impeding upon motor or coordination skills later in life.

However, it is important to note that these structural differences do not determine a child’s future; instead, they are helpful signals where additional support may be needed. With the right interventions and support system, many preterm children can thrive in life, both academically and socially.

Long-Term Neurological and Behavioral Outcomes

Research has shown that the degree of prematurity often correlates with neurological outcomes. Infants born before 28 weeks face the highest risks, but even “late preterm” babies (34–36 weeks) can experience subtle developmental challenges.

Common long-term outcomes include:

• Cognitive delays – Premature children may have lower average IQ scores compared to full-term peers, particularly in language and executive function.

• Motor impairments – Conditions such as cerebral palsy (characterized by difficulty with movement and coordination, tremors, and abnormal musculature) occur more frequently in extremely preterm infants due to white matter injury or hypoxia.

• Behavioral and emotional difficulties – The risk of ADHD, anxiety, and social challenges that can persist into adolescence is increased (Johnson & Marlow, 2017).

• Learning differences – Reading, math, and working memory skills can be significantly impacted, especially without early academic intervention and support.

Despite these potential outcomes, many premature infants go on to lead healthy, fulfilling lives, especially when developmental progress is closely monitored and supported from the start.

The Power of Early Intervention

Early diagnosis and intervention can transform and alter a premature infant’s developmental trajectory. Programs that engage families soon after NICU discharge are particularly effective in improving both cognitive and motor outcomes.

Effective early interventions include:

• Physical and occupational therapy – Promotes motor coordination, muscle tone, and balance, improving the baby’s way of life over time.

• Speech and language therapy – Strengthens communication and future literacy skills.

• Parental education and responsive caregiving – Teaches parents how to recognize and respond to their baby’s cues, encouraging emotional bonding and brain development.

• Sensory stimulation programs – Gentle touch, music, or patterned visual input can enhance neural connectivity.

• Early Head Start and IDEA Part C programs – Both programs (IDEA: Individuals with Disabilities Education Act) provide assessments, therapy, and home visits to support early development.

In addition, nutrition plays a vital role. Breast milk, especially from the infant’s own mother, contains bioactive compounds that promote brain development and reduce inflammation, improving long-term outcomes. This is accomplished through the increase of white matter development and cortical thickness, which collectively result in improved cognitive function (Lechner & Vohr, 2017)

"Reduced Activation in Basal Ganglia Structures in CFS compared to Controls for the Win-Lose Contrast." by PLOS One is licensed under CC BY 4.0

Hope Through Innovation and Research

Modern neonatal research continues to offer hope for preterm infants and their families. Technologies like functional MRI and diffusion tensor imaging help scientists map how the preterm brain develops over time and test therapies that promote recovery.

Promising innovations include:

• Neuroprotective medications: One potential medication is erythropoietin, which may enhance brain recovery after injury. Erythropoietin is a hormone that is naturally produced by the human body to stimulate red blood cell growth, but its effects may extend beyond this, including reversing secondary neuroinflammatory processes and balancing oxygen concentration/presence (Rey et al., 2019).

• Kangaroo Mother Care, involving skin-to-skin contact, which improves oxygenation, temperature regulation, and bonding (Cleveland Clinic, 2020). 

• Developmental NICU care models that control light, sound, and stress while increasing family involvement.

Together, these innovations highlight a powerful message: the premature brain is resilient, especially when nurtured with compassionate care and stimulation.

From Fragility to Flourishing

Premature birth is not the end of a story; it’s the beginning of a unique journey. While prematurity can present neurological challenges, early recognition and intervention offer a path to resilience. Through family engagement, therapy, and medical research, premature infants can grow into thriving, capable individuals who defy early odds.

Every small step, whether that’s a parent’s touch, a therapist’s encouragement, or a moment of connection, strengthens the foundation for lifelong development. With continued compassion and attention, every premature child can not only survive but truly flourish.

Author Bio:

Tyler Hu is a Biological Sciences major at the University of California, Irvine. With experience in ophthalmology research and clinical environments, he is passionate about combining medical research with compassionate care to improve early-life outcomes.