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Published on: August 25, 2014
Crying behavior and emotional-behavioral outcomes in high-risk very preterm infants: A prospective cohort study
Babette Steigelmann1, Nienke H Van Dokkum2, Arend F Bos3
1University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Developmental Neurology, Groningen, the Netherlands; Health in Context Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Insights
Excessive crying in very preterm infants is not linked to later emotional or behavioral issues, providing reassurance for families. Further research should examine other developmental impacts.
Area of Science:
- Neonatal Development
- Infant Psychology
- Perinatal Medicine
Background:
- Regulatory problems (RPs) like excessive crying (EC), sleep, and feeding issues affect 5-20% of infants.
- The long-term impact of infant RPs on behavior is unclear, especially in high-risk preterm populations.
Purpose of the Study:
- To investigate the association between excessive crying in early infancy and later emotional and behavioral outcomes.
- To assess these associations in a cohort of high-risk very preterm infants.
Main Methods:
- Prospective observational study of 329 very preterm infants (gestational age <30 weeks).
- Parental reports of crying duration collected at 3 and 6 months corrected age.
- Emotional and behavioral outcomes assessed using BITSEA at 12 months and CBCL at 24 months.
- Statistical analysis included univariable and multivariable linear regressions, controlling for perinatal risks and maternal anxiety.
Main Results:
- 13% of infants exhibited excessive crying (≥3 hours/day) at 3 months.
- Crying behavior was not significantly associated with BITSEA, CBCL internalizing, or externalizing scores in multivariable analyses.
- Maternal trait anxiety was associated with higher BITSEA problem scores.
Conclusions:
- Excessive crying in very preterm infants does not appear to predict later emotional or behavioral problems.
- Findings offer reassurance to families regarding infant crying.
- Further research is recommended to explore crying's influence on other developmental areas.
Purpose:
Regulatory problems (RPs), including excessive crying (EC), sleeping, and feeding difficulties, affect 5-20 % of infants. Their association with later behavioral and emotional problems remains unclear, particularly in preterm populations at elevated neurodevelopmental risk.
Methods:
This prospective observational study included 329 high-risk very preterm infants (gestational age <30 weeks and/or birthweight <1000 g). Parental reports of crying behavior (hours/day) were collected at three and six months corrected age. Emotional and behavioral outcomes were assessed using the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) at 12 months and the Child Behavior Checklist (CBCL) at 24 months. Univariable and multivariable linear regressions were conducted, correcting for perinatal risk factors and maternal trait anxiety.
Results:
Among 329 infants (56 % male; mean gestational age 28 weeks), 42 (13 %) exhibited EC (≥3 h/day) at three months of age. Crying behavior was associated with higher BITSEA problem scores in univariable analysis (β = 0.187, p = 0.009), but not in multivariable analysis (β = 0.157, p = 0.215). No significant associations were observed between crying behavior and CBCL internalizing or externalizing scores in univariable (β = 0.066, p = 0.459; β = 0.038, p = 0.672) or multivariable analysis (β = 0.301, p = 0.052; β = 0.202, p = 0.222). Maternal trait anxiety was significantly associated with higher BITSEA problem scores (β = 0.353, p = 0.006).
Conclusion:
In very preterm infants, crying behavior was not associated with emotional or behavioral problems, offering reassurance to families. Further studies should explore its influence on other developmental domains.
