Neonatal neurobehavioral patterns help in predicting cognitive and motor delays in toddlers: JAMA

USA: A new study found that among preterm Infants, high-risk neonatal neurobehavioral patterns at NICU discharge were associated with adverse cognitive, motor, and behavioural outcomes at 2 years of age. The article was published in the JAMA Network Open.

WHO estimates 15 million preterm births globally every year. Preterm infants are more vulnerable to medical complications while in the neonatal intensive care unit (NICU) which may lead to neurodevelopmental impairment. Rates of morbidities may vary, but they are associated with a spectrum of developmental outcomes, including cognitive, language, and motor. Behavior problems, reported in 13% to 46% of very preterm and low birth weight infants, are also of clinical concern, as they may affect long-term academic, home, and social functioning. Identifying poor outcomes and treatable risk factors among very preterm infants is challenging, thus improving early risk detection and intervention targets to potentially address developmental and behavioural delays are needed.

McGowan EC, Brown Alpert Medical School and Women and Infants Hospital, Rhode Island and colleagues conducted a study to determine associations between neonatal neurobehavior, neonatal medical risk, and 2-year outcomes using the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale (NNNS).

Investigators enrolled 679 infants born at less than 30 weeks gestation. NNNS examinations were completed the week of NICU discharge, and 6 profiles of neurobehavior were identified by latent profile analysis. The primary outcome was set as Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), cognitive, language, and motor scores of less than 85 and Child Behavior Checklist (CBCL) T scores greater than 63. Two NNNS behaviour profiles were considered high behavioural risk. Infants with at least 2 medical morbidities (n = 123) were considered high medical risk.

Key findings of the study: 

• Infants with high behavioural and high medical risk were 4 times more likely to have Bayley-III motor scores less than 85 compared with those with low behavioural and low medical risk.

• Infants with high behavioural and high medical risk also had an increased risk for cognitive scores less than 85.

• Only infants with high behavioural and low medical risk were in the clinical range for CBCL internalizing and total problem scores.

The authors conclude that among preterm infants with varying degrees of medical risk, neonatal neurobehavioral assessments at NICU discharge increased the detection of adverse cognitive and motor outcomes at 2 years of age. Ths study also showed that neurobehavioral patterns of poor regulation and functioning alone were associated with 2-year behaviour problems.

The present study data suggests that neurobehavioral assessments of preterm infants may help to identify those at risk of adverse outcomes beyond medical risk alone and could potentially lead to early, targeted interventions.

Reference:

McGowan EC, Hofheimer JA, O'Shea TM, et al. Analysis of Neonatal Neurobehavior and Developmental Outcomes Among Preterm Infants. JAMA Netw Open. 2022;5(7):e2222249. doi:10.1001/jamanetworkopen.2022.22249