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Updated: May 24, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Active head lifting from supine in early infancy: an indicator for non-optimal cognitive outcome in late infancy
Ingrid C Van Haastert1, Floris Groenendaal, Maria K Van de Waarsenburg
1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
Insights
Active head lifting from supine (AHLS) in infancy is linked to poorer cognitive development in toddlers. This association was observed in both preterm and term-born infants, indicating a potential early marker for developmental concerns.
Area of Science:
- Neonatal Development
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Active head lifting from supine (AHLS) is a developmental milestone observed in early infancy.
- The long-term implications of early motor behaviors, such as AHLS, on cognitive development are not fully understood.
- Early identification of potential developmental risks is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between the presence of active head lifting from supine (AHLS) in early infancy and cognitive outcomes in the second year of life.
- To determine if this association differs between preterm and term-born infants.
- To explore potential sex-based differences in the association.
Main Methods:
- Infants admitted to a tertiary neonatal intensive care unit had AHLS presence recorded.
- Infants with AHLS were randomly sampled and paired with two comparison infants without AHLS, matched for sex, gestational age, birth year, assessment timing, and developmental test.
- Cognitive outcomes were assessed using standardized developmental tests, and brain injury was classified from neonatal cranial ultrasound scans.
Main Results:
- A total of 127 infants with AHLS (87 preterm, 40 term) were identified and compared to matched controls.
- Infants with AHLS demonstrated significantly lower mean cognitive outcomes in the second year of life compared to infants without AHLS, in both preterm (p=0.002) and term (p=0.004) groups.
- The negative association between AHLS and cognitive outcome persisted even after excluding infants with cerebral palsy and was most pronounced in term male infants.
Conclusions:
- Active head lifting from supine (AHLS) in early infancy is associated with less favorable cognitive outcomes in the second year of life.
- This association is present in both preterm and term-born infants.
- AHLS may serve as an early indicator for potential neurodevelopmental concerns requiring further monitoring.
Aim:
To explore whether active head lifting from supine (AHLS) in early infancy is associated with cognitive outcome in the second year of life.
Method:
The presence of AHLS was always recorded in the notes of infants admitted to our tertiary neonatal intensive care unit. Random sampling was used to pair infants with AHLS with two comparison infants without AHLS whose sex, gestational age, birth year (1993-2009), time of assessment, and developmental test (Griffiths Mental Development Scales, Mental Scale of the Bayley Scales of Infant Development-II, or cognitive subtest of the Bayley Scales of Infant and Toddler Development-III) were comparable. Brain injury identified from neonatal cranial ultrasound scans was classified as no - mild or moderate - severe. Z-scores of cognitive test outcomes were calculated for multivariable analysis.
Results:
Eighty-seven preterm (34 males, 53 females) and 40 term (17 males, 23 females) infants with AHLS were identified. AHLS was documented at a mean (corrected) age of 7.0 (SD 1.7) and 8.1 (SD 2.2) months respectively. The cognitive assessments were performed at a mean corrected age of 15.7 (SD 1.7) and 23.9 (SD 1.6) months in preterm infants, and 19.1 (SD 2.3) months in term infants. The mean cognitive outcome of preterm and term infants with AHLS was lower than that of infants without AHLS (p=0.002 and p=0.004 respectively). This remained after excluding infants with cerebral palsy with matching comparison infants (p=0.001 in preterm and p=0.001 in term infants). The mean difference was highest (1.35SD) between term male infants and comparison infants (p=0.001).
Interpretation:
AHLS is associated with a less favourable cognitive outcome in the second year of life in preterm as well as in term-born infants than in comparison infants.
