Daphna Yasova Barbeau, MD

Hi everybody. Today I am thrilled to say I have two very special guests in the studio with me, Dr. Susan Hintz and Dr. Jonathan Litt. I'll introduce them in just a second.

Today, we are setting the stage for what will be a series on The Incubator in the coming week. We're having this series because a wonderful special issue came out in Children entitled “The Implications of Preterm Birth for Health and Well-Being Over the Life Course.” Drs. Litt and Hintz are the special issue editors. They’re both coming to us from Stanford University. Dr. Jonathan Litt is a neonatologist and Associate Professor of Pediatrics, and Dr. Susan Hintz is also a neonatologist and Professor of Pediatrics. Thank you both for joining me today.

To help people understand the breadth of this project, this was your idea, using a life course framework to talk about what preterm birth means long term for our babies. You’ve brought together a number of experts in the field – a total of 12 articles and contributors from multiple disciplines. I want to give people a little background, so I’ll read a paragraph from your call for submissions. You wrote:

“Dear colleagues, infants born prematurely are surviving in greater numbers, even from the earliest gestational ages. However, preterm birth is associated with ongoing chronic health problems, multi-morbid conditions, developmental challenges, and functional limitations in childhood and beyond. Though common, such outcomes are not a foregone conclusion, varying by infant and maternal health, experiences during hospitalization, and the familial and social context in which the child lives. Therapeutic, material, and psychosocial supports for the infant and family pre- and postnatally and throughout childhood are vital to ensure the best possible outcomes for all. Children and families exist within a dynamic, multi-layered ecosystem of community, social, educational, and economic services, programs, and policies that support growth and development. Such a life course health development perspective is instrumental to identifying, quantifying, and ameliorating the complex, multi-level threats to health and well-being for infants born prematurely.”

So, Dr. Litt, maybe you can tell us a little bit, what is this “life course”? What do we need to know about it before we can really understand where you went with this initiative?

Jonathan Litt

Sure. The life course, to me as a neonatologist and really as a pediatrician, is so central to what we do. If we take a step back and think beyond academia, our job caring for young infants is to understand how the transition from fetal to neonatal life affects their health at that moment and long term. We’re setting babies up for success, for how they grow and develop.

My academic work has delved into how others have thought about this rather magical process of becoming a fully-fledged human being. There are many different concepts and frameworks that inform our understanding, from medicine to psychology to education.

The Life Course Health Development model brings together many of those frameworks: developmental psychology, basic science, how early exposures and experiences affect our bodies long term. It’s a useful lens for both research and clinical care, helping us understand outcomes over time and how we can best support optimal development.

Susan and I are both deeply involved in high-risk infant follow-up, so our perspectives really span from the earliest stages through later development. Life course thinking helps us connect those dots.

Daphna Yasova Barbeau, MD

I love that. Thanks for that introduction. So, Dr. Hintz, I’ll let you give your input too. For our audience, many are busy clinicians in the NICU, focused on the day-to-day management of critically ill babies or getting them home safely and quickly. Why should every neonatologist care about the life course?

Susan Hintz

Thanks for that question, because Jonathan and I have talked about this a lot. As he said, there are many frameworks for thinking about how we can do better for our patients and families. Life course conceptualization is one of them, and it ties into what many people already know about follow-through principles. It can feel overwhelming because neonatologists often say, “I’m focused on the day to day; I’m not the person who’s thinking about the rest of their lives.” But we see it as the opposite — why wouldn’t we think about their lives beyond the NICU?

We’re privileged to be neonatologists. We’re there at the transition from fetal to neonatal life, integrated into the family’s journey for months or years. We have a natural opportunity by virtue of the fact that they are right there in the NICU to identify challenges and resilience factors that that family may have, to understand environmental or societal issues that may be problematic. And then we can help connect them with supports.

The World Health Organization identifies “building health throughout the life course” as one of its strategic goals. They highlight three main components: first is the longevity effect – because children today, including our patients, are living longer than ever before. The second is the chronicity effect - many of these children live with chronic conditions due to medical advances that allow survival. Lastly is health for development - this focuses on supporting optimal life and well-being, not just preventing disease.

This isn’t about every neonatologist mastering every aspect but about recognizing that we do have a stake in shaping lifelong health, starting in the NICU.

Jonathan Litt

That was so wonderfully said. For me, instead of feeling overwhelmed, the life course perspective is actually centering. It grounds us in our role in this lifelong trajectory. If you think about it, neonatology is one of just a few fields focused on a specific life phase, alongside adolescent medicine and geriatrics. It’s a natural framing for what we do.