A psychoneuroimmunologic examination of cumulative perinatal steroid exposures and preterm infant behavioral follow-up
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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Isabell B Purdy1, Lynne Smith, Dorothy Wiley
1Department of Pediatrics, Neonatology, David Geffen School of Medicine at University of California, Los Angeles, 90096, USA. ipurdy@mednet.ucla.edu
Insights
This study examined how perinatal steroid (PNS) exposure in preterm infants affects long-term behavior. Higher PNS exposure was linked to more behavioral issues, but overall effects were reassuring.
Area of Science:
- Psychoneuroimmunology
- Neonatal Research
- Developmental Psychology
Background:
- Preterm infants often receive treatments impacting development.
- Glucocorticoid exposure is a concern for neurodevelopmental outcomes.
Purpose of the Study:
- To investigate the link between perinatal steroid (PNS) exposure and behavioral problems in children born preterm.
- To determine if maternal/infant factors influence these relationships.
Main Methods:
- 45 mother-child dyads of preterm infants (born at ~28 weeks) were studied.
- Child Behavior Checklist (CBCL) assessed behavior; Clinical Risk Index for Babies (CRIB) scored birth stress.
- Retrospective review identified PNS dosage, sepsis, and immune markers.
Main Results:
- Higher PNS exposure (>0.2 mg/kg) was associated with more behavioral problems (e.g., attention, conduct).
- Sepsis, timing of initial PNS, and NICU length percentile correlated with behavioral outcomes.
- Immune markers and CRIB scores also showed associations with specific behavioral issues.
Conclusions:
- While higher PNS exposure showed associations with more behavioral problems, the overall long-term effects appear reassuring.
- Further research into influencing factors like immune markers is warranted.
Purpose:
This study's aim was to explore relationships between preterm infant behavioral outcomes and maternal/infant glucocorticoid (dexamethasone [DEX]) treatments using a psychoneuroimmunologic approach. Research questions were (a) do relationships exist between infant cumulative perinatal steroid (PNS) exposure and child behavioral problems? and (b) do maternal/infant characteristics (e.g., immune markers and biophysiologic stressors) influence these relationships?
Methods:
The convenience sample comprised 45 mother-child dyads in which the children (mean age 8 years ± 2.3) had been born at a mean postconceptional age of 28 weeks (± 4.2). We used the Child Behavior Checklist (CBCL) to assess behavior, the Clinical Risk Index for Babies (CRIB) to score stress at birth, and retrospective record review to identify additional perinatal factors (PNS dosage, sepsis, and maternal and infant complete blood counts near delivery).
Results:
Children were dichotomized into high (> 0.2 mg/kg; n = 20) versus low-no (≤0.2 mg/kg; n = 25) PNS exposure groups. Significant relationships existed between CBCL Total Problems score and sepsis, PNS exposure, timing of initial PNS, and infant length percentile at discharge. Competence problems were significantly associated with PNS, neonatal intensive care unit (NICU) infant length percentile, CRIB score, sepsis, retinopathy of prematurity, hearing deficit, and immunity markers (i.e., maternal lymphocyte percentage and infant band/seg ratio). Children in the higher PNS group exhibited more behavioral problems (e.g., withdrawn, attention, conduct, social, and rule breaking problems), but there were no significant differences. The findings are reassuring regarding long-term effects of this PNS dose on preterm infant behavioral outcomes.
