Acoustic Cry Characteristics in Preterm Infants and Developmental and Behavioral Outcomes at 2 Years of Age

• Type of Material: Article
• Authors: Andrew W Manigault, Women and Infants Hospital of Rhode Island; Stephen J Sheinkopf, University of Missouri; Brian S Carter, Children's Mercy Hospitals and Clinics; Jennifer Check, Wake Forest University; Jennifer Helderman, Wake Forest University; Julie A Hofheimer, The University of North Carolina at Chapel Hill; Elisabeth C McGowan, The Warren Alpert Medical School; Charles R Neal, John A. Burns School of Medicine; Michael O'Shea, The University of North Carolina at Chapel Hill; Steven Pastyrnak, Spectrum Health; Lynne M Smith, Harbor-UCLA Medical Center; Todd Everson, Emory University; Carmen Marsit, Emory University; Lynne M Dansereau, Women and Infants Hospital of Rhode Island; Sheri A Dellagrotta, Women and Infants Hospital of Rhode Island; Barry M Lester, Women and Infants Hospital of Rhode Island
• Language: English
• Date: 2023-02-01
• Publisher: JAMA Network Open.
• Publication Version: Final Published Version
• Copyright Statement: 2023 Manigault AW et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2022.54151
• Title of Journal or Parent Work: JAMA Network Open
• Volume: 6
• Issue: 2
• Start Page: E2254151
• End Page: E2254151
• Grant/Funding Information: This work was funded by the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development grant R01HD072267 for design and conduct of study and grants 2UG1HD027904 and 5UG1HD068284 for collection and management of 2 year data.
• Keywords: Female; Infant, Newborn; Infant; Humans; Infant, Very Low Birth Weight; Premature Birth; Male; Pregnancy; Child, Preschool; Gestational Age; Infant, Premature; Cohort Studies
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Importance: Acoustic cry characteristics have been associated with severe medical problems in newborns. However, little is known about the utility of neonatal acoustic cry characteristics in the prediction of long-term outcomes of very preterm infants. Objectives: To evaluate whether acoustic characteristics of infant cry at neonatal intensive care unit (NICU) discharge are associated with behavioral and developmental outcomes at age 2 years in infants born very preterm. Design, Setting, and Participants: Infants born less than 30 weeks postmenstrual age (PMA) were enrolled from April 2014 through June 2016 as part of a multicenter (9 US university affiliated NICUs) cohort study and followed to adjusted age 2 years. Reported analyses began on September 2021. Data were analyzed from September 2021 to September 2022. Exposures: The primary exposure was premature birth (<30 weeks PMA). Main Outcomes and Measures: Cries were recorded during a neurobehavioral examination administered during the week of NICU discharge. Cry episodes were analyzed using a previously published computerized system to characterize cry acoustics. Year-2 outcomes included the Bayley-III Composite scores, Child Behavior Checklist (CBCL) and the Modified Checklist for Autism in Toddlers (M-CHAT R/F), dichotomized using clinically significant cutoffs (<85 on Bayley Language, Cognitive and/or Motor Composite scores, T-score >63 on the CBCL Internalizing, Externalizing and/or Total Problem Scales and total M-CHAT R/F score >2). Results: Analyzed infants (363 participants) were primarily male (202 participants [55.65%]) and had a mean [SD] gestational age of 27.08 [1.95] weeks). Cross-validated random forest models revealed that cry acoustics were associated with 2-year outcomes. Tests of diagnostic odds ratios (DOR) revealed that infants who exhibited total problem behavior CBCL scores greater than 63 at age 2 years were 3.3 times more likely (95% CI, 1.44-7.49) to be identified as so by random forest model estimates relative to other infants (scores ≤63); this association was robust to adjustment for family-wise type-I error rates and covariate measures. Similar associations were observed for internalizing (DOR, 2.39; 95% CI, 1.04-5.47) and externalizing (DOR, 2.25; 95% CI, 1.12-4.54) scores on the CBCL, clinically significant language (DOR, 1.71; 95% CI, 1.10-2.67) and cognitive (DOR, 1.70; 95% CI, 1.00-2.88) scores on the Bayley-III, and a positive autism screen on the M-CHAT (DOR, 1.91; 95% CI, 1.05-3.44). Conclusions and Relevance: In this cohort study of preterm infants, findings pointed to the potential use of acoustic cry characteristics in the early identification of risk for long-term developmental and behavioral deficits.