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Preterm birth is a leading cause of neurodevelopmental and neurocognitive impairment in childhood and is closely associated with psychiatric disease. The biological and environmental factors that confer risk and resilience for healthy brain development and long‐term outcome after preterm birth are uncertain, which presents challenges for risk stratification and for the discovery and evaluation of neuroprotective strategies. Neonatal magnetic resonance imaging reveals a signature of preterm birth that includes dysconnectivity of neural networks and atypical development of cortical and deep grey matter structures. Here we provide a brief review of perinatal factors that are associated with the MRI signature of preterm birth. We consider maternal and fetal factors including chorioamnionitis, fetal growth restriction, socioeconomic deprivation, and prenatal alcohol, drug and stress exposures; and neonatal factors including co‐morbidities of preterm birth, nutrition, pain and medication during neonatal intensive care, and variation conferred by the genome/epigenome. Association studies offer the first insights into pathways to adversity and resilience after preterm birth. Future challenges are to analyse quantitative brain MRI data with collateral biological and environmental data in study designs that support causal inference, and ultimately to use the output of such analyses to stratify infants for clinical trials of therapies designed to improve outcome.