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Conradt E, Tronick E, Lester BM. Evidence for neurobehavioral risk phenotypes at birth. Pediatr Res 2024:10.1038/s41390-024-03353-7. [PMID: 38907044 DOI: 10.1038/s41390-024-03353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/11/2024] [Accepted: 04/15/2024] [Indexed: 06/23/2024]
Abstract
Observations of newborn behavior provide clinicians and researchers with a first description of the neurobehavioral organization of the newborn that is largely independent of the postnatal environment. The Neonatal Network Neurobehavioral Scale (NNNS) was developed in 2004 to evaluate how prenatal exposure to substances such as cocaine is related to neurobehavioral outcomes. There are now 156 empirical articles published using the NNNS, which we review and summarize. Z-scores from published studies using the NNNS were compiled and aggregated supporting the replicability of three newborn neurobehavioral phenotypes: one typical and two that are predictive of later cognitive and behavioral delay; hyper- and hypo-dysregulated newborns. These phenotypes emerged from independent samples and research groups and were identified in a variety of populations, including infants with prenatal substance exposure, preterm infants, and healthy term infants. Our findings show that newborn neurobehavior can be measured in a reliable and valid manner and that certain behavioral phenotypes, identifiable at birth, can predict neurodevelopmental challenges. These findings have important clinical utility. Intervening early with infants exhibiting these risk phenotypes may prevent later neurodevelopmental delay. IMPACT: We reviewed all empirical studies published using the Neonatal Network Neurobehavioral Scale and found evidence for two replicable stress phenotypes that predict later behavioral outcomes. This study highlights the utility of the Neonatal Network Neurobehavioral Scale for early identification of newborn neurodevelopmental risk phenotypes. Early identification of neurodevelopmental risk, when neuroplasticity is high, may ultimately reduce the burden of subsequent neurobehavioral problems through early intervention.
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Affiliation(s)
- Elisabeth Conradt
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA.
| | - Edward Tronick
- University of Massachusetts Chan Medical School, Departments of Psychiatry and Pediatrics, Worcester, MA, USA
| | - Barry M Lester
- Brown University Alpert Medical School; Departments of Psychiatry and Pediatrics, Providence, RI, USA
- Women and Infants Hospital of Rhode Island, Center for Children and Families, Department of Pediatrics, Providence, RI, USA
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Martin M, Smith L, Hofheimer JA, McGowan EC, O'Shea TM, Pastyrnak S, Carter BS, Helderman J, Check J, Neal C, Roberts MB, Dansereau LM, Della Grotta SA, Lester BM. Bronchopulmonary dysplasia and neurobehavioural outcomes at birth and 2 years in infants born before 30 weeks. Arch Dis Child Fetal Neonatal Ed 2023; 108:142-148. [PMID: 35999044 PMCID: PMC9947192 DOI: 10.1136/archdischild-2021-323405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 08/02/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify neurobehavioural risks in preterm infants with bronchopulmonary dysplasia (BPD) prior to hospital discharge. DESIGN AND PATIENTS Longitudinal study of 676 newborns born before 30 weeks of gestation. SETTING Nine university NICUs affiliated with six universities. All were Vermont Oxford Network (VON) participants. PATIENTS AND INTERVENTIONS Infants were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study from April 2014 to June 2016. Prospective medical record reviews, VON definitions and criteria, and maternal interviews were used to collect maternal and neonatal medical variables and socioenvironmental data. MAIN OUTCOME MEASURES NICU Network Neurobehavioral Scale (NNNS) at the time of hospital discharge; Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and Gross Motor Function Classification System at 2 years' corrected age. RESULTS Infants with moderate/severe BPD were less attentive (Wald χ2 9.68, p=0.008), more lethargic (Wald χ2 9.91, p=0.007), with increased non-optimal reflexes (Wald χ2 7.37, p=0.025). Infants with moderate/severe BPD were more likely to have Bayley-III language and motor scores <85 (adjusted OR (aOR) 1.74, 95% CI 1.06 to 2.85, and aOR 2.06, 95% CI 1.10 to 3.85). Infants with both moderate/severe and mild BPD were more likely to have a cerebral palsy diagnosis (aOR 2.96, 95% CI 1.34 to 6.54, and aOR 2.81, 95% CI 1.32 to 5.99). CONCLUSIONS BPD severity presents risks for poor neurodevelopment at NICU discharge and at age 2 years. Early identification of poorly regulated behaviour can provide critical information for early preventive and targeted interventions with potential to improve long-term outcomes.
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Affiliation(s)
- Monika Martin
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Lynne Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Julie A Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Elisabeth C McGowan
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Steve Pastyrnak
- Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Brian Scott Carter
- Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jennifer Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Charles Neal
- Department of Pediatrics, University of Hawai'i at Mānoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Mary B Roberts
- Center for Primary Care and Prevention, Care New England Health System, Providence, Rhode Island, USA
| | - Lynne M Dansereau
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
- Brown Center for the Study of Children at Risk, Providence, Rhode Island, USA
| | - Sheri A Della Grotta
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
- Brown Center for the Study of Children at Risk, Providence, Rhode Island, USA
| | - Barry M Lester
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
- Brown Center for the Study of Children at Risk, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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Parikh AN, Triplett RL, Wu TJ, Arora J, Lukas K, Smyser TA, Miller JP, Luby JL, Rogers CE, Barch DM, Warner BB, Smyser CD. Neonatal Intensive Care Unit Network Neurobehavioral Scale Profiles in Full-Term Infants: Associations with Maternal Adversity, Medical Risk, and Neonatal Outcomes. J Pediatr 2022; 246:71-79.e3. [PMID: 35430247 PMCID: PMC10030163 DOI: 10.1016/j.jpeds.2022.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To examine healthy, full-term neonatal behavior using the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) in relation to measures of maternal adversity, maternal medical risk, and infant brain volumes. STUDY DESIGN This was a prospective, longitudinal, observational cohort study of pregnant mothers followed from the first trimester and their healthy, full-term infants. Infants underwent an NNNS assessment and high-quality magnetic resonance imaging 2-5 weeks after birth. A latent profile analysis of NNNS scores categorized infants into neurobehavioral profiles. Univariate and multivariate analyses compared differences in maternal factors (social advantage, psychosocial stress, and medical risk) and neonatal characteristics between profiles. RESULTS The latent profile analysis of NNNS summary scales of 296 infants generated 3 profiles: regulated (46.6%), hypotonic (16.6%), and fussy (36.8%). Infants with a hypotonic profile were more likely to be male (χ2 = 8.601; P = .014). Fussy infants had smaller head circumferences (F = 3.871; P = .022) and smaller total brain (F = 3.522; P = .031) and cerebral white matter (F = 3.986; P = .020) volumes compared with infants with a hypotonic profile. There were no differences between profiles in prenatal maternal health, social advantage, or psychosocial stress. CONCLUSIONS Three distinct neurobehavioral profiles were identified in healthy, full-term infants with hypotonic and fussy neurobehavioral features related to neonatal brain volumes and head circumference, but not prenatal exposure to socioeconomic or psychosocial adversity. Follow-up beyond the neonatal period will determine if identified profiles at birth are associated with subsequent clinical or developmental outcomes.
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Affiliation(s)
- Amisha N Parikh
- School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Regina L Triplett
- Department of Neurology, Washington University in St. Louis, St. Louis, MO.
| | - Tiffany J Wu
- School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Jyoti Arora
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Karen Lukas
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Tara A Smyser
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - J Philip Miller
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Joan L Luby
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO; Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO; Department of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Barbara B Warner
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Christopher D Smyser
- Department of Neurology, Washington University in St. Louis, St. Louis, MO; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO; Department of Radiology, Washington University in St. Louis, St. Louis, MO
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