Original ArticlePatterns of Altered Neurobehavior in Preterm Infants within the Neonatal Intensive Care Unit
Section snippets
Methods
This study was a prospective cohort design recruiting inborn admissions of preterm infants born at less than 30 weeks estimated gestational age (EGA) within the first 3 days of life between 2007 and 2010. Sample size calculations were conducted before enrollment. A sample size of 84 was needed to detect a medium effect with 80% power and α = 0.05; thus, we planned to enroll 120 infants to account for attrition. We chose a medium effect, given that small differences in neurobehavior might be
Results
Of the 120 infants enrolled in the study (Table I), 16 died, 1 was transferred to another hospital, 1 was later determined to have a congenital anomaly, and 6 withdrew from the study. In addition, 21 infants did not have neurobehavioral data for both 34 weeks PMA and term equivalent, leaving 75 infants with data from both evaluations. Of the 21 infants without assessment data at both time points, 8 were too unstable to undergo assessment at 34 weeks, and 13 were discharged before term and did
Discussion
The present study defines early neurobehavioral changes using the NNNS scale in high-risk preterm infants in the NICU. Our key findings are: (1) that preterm infants demonstrate alterations across many neurobehavioral domains of function by term equivalent compared with healthy term infants; (2) that significant changes in neurobehavior occur in the last 6 weeks before term equivalent; and (3) that aside from cerebral injury, perinatal exposures were not associated with early neurobehavioral
References (28)
Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances
Lancet Neurol
(2009)- et al.
Neurobehavioral assessment predicts motor outcome in preterm infants
J Pediatr
(2010) - et al.
Neurological and physical maturation in normal growth singletons from 37 to 41 weeks’ gestation
Early Hum Dev
(1999) - et al.
A new model of assessing the behavioral organization in preterm and full-term infants: two case studies
J Am Acad Child Psychiatry
(1981) - et al.
Trends in the NICU: a review of 25 years’ experience
Am J Perinatol
(2003) - et al.
Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5
BMJ
(2008) - et al.
Motor development in very preterm and very low-birth-weight children from birth to adolescence: a meta-analysis
JAMA
(2009) - et al.
Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children
Pediatrics
(2009) - et al.
Executive function in very preterm children at early school age
J Abnorm Child Psychol
(2009) - et al.
Developmental outcomes and quality of life in children born preterm at preschool- and school-age
J Pediatria
(2011)
Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996-1997
Pediatrics
Mapping the early cortical folding process in the preterm newborn brain
Cereb Cortex
Regional brain development in serial magnetic resonance imaging of low-risk preterm infants
Pediatrics
The Neonatal Intensive Care Unit Network Neurobehavioral Scale procedures
Pediatrics
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Supported by the National Institute of Health (R01 HD057098), the Washington University Intellectual and Developmental Disabilities Research Center (NIH/NICHD P30 HD062171), and the Doris Duke Foundation, none of which were involved in the study design, data collection, interpretation of data, writing the report, or in the decision to submit the paper for publication. The authors declare no conflicts of interest.