Mind the follow-up gap: recognising long-term mental health needs after very preterm birth

Advances in neonatal care have substantially improved survival among infants born very preterm (VPT; before 32 weeks of gestation), yet clinical follow-up and research remain largely focused on early childhood outcomes. Increasing evidence indicates that the consequences of VPT birth extend well beyond this period, encompassing neurodevelopmental, emotional, psychiatric, and social difficulties that may emerge or become more apparent during adolescence and adulthood. Despite these long-term vulnerabilities, specialised developmental surveillance typically ends in early childhood, leaving a gap between the timing of follow-up and the emergence of later difficulties. Once neonatal follow-up ends, responsibility becomes fragmented across healthcare, educational, and mental health services, while prematurity often loses its relevance in subsequent clinical assessments. This Perspective argues for a shift towards a life-course approach that recognises VPT birth as a developmental risk factor with potentially evolving consequences. Rather than advocating universal lifelong specialist follow-up, we propose a proportionate, risk-adapted model combining anticipatory guidance, targeted reassessment at key developmental transitions, improved continuity of developmental information across services, and accessible pathways back into care when new concerns arise. Greater awareness among healthcare professionals, educators, and families, alongside opportunities for peer support, could facilitate earlier recognition and intervention. Research priorities should also expand beyond traditional neonatal and early developmental outcomes to incorporate mental health, social participation, and outcomes valued by people born preterm and their families. Ultimately, improving long-term outcomes after VPT birth requires ensuring that advances in neonatal survival are matched by sustained attention to psychological wellbeing and functioning across the life course.