Survival of preterm infants has improved dramatically over the last several decades,1 even for those born at extremely low gestational ages.2 The impact of increasing rates of survival on motor, cognitive, and neurosensory outcomes is of keen interest to investigators, clinicians, and families. Some groups have found the risk of neurodevelopmental impairment (NDI) at two years of age – characterized by cognitive and motor scores and neurosensory impairment – to have decreased among infants born extremely preterm.3 Others have found rates of NDI to be unchanged in this population.4 Still others have noted declining rates of severe impairment with concomitant increases in milder delays.5

Preterm birth is associated with long-term health and developmental challenges through later childhood and adolescence. These include asthma-like chronic lung disease, derangements of metabolism and growth, kidney injury and chronic hypertension, functional impairments, behavior problems, and poor academic achievement.6 Later chronic health problems are associated with morbidities experienced during the neonatal period, the prevalence of which has changed over time. For some short-term morbidities like necrotizing enterocolitis7 and its association with later cerebral palsy,8 the risk has declined. For other common neonatal complications like bronchopulmonary dysplasia9 associated with asthma later in life10 the risk has remained stubbornly stable despite efforts to reduce their incidence with antenatal steroids, surfactant, and alternative modes of gentle ventilation. The impact of changing prevalence of neonatal morbidity on childhood and adolescent outcomes remains to be established. And though both early morbidity and chronic health problems are related to neurodevelopment,11 the relationships and pathways among these are also ill-defined.

Overshadowing these epidemiologic changes are notable racial and ethnic inequities in the likelihood of preterm birth and associated perinatal morbidities. Far less is known about the role of race and racism, ethnicity, nativity, and language on longer-term outcomes. Given that adverse perinatal events have the potential to alter trajectories of physical health, growth, and development over the life course, inequities in early life may have profound lifelong effects.12 We will review what is known about the associations of race, ethnicity, nativity, and language with short-term morbidity and long-term outcomes, providing a framework for understanding inequities in social, political, and historical context. We then offer guidance for next steps to gaining insight into mechanistic pathways and eliminating inequities in long-term neurodevelopmental outcomes through research, intervention, and advocacy.