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Updated: Dec 20, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Early neurobehavior at 30 weeks postmenstrual age is related to outcome at term equivalent age
Roberta Pineda1, Lara Liszka2, Terrie Inder3
1University of Southern California, Chan Division of Occupational Science and Occupational Therapy, Los Angeles, CA, United States of America; Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, United States of America; Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States of America.
Insights
Infant medical factors like prematurity and PDA impact early neurobehavior. Early neurobehavioral assessments in very preterm infants can predict later neurodevelopmental outcomes at term equivalent age.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Perinatal medicine
Background:
- Very preterm infants often experience neurodevelopmental challenges.
- Early identification of neurobehavioral patterns is crucial for timely intervention.
- Medical factors during infancy can significantly influence neurological development.
Purpose of the Study:
- To investigate the association between infant medical factors and early neurobehavioral performance.
- To determine if early neurobehavior at 30 weeks postmenstrual age (PMA) predicts neurobehavior at term equivalent age.
Main Methods:
- Prospective longitudinal study of 88 infants born ≤30 weeks estimated gestational age (EGA).
- Neurobehavioral assessments conducted at 30 weeks PMA (Premie-Neuro) and term equivalent age (NICU Network Neurobehavioral Scale [NNNS] and Hammersmith Neonatal Neurological Evaluation [HNNE]).
Main Results:
- Lower Premie-Neuro scores at 30 weeks PMA correlated with greater prematurity, patent ductus arteriosus (PDA), cerebral injury, and prolonged medical interventions (oxygen, intubation, TPN).
- Early neurobehavioral scores at 30 weeks PMA independently predicted neurobehavioral outcomes at term equivalent age, including motor quality, stress, asymmetry, excitability, and reflexes.
Conclusions:
- Medical factors significantly influence the neurobehavioral development of very preterm infants.
- Early neurobehavioral assessment at 30 weeks PMA serves as a reliable predictor of neurobehavioral status at NICU discharge.
Aims:
To determine 1) the relationship between infant medical factors and early neurobehavior, and 2) the relationship between early neurobehavior at 30 weeks postmenstrual age (PMA) and neurobehavior at term equivalent age.
Study Design:
In this prospective longitudinal study, 88 very preterm infants born ≤30 weeks estimated gestational age (EGA) had neurobehavioral assessments at 30 weeks PMA using the Premie-Neuro and at term equivalent age using the NICU Network Neurobehavioral Scale (NNNS) and Hammersmith Neonatal Neurological Evaluation (HNNE).
Results:
Lower Premie-Neuro scores at 30 weeks PMA were related to being more immature at birth (p = 0.01; β = 3.87); the presence of patent ductus arteriosus (PDA; p < 0.01; β = -16.50) and cerebral injury (p < 0.01; β = -20.46); and prolonged exposure to oxygen therapy (p < 0.01; β = -0.01), endotracheal intubation (p < 0.01; β = -0.23), and total parenteral nutrition (p < 0.01; β = -0.35). After controlling for EGA, PDA, and number of days of endotracheal intubation, lower Premie-Neuro scores at 30 weeks PMA were independently related to lower total HNNE scores at term (p < 0.01; β = 0.12) and worse outcome on the NNNS with poorer quality of movement (p < 0.01; β = 0.02) and more stress (p < 0.01; ß = -0.004), asymmetry (p = 0.01; β = -0.04), excitability (p < 0.01; β = -0.05) and suboptimal reflexes (p < 0.01; ß = -0.06).
Conclusion:
Medical factors were associated with early neurobehavioral performance at 30 weeks PMA. Early neurobehavior at 30 weeks PMA was a good marker of adverse neurobehavior at NICU discharge.
