Infant Social-Emotional Development Predicted by Newborn Neurobehavior

• In Event: The Utility of Newborn Neurobehavioral Assessments for Early Prediction of Developmental Risk

Abstract

Background: Behavioral and emotional problems during early childhood are prevalent and can lead to later maladaptive child outcomes (Bagner et al., 2012; Essex et al., 2009). Neonatal assessments capturing early neurobehavioral dysregulation may be effective in identifying infants at risk for later developmental disruptions (Lean et al., 2017). For example, more disturbances in neonatal neurobehavior was predictive of higher levels of internalizing and externalizing behaviors in children between 2 and 8 year of age (Canals et al., 2006; Liu et al., 2010; McGowan et al., 2022; Ohgi et al., 2003), and more optimal newborn neurobehavior was associated with increases in emotional empathy in children around 10 years of age (Feldman, 2015). Moreover, infant sex (DiPietro & Voegtline, 2017; Spinillo et al., 2009; Willoughby et al., 2007) and environmental factors (Bridgett et al., 2013; Field, 2014; Oyetunji & Chandra, 2020) can meaningfully impact infant development. Therefore, we examined whether newborn neurobehavior predicted infant social-emotional development and whether this association differed as a function of infant sex assigned at birth and/or infants’ caregiving environments.

Methods: Newborn neurobehavior was assessed in 221 infants (n=113 females) with the NICU Network Neurobehavioral Scale (NNNS; Lester & Tronick, 2004) an average of 33.6 hours after birth by a trained examiner. Birthing parents’ reports of their parenting stress were measured using the Parenting Stress Index (Abidin, 1995) when the infant was 7-months old. Birthing parents reported their infants’ social-emotional behaviors at 18-months with the Infant and Toddler Social and Emotional Assessment (Carter et al., 2003).

Results: Latent profile analysis of the NNNS data identified two profiles—a dysregulated neurobehavioral profile and a typical neurobehavioral profile. The dysregulated profile was characterized by higher excitability, arousal, handling, and stress scores, and lower regulation scores than the typical neurobehavioral profile. Infant sex moderated the association between NNNS profiles and externalizing behavior (b=6.69, p=.023, 95% CI[.91,12.46]). For female infants, but not male infants, dysregulated newborn neurobehavior predicted higher levels of externalizing behavior (b=5.63, p=.010) than the typical neurobehavioral profile (Figure 1). Parent stress also moderated the association between NNNS profiles and toddlers’ social-emotional competence scores (b=0.37, p=.001, 95% CI[.15,.58]). For infants whose caregivers reported low parenting stress, the dysregulated newborn neurobehavior predicted lower levels of competence (b=-5.96, p=.008) than newborns with a typical neurobehavioral profile (Figure 2). There were no statistically significant main effects or interactions for internalizing and dysregulated behaviors.

Discussion: Few studies have examined how newborn neurobehavioral scores predict child problem behaviors (Liu et al., 2010; Sucharew et al., 2012) and no studies have explored this relation prior to two years of age (McGowan et al., 2022). The NNNS is a vital early assessment that, along with other risk factors, could help identify subgroups of newborns at heightened risk for exhibiting social-emotional problems in infancy, allowing for more effective and targeted policies and interventions.

Authors

• Sarah E. Maylott, Duke Univeristy
  Presenting Author

• Madeleine Diane Bruce, University of Utah

• Lee Raby, University of Utah

• Katie Wyant-Stein, University of Utah

• Sheila E Crowell, University of Utah

• Liz Conradt, Duke University