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Updated: Mar 2, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Trajectories of Externalizing and Internalizing Behaviors in Preterm Children Admitted to a Neonatal Intensive Care

Emily D Gerstein1, Ashley C Woodman2, Cynthia Burnson3

  • 1University of Missouri-St. Louis, St. Louis, MO; University of Wisconsin-Madison, Madison, WI.

The Journal of Pediatrics
|May 24, 2017
PubMed

Insights

Preterm children exhibit three distinct behavior problem trajectories. Early intervention is crucial as child dysregulation, maternal depression, and socioeconomic factors predict more severe issues.

Area of Science:

  • Developmental Psychology
  • Pediatric Health
  • Behavioral Science

Background:

  • Preterm birth is associated with an increased risk of behavioral problems.
  • Understanding the developmental trajectories of these problems is crucial for early intervention.
  • Predictors of behavioral issues in preterm children require further investigation.

Purpose of the Study:

  • To identify distinct developmental trajectories of internalizing and externalizing behavior problems in preterm children from 16 months to 6 years.
  • To examine predictors of these behavior trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting.

Main Methods:

  • A longitudinal study followed 148 preterm children and their mothers from NICU discharge to age 6.
  • Behavioral trajectories were analyzed using semiparametric group-based methods.
  • Multinomial logistic regression identified significant risk factors for behavior problem trajectories.

Main Results:

  • Three distinct trajectories for internalizing and externalizing behaviors were identified in preterm children.
  • Behavior problems peaked between 24-36 months for higher-risk groups, then stabilized or declined.
  • Maternal depression, child dysregulation, lower gestational age, and socioeconomic challenges predicted less optimal trajectories.

Conclusions:

  • Preterm children follow one of three distinct developmental behavior trajectories.
  • Severe behavior problems emerge early and are linked to child dysregulation, maternal depression, and socioeconomic status.
  • Findings support targeted screening and monitoring for high-risk preterm populations.
Abstract

Keywords:
behavior problemsdysregulationlongitudinalmaternal depressionparentingparent–child interactionsprematurity

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