Growing up after a Neonatal Intensive Care Unit (NICU) stay involves navigating developmental challenges that affect individuals born preterm or with serious illnesses, low birth weight, or other complications requiring intensive neonatal care. Each year, these early health struggles impact over 13 million infants worldwide [1, 2]. Many face immediate complications, such as respiratory distress and infections, while others encounter long-term developmental challenges that influence physical, cognitive, and emotional growth throughout childhood and adolescence [3, 4]. 

Understanding the transition from neonatal care to adulthood is crucial for recognizing how early health challenges shape long-term outcomes. Research shows that individuals with a history of NICU stays due to serious illnesses, low birth weight, or other complications often experience developmental delays, learning disabilities, and increased rates of mental health issues. These factors can complicate their path to independence [5-8]. As they progress through early childhood, adolescence, and adulthood, they may face difficulties in social integration and economic stability [9]. Systemic barriers, including disparities in healthcare access and developmental support, often worsen these challenges [10].

Children who have spent time in the NICU often encounter developmental challenges that evolve from infancy through middle childhood. 

• Infancy (0-2 years): Many experience delays in physical growth, motor skills, and cognitive development due to physiological immaturity. These delays can limit their ability to explore, interact with their environment, and form critical cause-and-effect relationships [10]. 
• Early Childhood (3-6 years): Social and language development may require additional support. Many children with a history of neonatal complications struggle with socialization, including sharing and conflict resolution. Language acquisition may also be delayed due to potential hearing or cognitive impairments [11-13]. 
• Middle Childhood (7-11 years): Academic skills, such as reading and mathematics, often present challenges due to earlier developmental delays. Peer relationships and emotional well-being may also be affected, with difficulties in forming friendships and coping with social pressures [10, 13]. 

Early screening for developmental delays remains essential for timely intervention. Occupational and speech therapy can help NICU graduates overcome these challenges, promoting academic success and social confidence [13-15].

Adolescence (12-18 years) marks a critical phase of physical, emotional, and social development that prepares individuals for adulthood. For those born preterm or with serious neonatal health conditions, this transition often presents unique challenges. 

• Physical Development: Puberty, growth spurts, and brain remodeling enhance decision-making and impulse control [10, 16]. Adolescents with a history of neonatal complications may experience variations in these changes due to earlier developmental delays. 
• Emotional Development: Adolescents begin shaping their identity while managing increasing pressures about their future [17]. Those with neonatal health challenges may struggle with self-confidence, but guidance from mentors and therapists can provide a safe space for self-expression and personal growth. 
• Social Development: Forming deeper friendships and navigating peer influences are crucial for self-esteem and a sense of belonging [10, 16]. Early life adversities, including neonatal health complications, can make this process more difficult, underscoring the importance of a strong support network [17]. 
• Future Planning: As adolescents consider career paths and higher education, those with a NICU history may feel additional pressure due to lingering health concerns [10]. Support from family and mentors can help them build confidence in navigating the transition to adulthood [17].

For individuals who faced health challenges at birth, adulthood outcomes depend on factors such as economic stability, mental health, and social integration. 

• Economic Stability: Rising living costs and a competitive job market make financial independence increasingly difficult [18]. Fear of failure often adds to these challenges, potentially hindering career progress. 
• Mental Health: NICU graduates experience higher rates of anxiety, low self-esteem, and difficulty regulating emotions [16]. These challenges can persist into adulthood, affecting overall well-being and the ability to navigate life transitions [19]. 
• Social Integration: Developing strong social skills and meaningful relationships is crucial for a successful adult life. Many NICU graduates benefit from community programs that promote social involvement and long-term support [20, 21]. 
• Support Systems: Parental involvement plays a key role in helping NICU graduates navigate adulthood. Parents who engage in therapy and collaborate with healthcare providers can reinforce emotional and social development, ensuring their children receive ongoing support as they transition into independent living [15, 22].