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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Abnormal infant neurobehavior and later neurodevelopmental delays in children with critical CHD
Kathleen Campbell1,2, Lauren Malik3, Courtney Jones3
1Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA.
Insights
Infants with critical congenital heart disease (CHD) showing poor attention in the NICU may face later motor delays. Impaired infant attention can be a sensitive marker for this risk.
Area of Science:
- Neonatal Neurology
- Developmental Pediatrics
- Pediatric Cardiology
Background:
- Infants with critical congenital heart disease (CHD) often exhibit neurobehavioral abnormalities.
- Early neurobehavioral assessment may predict later developmental outcomes in this population.
Purpose of the Study:
- To investigate the association between abnormal infant neurobehavior, specifically attention, in the first month of life and neurodevelopmental outcomes at 1-2 years of age in infants with critical CHD.
Main Methods:
- Retrospective cohort study of 189 infants with critical CHD.
- Neurobehavioral assessment using the Neonatal ICU Network Neurobehavioral Scales (NNNS).
- Neurodevelopmental outcomes assessed using the Bayley Scales of Infant Development-III; regression analyses were performed.
Main Results:
- 69% of infants had abnormal NNNS attention scores.
- Abnormal infant attention demonstrated high sensitivity (92%) but low specificity (36%) for later motor delay.
- Impaired infant attention was associated with later motor delay, particularly visual-motor development, though not independently in multivariable analyses.
Conclusions:
- Impaired infant attention in the neonatal period may serve as a sensitive clinical marker for identifying infants with critical CHD at risk for later motor delays.
- Visual-motor neurodevelopmental abnormalities may be captured by early attention assessments in infants with critical CHD.
Abstract:
Infants with critical CHD have abnormal neurobehavior assessed by the Neonatal ICU Network Neurobehavioral Scales. This retrospective cohort study hypothesized associations between abnormal infant neurobehavior in the first month of life and later neurodevelopmental outcomes at 1-2 years of age. Associations between abnormal infant attention (orienting to and tracking stimuli) on the Neonatal ICU Network Neurobehavioral Scales and later motor, cognitive, and language neurodevelopmental outcomes on the Bayley Scales of Infant Development-III at follow-up were examined with descriptive statistics and univariable and multivariable regression. Multiple imputation was used to account for missing outcome data. 189 infants with critical CHD were included, and 69% had abnormal neurobehavioral attention scores. 58 (31%) returned as toddlers for neurodevelopmental follow-up, of which 23% had motor delay. Abnormal infant attention had high sensitivity (92%, 95% CI 60-100%) but low specificity (36%, 95% CI 23-52%) for later motor delay. Higher infant attention scores were associated with higher later motor scores in univariable analysis (coefficient 3.49, 95% CI 0.52,6.46, p = 0.025), but not in multivariable analyses. Neither cognitive nor language scores were associated with infant attention scores. Lower birth weight and male sex were significantly associated with lower motor scores in multivariable analysis (p = 0.048, 0.007). Although impaired infant attention is interdependent with other clinical and demographic risk factors, it may be a sensitive clinical marker of risk for later motor delay. In children with critical CHD, impaired infant attention may be capturing early signs of abnormal visual-motor neurodevelopment.
