The Relationship Between Home Environment And Infant Neuropsychological Outcomes:Comparison Between Preterm And Full-term Infants

Background:Home environment plays an important role in children’s development,and high-quality home environment is associated with better neuropsychological outcomes of children.However,studies have shown mixed results about whether the relationship between home environment and children’s neuropsychological outcomes remains the same in preterm and full-term children,and there is a lack of research on the relationship difference in infancy.Three models were proposed to explain the interaction between environment and individual risk factors,including the additive main effect model,diathesis-stress model,and differential susceptibility model,which provide a new way to compare the relationship between home environment and infant neuropsychological outcomes in preterm and full-term infants.Therefore,this study aims to examine the specific interaction pattern between home environment and birth status(preterm vs.full-term),and compare the relationship between home environment and infant neuropsychological outcomes in preterm infants and full-term infants.Methods:A convenient sample of infants who received physical examination and vaccination in the children’s health clinics of two third-class hospitals in Jinan from December 2020 to September 2021,or who were followed up in the neonatal intensive care unit of one of the hospitals from June to September 2021 was recruited.The infants’ mothers reported on the 0-1 Years Child Home Nurture Environment Questionnaire to measure the home environment,and clinical nurses assessed the neuropsychological outcomes of infants using the software developed according to the China Developmental Scale for Children(CDSC).Hierarchical multiple regression and Region of Significance Analysis were used to examine the specific interaction pattern between home environment and birth status(preterm vs.fullterm).Re-parameterized Regression Model was used to validate the interaction pattern between the home environment and birth status(preterm vs.full-term).SPSS25.0 and Mplus8.0 were used for the statistical analyses.P<0.05 was considered statistically significant.Results:The scores of the home environment questionnaire and its four dimensions did not differ significantly between the preterm and full-term infants.Preterm infants had lower scores in the developmental quotient and its five domains,including gross motor,fine motor,adaptability,language,and social behavior than their full-term counterparts.Hierarchical multiple regression showed that the interaction between the home environment and birth status(preterm vs.full-term)was not statistically significant,while they had independent effects on developmental quotient(B=0.08,t=0.961,P=0.337),gross motor(B=-0.18,t=1.108,P=0.269),fine motor(B=0.04,t=0.332,P=0.740),and language(B=0.11,r=0.809,P=0.419),respectively,which met the additive main effect model.The results indicated that the relationship between home environment and infant neuropsychological outcomes(developmental quotient,gross motor,fine motor,and language)did not differ between preterm infants and full-term infants.However,statistically significant interaction between home environment and birth status(preterm vs.full-term)on infants’ social behavior was found(B=0.36,t=2.430,P=0.016).Region of Significance Analysis and Re-parameterized Regression Model further explored and validated that such interaction pattern conformed to the strong diathesis-stress model.Specifically,the relationship between home environment and social behavior in preterm infants was stronger than that in full-term infants,and there was no statistical significance in the relationship between home environment and social behavior in full-term infants.Conclusions:Our results showed that there was no significant difference in the quality of home environment between preterm and full-term infants.The developmental quotient,gross motor,fine motor,and language of preterm infants were worse than their full-term counterparts.High-quality home environment was associated with better developmental quotient,gross motor,fine motor,and language both in preterm and full-term infants.However,the relationship between home environment and social behavior was stronger in preterm infants than that in full-term infants,which fitted the strong diathesis-stress model.Preterm infants were more sensitive to the low-quality home environment and thus showed worse social behavior under negative home environment.The findings suggest that more attention should be paid to the home environment of preterm children,and effective intervention should be carried out for the families of preterm children with poor home environment,which may be of great value in improving the neuropsychological outcomes of preterm children,especially social behavior.