Neurobehavioral Assessment Predicts Motor Outcome in Preterm Infants

Objective

To determine whether Neonatal Intensive Care Unit Network Neurobehavior Scales (NNNS) at 44 weeks predict motor outcome at 2 years in preterm infants from the Maternal Lifestyles Study (MLS).

Study design

Data were collected on all preterm infants (<36 weeks) in the MLS who underwent an NNNS at 44 weeks (n = 395) and neurologic examination at 12 to 36 months or Bayley Psychomotor Development Index (PDI) at 24 months (n = 270). Logistic regression analyzed NNNS summary scores associated with cerebral palsy (CP) or PDI <70, while controlling for birth weight ≤1250 g.

Results

Eighteen of 395 infants (5%) had CP; 24 of 270 infants (9%) had PDI <70. CP was associated with low quality of movement (odds ratio [OR], 1.95; 95% CI, 1.24-3.06; P = .004) and high lethargy (OR, 1.67; 95% CI, 1.01-2.76; P = .045). The model contributed 19% of the variance in CP diagnosis at 12 to 36 months (R² = .19, P < .001). Low PDI was associated with low handling (OR, 1.83; 95% CI, 1.12-2.99; P = .017), low quality of movement (OR, 2.16; 95% CI, 1.38-3.38; P = .001), and hypotonia (OR, 1.63; 95% CI, 1.14-2.32; P = .007). The model contributed 26% of the variance in PDI <70 at 24 months (R² = 0.26, P < .001).

Conclusions

The neurobehavioral profile of under-arousal in 44-week-old preterm infants may predict poor motor outcome.

BPD, Bronchopulmonary dysplasia, BSID-II, Bayley Scales of Infant Development, 2nd edition, CA, Corrected age, CP, Cerebral palsy, ELBW, Extremely low birth weight, IVH, Intraventricular hemorrhage, MLS, Maternal Lifestyles Study, MRI, Magnetic resonance imaging, NAPI, Neurobehavioral Assessment of the Preterm Infant, NBAS, Neonatal Behavioral Assessment Scale, NNNS, Neonatal Intensive Care Unit Network Neurobehavior Scales, OR, Odds ratio, PCA, Post-conceptional age, PDI, Psychomotor Development Index, PVL, Periventricular leukomalacia, SGA, Small for gestational age