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Updated: Aug 6, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Babies at double hazard: early development of infants at biologic and social risk
Insights
Early childhood development is impacted by social class and behavioral issues. Environmental factors significantly affect cognitive development in both full-term and premature infants.
Area of Science:
- Developmental Psychology
- Pediatrics
- Sociology
Background:
- Neonatal intensive care unit (NICU) graduates are a vulnerable population.
- Socioeconomic status and behavioral factors may influence long-term developmental outcomes.
- Understanding environmental impacts on cognitive development is crucial for early intervention.
Purpose of the Study:
- To investigate the long-term cognitive and psychosocial development of NICU graduates.
- To identify factors associated with cognitive decline in early childhood.
- To examine the differential impact of environmental factors on full-term versus premature infants.
Main Methods:
- Longitudinal study of 114 NICU infants followed from birth to 3.5 years.
- Exclusion of infants with severe brain damage or mental retardation at 7 months.
- Cognitive and behavioral assessments at various developmental milestones.
Main Results:
- Normal cognitive development observed until 15 months.
- Significant cognitive decline observed from 28 months, associated with social class.
- Behavioral maladjustment led to impaired cognitive development across all social classes.
- Neurologic pathology and gestational age (small for gestational age vs. appropriate for gestational age) did not significantly affect IQ at 3.5 years.
- Premature infants showed greater vulnerability to environmental insufficiencies.
Conclusions:
- Environmental deficits and stresses negatively impact cognitive and psychosocial development in NICU graduates.
- Social class and behavioral maladjustment are key predictors of cognitive decline.
- Premature infants are more susceptible to adverse environmental influences than full-term infants.
Abstract:
From the population of a neonatal intensive care unit, 114 infants and their families were followed from birth to age 3 1/2 years. Infants showing massive brain damage at birth and/or severe mental retardation at 7 months of age were excluded from this analysis. The remainder were predominantly poor and nonwhite. The group showed normal cognitive development through age 15 months. By 28 months of age and thereafter, a severe decline in cognitive status proved to be associated with social class. In addition, serious behavioral maladjustment led to improverished cognitive development. The incidence of maladjustment was unrelated to social class. The impact of maladjustment on test scores was significant in all classes, but greater for the higher rather than the lower socioeconomic social groups. Neither neurologic pathology (excepting severe brain damage) nor gestational age (small for gestation age [SGA] vs appropriate for gestational age [AGA]) had a significant effect on IQ scores at 3 1/2 years of age. It is suggested that environmental deficits and stresses impair early cognitive and psychosocial development for both full-term and premature infants, but that the latter group is more vulnerable to environmental insufficiencies than are full-term babies.
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