The Journal of Pediatrics
Volume 156, Issue 3 , Pages 366-371 , March 2010

Neurobehavioral Assessment Predicts Motor Outcome in Preterm Infants

  • Bonnie E. Stephens, MD

      Affiliations

    • Department of Pediatrics, Alpert Brown Medical School, Providence, RI
    • Corresponding Author InformationReprint requests: Bonnie E. Stephens, MD, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905.
    • ,
  • Jing Liu, PhD

      Affiliations

    • Maternal Lifestyle Study (MLS), NICHD Neonatal Research Network, Bethesda, MD
    • ,
  • Barry Lester, PhD

      Affiliations

    • Department of Pediatrics, Alpert Brown Medical School, Providence, RI
    • Maternal Lifestyle Study (MLS), NICHD Neonatal Research Network, Bethesda, MD
    • ,
  • Linda Lagasse, PhD

      Affiliations

    • Department of Pediatrics, Alpert Brown Medical School, Providence, RI
    • Maternal Lifestyle Study (MLS), NICHD Neonatal Research Network, Bethesda, MD
    • ,
  • Seetha Shankaran, MD

      Affiliations

    • Maternal Lifestyle Study (MLS), NICHD Neonatal Research Network, Bethesda, MD
    • ,
  • Henrietta Bada, MD

      Affiliations

    • Maternal Lifestyle Study (MLS), NICHD Neonatal Research Network, Bethesda, MD
    • ,
  • Charles Bauer, MD

      Affiliations

    • Maternal Lifestyle Study (MLS), NICHD Neonatal Research Network, Bethesda, MD
    • ,
  • Abhik Das, PhD

      Affiliations

    • Maternal Lifestyle Study (MLS), NICHD Neonatal Research Network, Bethesda, MD
    • ,
  • Rosemary Higgins, MD

      Affiliations

    • Maternal Lifestyle Study (MLS), NICHD Neonatal Research Network, Bethesda, MD

Received 20 March 2009 ,Revised 27 July 2009 ,Accepted 16 September 2009.

References 

  1. Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol. 2000;5:89–106
  2. Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics. 2000;105:1216–1226
  3. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med. 2000;343:378–384
  4. Hack M, Wilson-Costello D, Friedman H, Taylor GH, Schluchter M, Fanaroff AA. Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g: 1992-1995. Arch Pediatr Adolesc Med. 2000;154:725–731
  5. Hintz SR, Kendrick DE, Vohr BR, Poole WK, Higgins RD. Changes in neurodevelopmental outcomes at 18 to 22 months' corrected age among infants of less than 25 weeks' gestational age born in 1993-1999. Pediatrics. 2005;115:1645–1651
  6. Vohr BR, Allan WC, Westerveld M, Schneider KC, Katz KH, Makuch RW, et al. School-age outcomes of very low birth weight infants in the indomethacin intraventricular hemorrhage prevention trial. Pediatrics. 2003;111:e340–e346
  7. Laptook AR, O'Shea TM, Shankaran S, Bhaskar B. Adverse neurodevelopmental outcomes among extremely low birth weight infants with a normal head ultrasound: prevalence and antecedents. Pediatrics. 2005;115:673–680
  8. Ambalavanan N, Nelson KG, Alexander G, Johnson SE, Biasini F, Carlo WA. Prediction of neurologic morbidity in extremely low birth weight infants. J Perinatol. 2000;20:496–503
  9. Singer L, Yamashita T, Lilien L, Collin M, Baley J. A longitudinal study of developmental outcome of infants with bronchopulmonary dysplasia and very low birth weight. Pediatrics. 1997;100:987–993
  10. Vohr BR, Wright LL, Poole WK, McDonald SA. Neurodevelopmental outcomes of extremely low birth weight infants <32 weeks' gestation between 1993 and 1998. Pediatrics. 2005;116:635–643
  11. Shankaran S, Johnson Y, Langer JC, Vohr BR, Fanaroff AA, Wright LL, et al. Outcome of extremely-low-birth-weight infants at highest risk: gestational age < or =24 weeks, birth weight < or =750 g, and 1-minute Apgar < or =3. Am J Obstet Gynecol. 2004;191:1084–1091
  12. Msall ME, Buck GM, Rogers BT, Merke D, Catanzaro NL, Zorn WA. Risk factors for major neurodevelopmental impairments and need for special education resources in extremely premature infants. J Pediatr. 1991;119:606–614
  13. Grether JK, Nelson KB, Emery ES, Cummins SK. Prenatal and perinatal factors and cerebral palsy in very low birth weight infants. J Pediatr. 1996;128:407–414
  14. Ment LR, Bada HS, Barnes P, Grant PE, Hirtz D, Papile LA, et al. Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;58:1726–1738
  15. Ment LR, Allan WC, Makuch RW, Vohr B. Grade 3 to 4 intraventricular hemorrhage and Bayley scores predict outcome. Pediatrics. 2005;116:1597–1598author reply 8
  16. Aziz K, Vickar DB, Sauve RS, Etches PC, Pain KS, Robertson CM. Province-based study of neurologic disability of children weighing 500 through 1249 grams at birth in relation to neonatal cerebral ultrasound findings. Pediatrics. 1995;95:837–844
  17. Woodward TS, Meier B, Cairo TA, Ngan ET. Temporo-prefrontal coordination increases when semantic associations are strongly encoded. Neuropsychologia. 2006;44:2308–2314
  18. Inder TE, Warfield SK, Wang H, Huppi PS, Volpe JJ. Abnormal cerebral structure is present at term in premature infants. Pediatrics. 2005;115:286–294
  19. Dammann O, Leviton A. Neuroimaging and the prediction of outcomes in preterm infants. N Engl J Med. 2006;355:727–729
  20. Hintz SR, O'Shea M. Neuroimaging and neurodevelopmental outcomes in preterm infants. Semin Perinatol. 2008;32:11–19
  21. Mirmiran M, Barnes PD, Keller K, Constantinou JC, Fleisher BE, Hintz SR, et al. Neonatal brain magnetic resonance imaging before discharge is better than serial cranial ultrasound in predicting cerebral palsy in very low birth weight preterm infants. Pediatrics. 2004;114:992–998
  22. Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med. 2006;355:685–694
  23. Constantinou JC, Adamson-Macedo EN, Mirmiran M, Ariagno RL, Fleisher BE. Neurobehavioral assessment predicts differential outcome between VLBW and ELBW preterm infants. J Perinatol. 2005;25:788–793
  24. Constantinou JC, Adamson-Macedo EN, Mirmiran M, Fleisher BE. Movement, imaging and neurobehavioral assessment as predictors of cerebral palsy in preterm infants. J Perinatol. 2007;27:225–229
  25. Prechtl HF, Einspieler C, Cioni G, Bos AF, Ferrari F, Sontheimer D. An early marker for neurological deficits after perinatal brain lesions. Lancet. 1997;349:1361–1363
  26. Lester BM, Tronick EZ. The Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Pediatrics. 2004;113:631–699
  27. Bayley N. Bayley Scales of Infant Development. 3rd ed.. San Antonio, TX: Psychological Corporation; 2006;
  28. Miller-Loncar C, Lester BM, Seifer R, Lagasse LL, Bauer CR, Shankaran S, et al. Predictors of motor development in children prenatally exposed to cocaine. Neurotoxicol Teratol. 2005;27:213–220
  29. Brown NC, Doyle LW, Bear MJ, Inder TE. Alterations in neurobehavior at term reflect differing perinatal exposures in very preterm infants. Pediatrics. 2006;118:2461–2471
  30. Brown NC, Anderson PJ, Howard K, Bear MJ, Wang H, Hunt RW, et al. Clinical validity of early neurobehavioural assessments of very preterm infants [abstract]. E-PAS. 2004;3304
  31. Lester BM, Tronick EZ, LaGasse L, Seifer R, Bauer CR, Shankaran S, et al. The maternal lifestyle study: effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants. Pediatrics. 2002;110:1182–1192
  32. Napiorkowski B, Lester B, Freier C, Brunner S, Dietz L, Nadra A, et al. Effects of in utero substance exposure on infant neurobehavior. Pediatrics. 1996;98:71–75
  33. Singer L. MDMA Use During Pregnancy and Early Infant Outcomes. In: Annual meeting of the XVth Biennial International Conference on Infant Studies. Kyoto, Japan; June 19, 2006.
  34. Carvalho de Moraes Barros M . Guinsburg R, de Araujo Peres C, Mitsuhiro S, Chalem E, Laranjeira R. Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period. J Pediatr. 2006;149:781–787
  35. Law KL, Stroud LR, LaGasse LL, Niaura R, Liu J, Lester BM. Smoking during pregnancy and newborn neurobehavior. Pediatrics. 2003;111:1318–1323
  36. Stroud LR, Paster RL, Papandonatos GD, Niaura R, Salisbury AL, Battle C, et al. Maternal smoking during pregnancy and newborn neurobehavior: effects at 10 to 27 days. J Pediatr. 2009;154:10–16
  37. Brazelton TB. Neonatal Behavioral Assessment Scale. Philadelphia: JB Lippincott; 1973;
  38. Finnegan LP. Neonatal abstinence syndrome: assessment and pharmacotherapy. New York: Excerpta Medica; 1986;
  39. Lester BM. The Maternal Lifestyles Study. Ann N Y Acad Sci. 1998;846:296–305
  40. Bayley N. Bayley Scales of Infant Development-II. San Antonio, TX: Psychological Corporation; 1993;
  41. Allan WC, Vohr B, Makuch RW, Katz KH, Ment LR. Antecedents of cerebral palsy in a multicenter trial of indomethacin for intraventricular hemorrhage. Arch Pediatr Adolesc Med. 1997;151:580–585
  42. Garcia JM, Gherpelli JL, Leone CR. The role of spontaneous general movement assessment in the neurological outcome of cerebral lesions in preterm infants. J Pediatr (Rio J). 2004;80:296–304
  43. Spittle AJ, Brown NC, Doyle LW, Boyd RN, Hunt RW, Bear M, et al. Quality of general movements is related to white matter pathology in very preterm infants. Pediatrics. 2008;121:e1184–e1189
  44. Feldman R, Eidelman AI. Neonatal state organization, neuromaturation, mother-infant interaction, and cognitive development in small-for-gestational-age premature infants. Pediatrics. 2006;118:e869–e878
  45. Korner AF, Constantinou J, Dimiceli S, Brown BW, Thom VA. Establishing the reliability and developmental validity of a neurobehavioral assessment for preterm infants: a methodological process. Child Dev. 1991;62:1200–1208
  46. Majnemer A, Brownstein A, Kadanoff R, Shevell MI. A comparison of neurobehavioral performance of healthy term and low-risk preterm infants at term. Dev Med Child Neurol. 1992;34:417–424
  47. Majnemer A, Rosenblatt B, Riley PS. Influence of gestational age, birth weight, and asphyxia on neonatal neurobehavioral performance. Pediatr Neurol. 1993;9:181–186
  48. Mouradian LE, Als H, Coster WJ. Neurobehavioral functioning of healthy preterm infants of varying gestational ages. J Dev Behav Pediatr. 2000;21:408–416
  49. Wolf MJ, Koldewijn K, Beelen A, Smit B, Hedlund R, de Groot IJ. Neurobehavioral and developmental profile of very low birthweight preterm infants in early infancy. Acta Paediatr. 2002;91:930–938
  50. Volpe JJ. Neurology of the newborn. 5th ed.. Philadelphia, PA: Saunders Elsevier; 2008;

 Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal Lifestyles Study. Presented in part at the annual meeting of the Society for Pediatric Research, May, 2007, Toronto, Canada. The authors declare no conflicts of interest.

PII: S0022-3476(09)00922-6

doi: 10.1016/j.jpeds.2009.09.042

The Journal of Pediatrics
Volume 156, Issue 3 , Pages 366-371 , March 2010

Article Tools