Early-life factors associated with neurobehavioral outcomes in preterm infants during NICU hospitalization

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Updated: Sep 29, 2025

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
19:15

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Published on: August 25, 2014

86.5K

Tingting Zhao1, Thao Griffith2, Yiming Zhang3

  • 1School of Nursing, University of Connecticut, Storrs, CT, USA.

Pediatric Research
|March 26, 2022
PubMed

Insights

Early life pain and stress negatively impact preterm infant neurobehavioral outcomes. Higher gestational age and maternal breastmilk intake are linked to better development.

Area of Science:

  • Neonatal care
  • Neuroscience
  • Developmental pediatrics

Background:

  • Preterm infants are susceptible to adverse effects of early life pain and stress.
  • NICU environments often involve numerous pain and stress-inducing events for infants.
  • Understanding these influences is crucial for optimizing infant development.

Purpose of the Study:

  • To examine how early-life pain/stress and medical factors affect neurobehavioral outcomes in preterm infants.
  • To identify key predictors of neurobehavioral development in this vulnerable population.
  • To inform interventions aimed at improving outcomes for preterm infants.

Main Methods:

  • A prospective cohort study of 92 preterm infants (28-32 weeks gestational age).
  • Pain/stress measured using the Neonatal Infant Stressor Scale (NISS) in the first 28 days.
  • Neurobehavioral outcomes assessed using the NICU Network Neurobehavioral Scale at 36-38 weeks post-menstrual age.
  • Statistical analyses included functional regression and machine learning models.

Main Results:

  • Higher acute and chronic pain/stress scores were associated with increased stress and poorer self-regulation and movement quality.
  • Younger gestational age (<31.57 weeks) predicted worse stress/abstinence, self-regulation, and excitability.
  • Younger gestational age (<30.57 weeks) predicted poorer quality of movement.
  • Greater maternal breastmilk intake correlated with better self-regulation, excitability, and movement quality in older preterm infants.

Conclusions:

  • Preterm infants' neurobehavioral outcomes are significantly affected by early-life pain and stress.
  • Increased gestational age and higher maternal breastmilk intake are associated with improved neurobehavioral outcomes.
  • Further research is needed to explore the long-term impacts and potential buffering effects of breastmilk.
Abstract

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