Page 78 - Sample Moderate prematurity, socioeconomic status, and neurodevelopment in early childhood

Chapter 7
of selection bias was very limited since only 2% to 3% of the male population was exempted from conscription, in most cases due to severe handicaps or congenital disorders.
IMPLICATIONS
The findings of the studies reported on in this thesis provide new insights relevant to preventive healthcare. On the basis of these finding, we offer recommendations for clinical practice and policy in PCH and we put forward several suggestions for further research aimed at two dimensions: 1) disentangling the pathways that lead to neurodevelopmental problems, and 2) the role of emotion regulation in promoting and maintaining mental and physical health in the long term.
Implications for clinical practice and policy
The greater part of the findings in this thesis applies to clinical practice in Dutch PCH centres. From our results it follows that indicators of low family SES and signs of co-occurring problems could contribute to the efficient detection of early emerging developmental and psychosocial problems in MP children.
In 2013, the Dutch National Centre for Preventive Youth Healthcare published a guideline on the early identification of developmental and psychosocial problems in preterm and small-for-gestational-age children.87 This guideline also aimed at early detection of developmental and health problems in MP children, but specific recommendations were lacking. The findings presented in this thesis will help to specify the guidelines for MP children, who comprise by far the largest group of preterm children with whom PCH professionals are confronted. In particular, refinement of the guideline is needed because most, i.e. approximately 80% to 90%, of MP children will have no significant developmental or psychosocial problems.88 In other words, PCH professionals know which MP children would benefit most from interventions, and we believe that the findings presented here will contribute to understanding this.
First, we found that the combined biological and social risk of MP children with low SES translates into a substantial increased risk of neurodevelopmental problems. This implies that increased awareness is warranted for the relatively large group of MP children with low family SES. Preterm birth occurs more often in low SES families, but low SES was not an explanation for the association between
128