Looking beyond survival: helping preterm children thrive

When a baby arrives a few weeks earlier than expected, the immediate focus for whanau and clinicians is getting through those critical first days and weeks. But research from the University of Auckland’s Liggins Institute is looking one step further to answer a crucial question: What will happen next? 

“Most of these children will be absolutely fine and go on to do amazing things,” says Dr Caroline Walker, a senior research fellow working on the Liggins Institute project.

But some struggle. “The question is whether we can identify the ones who might benefit from some extra support and care.”

Walker is involved in a long-running research programme following more than 600 children born between 32 and 36 weeks of pregnancy, which is regarded as moderate to late preterm.

The study aims to better understand how early birth influences development and how children who need extra support can be identified as early as possible.

Walker says the smallest and earliest-born babies often receive the most attention, but more than 80 percent of preterm births occur during later periods of pregnancy. In Aotearoa New Zealand, that represents more than 3,500 babies every year.

The study tracks participants from birth through childhood, combining developmental assessments with advanced brain imaging to build a clearer picture of how early experiences shape later outcomes.

Most of these moderate to late preterm children grow up healthy and develop well, Walker says. However, they are at greater risk of learning and developmental difficulties than babies born at full term.

The problem? ”We don't really know how to predict which babies are going to have issues or concerns, and which babies are going to be absolutely fine.”

In the study, babies undergo MRI scans of the brain soon after birth. Researchers are particularly interested in white matter, the network of connections that allows different parts of the brain to communicate with one another.

“We can see some changes in the brains of these babies when they're first born,” Walker says. “What we don't yet know is exactly what those changes mean.”

The team is investigating whether the changes are linked to babies' health, medical care or other early-life factors, and whether they affect development later in childhood.

The study is now approaching an important milestone, with two-year follow-up assessments nearly complete.

Researchers will continue tracking participants through childhood, including MRI scans at seven years of age. The seven-year follow-up phase is expected to conclude in 2032.

The project is a lesson in patience. Recruiting enough participants took some time, and meaningful answers can only emerge as children get older.

But even before the final results are known, the research is uncovering intriguing findings.

One area of interest is feeding, Walker says. Babies born preterm often cannot breastfeed immediately because the coordination required for sucking, swallowing and breathing is still developing. Many receive nutrition through feeding tubes or intravenous support.

Researchers have found that something remarkably simple may help.

During feeding, some babies are given the taste and smell of milk via drops of milk on their tongue or on a gauze pad beside their nose – even when the nutrition itself is delivered through a tube. Early results suggest those babies have better developmental outcomes at two years of age.

Walker's current work is exploring whether those sensory experiences are  associated with positive changes in brain development.

A winding road

Walker’s route to studying the brains of newborns was far from straightforward.

She began her career as a molecular biologist studying the mechanisms that influence health and wellbeing in dairy cattle. 

Later, she moved into child development research, where an interest in biological mechanisms expanded into a broader fascination with how children grow and thrive.

The opportunity to work with the Liggins Institute’s Distinguished Professor Dame Jane Harding's preterm birth study brought those interests together, combining cutting-edge MRI research with questions that have direct relevance for families.

For Walker, research is not simply about collecting information. The team supports participating families, providing clinical referrals when concerns arise, and reassurance when children are progressing well.

That human connection has remained central to her work. Speaking recently on Auckland's bFM radio station, Walker described the research as “purposeful”, driven by a desire to ensure children born early have every opportunity to reach their potential.

Most preterm babies will go on to do “amazing things”, she says. The challenge is making sure the ones who need a little extra help are identified early enough to benefit.

If researchers can achieve that, the impact could last a lifetime.