Candidate/Environment: Dr. Shah is a board-certified Developmental-Behavioral Pediatrician who is committed to engaging in research that bridges the fields of Developmental Pediatrics and Infant Mental Health. She has received training in medical and behavioral sciences and was supported by an early career development award (K12 HD041648) which provided her with introductory training in statistics, resulting in a Master's of Clinical Research. She has develope a programmatic research focus on social-emotional outcomes of infants at developmental risk, with a special focus on these processes in preterm infants. This mentored career development award will allow her to continue her programmatic development in an emerging area of research (outcomes of late preterm infants (LPIs)). She has identified a comprehensive mentoring team at the University of Michigan Center for Human Growth and Development, an interdisciplinary child development research center, to provide methodological and content expertise, including Pamela Davis-Kean, PhD (Associate Professor of Psychology and Center Director: Institute for Social Research); Niko Kaciroti, PhD (Research Scientist of Biostatistics); John Barks, MD (Professor of Neonatology); Brenda Volling, PhD, (Professor and Chair, Developmental Psychology) and Julie Lumeng, MD (Associate Professor of Pediatrics). The University of Michigan has demonstrated a commitment to her career development. She has also Identified additional faculty members with specialized expertise in the areas of early brain development (Hannah Glass, MDCM, UCSF), late preterm infants (Lucky Jain, MD, Emory University), and neuropsychological assessment (Seth Warschausky, PhD, University of Michigan) who will provide additional training experiences that will integrate with her future career goals focused on understanding the mechanisms in the perinatal and postnatal environments associated with increased developmental risk in LPIs. Training and Career Goals: Dr. Shah's career goal is to improve outcomes for late preterm infants by better understanding the mechanisms in the perinatal and post-natal environments that are associated with increased developmental risk. Her career goals will focus on answering the following questions: (1) What features of the perinatal period are associated with increased developmental risk; (2) How do differences in parenting and the quality of the early caregiving environment modify the developmental trajectories of these infants; (3) Which late preterm infants are most likely to benefit from the provision of early intervention services; and (4) What are the key developmental time periods when intervention effects are most robust, and should be implemented? To prepare her to address these questions, Dr. Shah has identified 5 key training goals which she will achieve during this 4-year K-award: [1] Develop skills in conducting longitudinal data analysis; [2] Develop knowledge of the biologic mechanisms by which features of the perinatal period may contribute to developmental vulnerabilities in LPIs; [3] Develop increased content expertise and skills in the measurement of family systems and parenting behavior in infancy; [4] Develop skills in primary data collection; and [5] Develop familiarity with neuropsychological tools to assess neurocognitive functioning. These training goals are overseen by an integrated mentoring team, and will facilitate her ability to develop refined hypotheses regarding how features of the perinatal environment may be associated with neurodevelopmental outcomes in late preterm infants. Research: Late preterm infants (LPIs) (infants born between 34-36 weeks gestation) account for 75% of infants born prematurely. LPIs manifest increased developmental vulnerabilities compared to full term infants, though reasons for their developmental vulnerability remain largely under-researched. Understanding the biological vulnerabilities and the potential modifiable factors associated with suboptimal development in this population has the potential to inform the clinical management of LPIs in the peri- and postnatal environments. Using a nationally representative sample containing over 1100 late preterm infants, this investigation will address 3 specific aims: SA-1: Examine how variations in brain development characterized by differences in gestational age, neonatal risk and intrauterine growth status are associated with cognitive trajectories of LPIs from 9mo-kindergarten. SA-2: Examine how variations in the proximal (e.g., parenting) and distal environments (e.g., early intervention enrollment and socioeconomic status) are associated with differences in cognitive trajectories of late preterm infants. SA-3: Examine how specific sequelae in the immediate perinatal period and proximal neurocognitive processes (e.g., self-regulation) are associated with differences in cognitive outcomes of late preterm infants. Future Implications: This research can elucidate the perinatal biological and environmental factors associated with developmental vulnerability in late preterm infants. Results can inform practice regarding care in the immediate post-partum period and shape policy recommendations for developmental surveillance for LPIs who account for >400,000 preterms born each year and who currently receive no specialized follow-up care.

Public Health Relevance

Late reterm infants manifest increased developmental vulnerabilities compared to full term infants, yet they receive no specialized developmental follow-up care unlike infants born more prematurely, and little is known about the factors associated with their increased developmental risk. This application will examine how cognitive development in late preterm infants is associated with variations in perinatal biological risk (i.e neonatal risk, gestational age and birth-weight variations), early parenting, and the quality of early experiences in the non-parental environment. We anticipate that the findings from this investigation can guide changes in perinatal care and inform the type of developmental surveillance provided to infants born in the late preterm period, who account for almost 75% of infants born preterm or >400,000 late preterm births per year.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Clinical Investigator Award (CIA) (K08)
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Pediatrics Subcommittee (CHHD)
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Freund, Lisa S
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Shah, Prachi; Kaciroti, Niko; Richards, Blair et al. (2016) Developmental Outcomes of Late Preterm Infants From Infancy to Kindergarten. Pediatrics 138:
Shah, Prachi E; Kaciroti, Niko; Richards, Blair et al. (2016) Gestational Age and Kindergarten School Readiness in a National Sample of Preterm Infants. J Pediatr 178:61-67