Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program

• Type of Material: Article
• Authors: Steven L. Pastyrnak, Helen DeVos Hospital; Stephen J. Sheinkopf, University of Missouri; Lynn M. Smith, University of California Los Angeles; Xueying Zhang, Icahn School of Medicine at Mount Sinai; Barry M. Lester, Brown University; Marie Camerota, Brown University; Elisabeth C. McGowan, Brown University; Judy Aschner, Hackensack Meridian School of Medicine; Annemarie Stroustrup, Cohen Children’s Medical Center; Margaret R. Karagas, Dartmouth College; Elisabeth Conradt, Duke University; Sheila E. Crowell, University of Utah; Patricia Brennan, Emory University; Brian S. Carter, Children’s Mercy Hospital; Jennifer Check, Wake Forest School of Medicine; Lynne M. Dansereau, Women and Infants Hospital; Sheri A. DellaGrotta, Women and Infants Hospital; Todd M. Everson, Emory University; Jennifer B. Helderman, Wake Forest School of Medicine; Julie A. Hofheimer, University of North Carolina; Jordan R. Kruiper, Johns Hopkins University; Cynthia M. Loncar, Brown University; Carmen Marsit, Emory University; Charles R. Neal, University of Hawaii; Thomas Michael O'Shea, University of North Carolina
• Language: English
• Date: 2023-08
• Publisher: Nature Portfolio
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2023, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc
• Final Published Version (URL): https://doi.org/10.1038%2Fs41390-023-02540-2
• Title of Journal or Parent Work: Pediatric Research
• Volume: 94
• Issue: 2
• Start Page: 762
• End Page: 770
• Grant/Funding Information: Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 (PRO Core), UH3OD023320 (Aschner), UH3OD023318 (Dunlop), UH3OD023275 (Karagas), UH3OD023347 (Lester), UH3OD023249 (Stanford), UH3OD023348 (O’Shea). Dr. Camerota was additionally supported by a career development award from the National Institute of Mental Health (NIMH), grant K01MH129510 (Camerota). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: perinatal exposure; term-born; preterm; neurobehavioral profiles; socioeconomic factors; NICU Network Neurobehavioral Scale (NNNS); substance use; prenatal; neonatal
• Research Categories: Biology, Neuroscience; Health Sciences, Public Health

Abstract

Background: Single-cohort studies have identified distinct neurobehavioral profiles that are associated with prenatal and neonatal factors based on the NICU Network Neurobehavioral Scale (NNNS). We examined socioeconomic, medical, and substance use variables as predictors of NNNS profiles in a multi-cohort study of preterm and term-born infants with different perinatal exposures. Methods: We studied 1,112 infants with a neonatal NNNS exam from the Environmental influences on Child Health Outcomes (ECHO) consortium. We used latent profile analysis to characterize infant neurobehavioral profiles and generalized estimating equations to determine predictors of NNNS profiles. Results: Six distinct neonatal neurobehavioral profiles were identified, 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. Infants in the hypo-aroused profile were more likely to be male, have younger mothers, and have mothers who were depressed prenatally. Infants in the hyper-aroused profile were more likely to be Hispanic/Latino and have mothers who were depressed or used tobacco prenatally. Conclusions: We identified two dysregulated neurobehavioral profiles with distinct perinatal antecedents. Further understanding of their etiology could inform targeted interventions to promote positive developmental outcomes.