Abstract
Background
Psychosocial adversity escalates medical risk for poor outcomes in infants born <30 weeks gestation. Neonatal neurobehavior and maternal psychological and socioenvironmental assessments may identify the earliest specific intervention needs. We hypothesized that maternal prenatal anxiety, depression, and adverse medical and socioenvironmental conditions would be associated with less optimal neonatal neurobehavior at neonatal intensive care unit (NICU) discharge.
Methods
We studied 665 infants at 9 university NICUs. Risk indices of socioenvironmental, maternal, and neonatal medical factors were obtained from standardized, structured maternal interviews and medical record reviews. Brain injuries were classified by consensus ultrasonogram readings. NICU Network Neurobehavioral Scale (NNNS) exams were conducted at NICU discharge.
Results
On the NNNS, generalized estimating equations indicated infants of mothers with prenatal anxiety had less optimal attention, and those born to mothers with prenatal depression had increased lethargy. Maternal medical complications predicted suboptimal reflexes. Socioenvironmental risk predicted lower self-regulation and movement quality. Infants with more severe neonatal medical complications had lower attention, increased lethargy, and suboptimal reflexes.
Conclusions
Combined information from the observed associations among adverse prenatal maternal medical and psychosocial conditions, and neonatal complications may assist in the early identification of infants at elevated neurobehavioral risk.
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Acknowledgements
This work was funded by National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) Grant R01HD072267. We greatly appreciate the individuals whose expertise has so enriched the NOVI Study: We thank colleagues at the University of North Carolina at Chapel Hill, Samantha Meltzer-Brody, M.D., and Alison Stuebe, M.D., for consultation regarding maternal assessments and well-being; Victoria Childers, RN, Nanette Coulon, Wayne Price, M.D., Carl Seashore, M.D., Karen Wood, M.D., for assistance with multisite NNNS training, Carl Bose, MD, and Martin McCaffrey, MD, for consultation regarding neonatal medical data collection; Brown University faculty Linda LaGasse, Ph.D., for early leadership with the NOVI Data Center, and Lynne Andreozzi Fontaine, Ph.D., for consultation on NNNS training; and ELGAN Study investigators (NIH grant 1U01 NS 40069, Alan Leviton, PI), generously provided us with materials for training and diagnostic criteria regarding brain abnormalities. Our immense gratitude goes to our NOVI families, whose participation has made our study successful, and to the data collection site teams of Co-PIs, coordinators, NNNS examiners, and neuroradiologists listed below, for their commitment to our families and study goals. In memory of Zack Boukydis, PhD, whose caring ways with vulnerable babies and their parents continue to inspire us.
Brown Alpert Medical School and Women and Infants Hospital, Providence, RI: Amy Salisbury, Ph.D., Elizabeth Danella MOT, OTR/L, Lynne Andreozzi, Ph.D., Erica Oliveira, BA, Brenda Rosario Perez, BA, BS.
Children’s Mercy Hospital, Kansas City, MO: Howard Kilbride, M.D., Anne Holmes, RN, MSN, CCRC, Allison Knutson, RNC-NIC, Denise Smith, RN, MSN, RNC, NNP.
Harbor-UCLA Medical Center, Torrance, CA: Lucinda Santos, MHA, Jennifer Huynh, RN.
Miller Children’s and Women’s Hospital Long Beach, Long Beach, CA: Lucinda Santos, MHA, Aimee Burdick, PT, DPT, PCS, Alison Yamaguchi, PT.
Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI: Edgar J. Beaumont, M.D., Virginia DeWitt, BSN, RN, BS, Stephanie Fagerman, MS, MB, Kathy Nystrom, BSN, RN, Emily Gleason, BSN, RN, Karen Pawloski, RN, Rebecca McCurdy, PNP-PC, Jason Powell, PT.
University of Hawaii John A. Burns School of Medicine, Honolulu, HI: Venkataraman Balaraman MBBS, Mari Uehara, M.D., Joann Cheung, MA, CCRC, Micah Tong, CCRP, Pattaraporn Chun, MD, Eydie Nakasone, Jayna Lee.
Wake Forest School of Medicine, Winston Salem, NC: Jennifer Check, M.D., MS, Shannon Green Hanson, Ph.D., MPH, April Stewart, Heather Vye, PT, MPT, PCS, Kerry Dudziak MS, OTR/L, Kristi Lanier, RN, BSN, Nancy Peters, RN, Caroline Ludwig, BS, Melissa Tuttle.
Ultrasound Neuroradiology Consultants: Steve Bezinque, DO, Heather Borders, M.D., Joseph Junewick, M.D., Brad Betz, M.D., Spectrum Health-Helen Devos Hospital; and Barbara Specter, M.D., Wake Forest School of Medicine.
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Dr. Hofheimer conceptualized, designed, drafted, and revised this manuscript with coauthors’ contributions, contributed to the conceptualization and design of the study, and lead the study site teams in protocol implementation and data collection. Drs. Smith, McGowan, Carter, and Neal contributed to the conceptualization and design of the study, reviewed and revised the manuscript, and led their respective sites’ study teams in protocol implementation. Drs. O’Shea and Lester led the conceptualization and design of the study, and critically reviewed and revised the manuscript. Drs. Helderman, Pastrynak, and Soliman reviewed and revised the manuscript, and led their respective sites’ study teams in protocol implementation. Ms. Dansereau developed the database for this manuscript, implemented the statistical analyses, and reviewed and revised the manuscript. Ms. DellaGrotta worked with the study site teams to execute the protocol, supervised data collection, designed the data collection instruments, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Hofheimer, J.A., Smith, L.M., McGowan, E.C. et al. Psychosocial and medical adversity associated with neonatal neurobehavior in infants born before 30 weeks gestation. Pediatr Res 87, 721–729 (2020). https://doi.org/10.1038/s41390-019-0607-1
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DOI: https://doi.org/10.1038/s41390-019-0607-1
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