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. 2013 Mar;162(3):470-476.e1.
doi: 10.1016/j.jpeds.2012.08.011. Epub 2012 Oct 1.

Patterns of altered neurobehavior in preterm infants within the neonatal intensive care unit

Roberta G Pineda  1 , Tiong Han Tjoeng, Claudine Vavasseur, Hiroyuki Kidokoro, Jeffrey J Neil, Terrie Inder
Affiliations

Patterns of altered neurobehavior in preterm infants within the neonatal intensive care unit

Roberta G Pineda et al. J Pediatr. 2013 Mar.

Abstract

Objective: To investigate differences in neurobehavior between preterm infants at term and full-term infants, changes in neurobehavior between 34 weeks postmenstrual age (PMA) and term equivalent in the preterm infant, and the relationship of neurobehavior to perinatal exposures.

Study design: In this prospective cohort study, 75 infants were tested at 34 weeks PMA and again at term using the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Infants underwent magnetic resonance imaging at term equivalent. Regression was used to investigate differences in the scale's domains of function across time and in relation to perinatal exposures.

Results: At term equivalent, preterm infants exhibited altered behavior compared with full-term infants, with poorer orientation (P < .001), lower tolerance of handling (P < .001), lower self-regulation (P < .001), poorer reflexes (P < .001), more stress (P < .001), hypertonicity (P < .001), hypotonia (P < .001), and more excitability (P = .007). Preterm infants from 34 weeks PMA to term equivalent, demonstrated changes in motor functions with declining quality of movement (P = .006), increasing hypertonia (P < .001), decreasing hypotonia (P = .001), and changes in behavior with increasing arousal (P < .001), increasing excitability (P < .001), and decreasing lethargy (P < .001). Cerebral injury was associated with more excitability (P = .002). However, no associations were detected between any of the perinatal exposures and developmental change from 34 weeks PMA to term equivalent.

Conclusion: Preterm infants have altered neurobehavior in a broad number of domains at term equivalent. Cerebral injury alters neurobehavior but does not appear to impair early neurobehavioral changes. Important neurobehavioral changes occur before term, and this provides an opportunity for interventions in the neonatal intensive care unit.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
NNNS behavioral domains of function at 34 weeks PMA and 40 weeks PMA, compared with full term published norms. Straight horizontal line represents full term infant norms. *Statistically significant difference between function at 34 weeks PMA to 40 weeks PMA (p<.01) **Statistically significant difference between function at 40 weeks PMA compared with full term infant norms (p<.01)
Figure 2
Figure 2
NNNS motor domains of function at 34 weeks PMA and 40 weeks PMA, compared with full term published norms. Straight horizontal line represents full term infant norms. *Statistically significant difference between function at 34 weeks PMA to 40 weeks PMA **Statistically significant difference between function at 40 weeks PMA compared with full term infant norm
See this image and copyright information in PMC

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