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Updated: Jun 22, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Heart rate characteristics and neurodevelopmental outcome in very low birth weight infants
K Addison1, M P Griffin, J R Moorman
1Department of Pediatrics, Wake Forest University School of Medicine, NC 27157, USA.
Insights
A higher cumulative heart rate characteristics (HRC) score in very low birth weight (VLBW) infants is linked to increased risks of cerebral palsy and cognitive delays. This non-invasive measure can predict adverse neurodevelopmental outcomes.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Clinical Informatics
Background:
- Sepsis in very low birth weight (VLBW) infants correlates with poor developmental outcomes.
- Abnormal heart rate characteristics (HRCs) can predict sepsis onset.
- The cumulative HRC score (cHRC) quantifies abnormal HRCs during neonatal hospitalization.
Purpose of the Study:
- To investigate the association between increasing cHRC and the risk of adverse neurodevelopmental outcomes in VLBW infants.
- To test if a higher cHRC score predicts poorer cognitive and psychomotor development, and cerebral palsy.
Main Methods:
- Collected data from 65 VLBW infants monitored for HRCs in the NICU.
- Assessed neurodevelopment at 12-18 months adjusted age using Bayley Scale of Infant Development-II and neurological examination for cerebral palsy.
- Calculated cumulative HRC scores (cHRC) for each infant.
Main Results:
- Increasing cHRC scores were significantly associated with higher risks of cerebral palsy (OR: 2.6) and delayed early cognitive development (OR: 2.3).
- These associations remained significant after adjusting for cranial ultrasound abnormalities.
- A trend towards association was observed between increasing cHRC and delayed psychomotor development (OR: 1.7), though not statistically significant.
Conclusions:
- The cumulative frequency of abnormal HRCs, assessed non-invasively in the NICU, is linked to increased risks of adverse neurodevelopmental outcomes in VLBW infants.
- The cHRC score serves as a valuable, non-invasive predictor of neurodevelopmental risks in this vulnerable population.
Background:
Sepsis in very low birth weight (VLBW) infants has been associated with an increased risk of adverse developmental outcome. We have identified abnormal heart rate characteristics (HRCs) that are predictive of impending sepsis, and we have developed a summary measure of an infant's abnormal HRCs during the neonatal hospitalization that we refer to as the cumulative HRC score (cHRC).
Objective:
In this study, we tested the hypothesis that increasing cHRC is associated with an increasing risk of adverse neurodevelopmental outcome in VLBW infants.
Method:
Data were collected on 65 VLBW infants whose HRCs were monitored while in the neonatal intensive care unit and who were examined at 12 to 18 months adjusted age. Using the Bayley Scale of Infant Development-II, we identified delays in early cognitive function (i.e., Mental Developmental Index <70) and psychomotor development (i.e., Psychomotor Developmental Index <70). Cerebral palsy (CP) was diagnosed using a standard neurological examination.
Result:
Increasing cHRC score was associated with an increased risk of CP (odds ratio per 1 standard deviation increase in cHRC: 2.6, 95% confidence limits: 1.42, 5.1) and delayed early cognitive development [odds ratio: 2.3 (1.3; 4.3)]. These associations remain statistically significant when adjusted for major cranial ultrasound abnormality. There was an association of increasing cHRC and delayed psychomotor development, which did not reach statistical significance [odds ratio: 1.7 (1.0, 3.0)].
Conclusion:
Among VLBW infants, the cumulative frequency of abnormal HRCs, which can be assessed non-invasively in the neonatal intensive care unit, is associated with an increased risk of adverse neurodevelopmental outcome.
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