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Evaluating Prenatal and Perinatal Factors Associated with Neonatal Neurobehavior in Preterm and Full-Term Infants in the ECHO Program

Sat, March 25, 8:15 to 9:45am, Salt Palace Convention Center, Floor: 1, Meeting Room 151 A-C

Abstract

Background: The NICU Network Neurobehavioral Scales (NNNS) is a standardized neonatal exam that assesses neuromotor tone, reflexes, behavior, and stress signs and predicts long-term developmental outcomes (Lester & Tronick, 2004; Liu et al., 2010). Single cohort studies have identified distinct neurobehavioral profiles using the NNNS and have shown that these profiles are associated with prenatal and neonatal factors (e.g., McGowan et al., 2020). We examined socioeconomic, medical, and maternal substance use variables as predictors of NNNS profiles in a multi-cohort study of infants spanning the full gestational age (GA) spectrum (i.e., 22 to 43 weeks) and with differing perinatal exposures.
Methods: Participants were 1,112 infants with a neonatal NNNS exam from the Environmental Influences on Child Health Outcomes (ECHO) consortium, representing 10 ECHO recruitment sites. We applied latent profile analysis (LPA) to the 12 NNNS summary scores to group newborns into mutually exclusive neurobehavioral profiles. Model fit statistics suggested a 6-profile solution was optimal. A number of maternal and neonatal characteristics were obtained from maternal self-report and medical record data and were examined as predictors of NNNS profiles using logistic generalized estimating equations.
Results: The majority of infants in the sample were born preterm (<37 weeks GA, n = 886, 80%). Six distinct neonatal neurobehavioral profiles were identified by LPA including two dysregulated profiles: a hypo-aroused profile (16%) characterized by lethargy, hypotonicity, and nonoptimal reflexes, and a hyper-aroused profile (6%) characterized by high arousal, excitability, and stress, with low regulation and poor movement quality (Figure 1). Adjusted analyses (Table 1) showed that infants who were male (OR = 1.37; 95% CI = 1.14 to 1.64), born to younger mothers (OR = 0.97, 95% CI = 0.94 to 0.99), or born to mothers who were depressed prenatally (OR = 1.51, 95% CI = 1.06 to 2.51) were more likely to be in the hypo-aroused profile. Infants who were Hispanic/Latino (OR = 1.67, 95% CI = 1.04 to 2.68), born to mothers who were depressed (OR = 2.50, 95% CI = 1.02 to 6.15), or used tobacco prenatally (OR = 1.73, 95% CI = 1.01 to 2.95) were more likely to be in the hyper-aroused profile. Secondary interaction analyses showed that maternal opioid use was associated with increased odds of being in the hypo-aroused profile, but only for infants born at later GA (e.g., at 37 weeks GA, OR = 3.52; 95% CI = 1.78 to 6.95). White race was associated with lower likelihood of being in the hyper-aroused profile, but only for infants born at earlier GA (e.g., at 27 weeks GA, OR = 0.47, 95% CI = 0.25 to 0.93).

Conclusions: We identified two dysregulated neurobehavioral profiles in infants with distinct perinatal antecedents. Further understanding of the etiology of neonatal neurobehavioral dysregulation could inform targeted interventions to promote positive developmental outcomes.

Group Authors

ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES (ECHO) PROGRAM

Authors