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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal state organization, neuromaturation, mother-infant interaction, and cognitive development in
Ruth Feldman1, Arthur I Eidelman
1Department of Psychology and the Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan, Israel. feldman@mail.biu.ac.il
Insights
Small-for-gestational-age premature infants exhibit developmental and cognitive delays, alongside challenges in mother-infant relationships. Extremely low birth weight infants face compounded risks, requiring specialized clinical attention.
Area of Science:
- Neonatal development
- Developmental pediatrics
- Perinatal medicine
Background:
- Premature infants born small-for-gestational-age (SGA) face unique developmental challenges.
- Understanding the interplay between neuromaturation, maternal-infant bonding, and cognitive outcomes is crucial for SGA infants.
- Intrauterine growth restriction and low birth weight are significant risk factors for adverse developmental trajectories.
Purpose of the Study:
- To investigate the relationships among neuromaturation, mother-infant relationship, and cognitive development in SGA premature infants.
- To assess the combined impact of birth weight and intrauterine growth restriction on developmental outcomes in this population.
- To identify predictors of cognitive development in SGA infants.
Main Methods:
- A cohort of 120 singleton premature infants was studied, with SGA infants matched to appropriate-for-gestational-age controls based on birth weight or gestational age.
- Neuromaturation was assessed using the Neonatal Behavioral Assessment Scale, and mother-infant interactions were evaluated at 3 and 24 months corrected age.
- Cognitive development was evaluated at 1 and 2 years corrected age using the Bayley Scale of Infant Development, 2nd edition.
Main Results:
- SGA infants demonstrated poorer neuromaturation, particularly in orientation and motor skills, and less organized neonatal states.
- Mother-infant interactions were marked by maternal intrusiveness and infant disengagement; cognitive outcomes were significantly lower in the SGA group.
- Extremely low birth weight (<1000g) SGA infants exhibited the most severe neurodevelopmental, social, and cognitive deficits.
Conclusions:
- SGA premature infants are at elevated risk for developmental delays and cognitive impairments, with compromised mother-infant relationships.
- Infants born at extremely low birth weight and who are SGA face a dual risk, necessitating heightened clinical vigilance.
- Early identification and targeted interventions are essential for improving outcomes in this vulnerable population.
Objective:
The purpose of this work was to examine the relations among neuromaturation, mother-infant relationship, and cognitive development in small-for-gestational-age premature infants and to assess the interactive effects of birth weight and intrauterine growth restriction on developmental outcomes.
Methods:
We studied 120 singleton premature infants (birth weight: 530-1790 g; gestational age: 25-35 weeks). In group 1, 40 small-for-gestational-age infants (22 girls) were case-matched with group 2 (n = 40) for birth weight (appropriate for gestational age matched for birth weight) and group 3 (n = 40) matched for gestational age (appropriate for gestational age matched for gestational age). Exclusion criteria included intraventricular hemorrhage grade 4, perinatal asphyxia, central nervous system infections, and genetic conditions. Infants were further divided into those born below and above 1000-g subgroups. Neonatal state organization was observed for 4 consecutive hours. Neuromaturation was assessed with the Neonatal Behavioral Assessment Scale. At 3 and 24 months' corrected age, mother-infant interaction was evaluated. At 1 and 2 years' corrected age, the infants' cognitive development was tested with the Bayley Scale of Infant Development, 2nd edition.
Results:
Small-for-gestational-age infants showed less organized state and less mature neurobehavioral profiles, particularly in the orientation and motor domains. Mother-infant interactions were characterized by maternal intrusiveness and miscoordination and negative infant engagement. Cognitive outcomes at 1 and 2 years were lower for the small-for-gestational-age group. Small-for-gestational-age infants born < 1000 g showed the poorest neurodevelopmental, social, and cognitive development of all of the groups. Cognitive outcomes at 2 years were predicted by small-for-gestational-age status, the interaction of actual birth weight and small-for-gestational-age status, neonatal state organization, and maternal intrusive behavior.
Conclusion:
Small-for-gestational-age premature infants are at higher risk for developmental and cognitive delays, as well as difficulties in the mother-infant relationship across infancy. Those born at extremely low birth weight are at a double risk. This group should receive special clinical attention and care.
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