Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program

Marie Camerota; Elisabeth C McGowan; Judy Aschner; Annemarie Stroustrup; Margaret R Karagas; Elisabeth Conradt; Sheila E Crowell; Patricia A Brennan; Brian S Carter; Jennifer Check; Lynne M Dansereau; Sheri A DellaGrotta; Todd M Everson; Jennifer B Helderman; Julie A Hofheimer; Jordan R Kuiper; Cynthia M Loncar; Carmen J Marsit; Charles R Neal; Thomas Michael O'Shea; Steven L Pastyrnak; Stephen J Sheinkopf; Lynne M Smith; Xueying Zhang; Barry M Lester

doi:10.1038/s41390-023-02540-2

Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program

Pediatr Res. 2023 Aug;94(2):762-770. doi: 10.1038/s41390-023-02540-2. Epub 2023 Feb 25.

Authors

Marie Camerota^{1

2}, Elisabeth C McGowan³, Judy Aschner^{4

5}, Annemarie Stroustrup⁶, Margaret R Karagas⁷, Elisabeth Conradt⁸, Sheila E Crowell⁹, Patricia A Brennan¹⁰, Brian S Carter¹¹, Jennifer Check¹², Lynne M Dansereau¹³, Sheri A DellaGrotta¹³, Todd M Everson¹⁴, Jennifer B Helderman¹², Julie A Hofheimer¹⁵, Jordan R Kuiper¹⁶, Cynthia M Loncar^{17

3}, Carmen J Marsit¹⁴, Charles R Neal¹⁸, Thomas Michael O'Shea¹⁵, Steven L Pastyrnak¹⁹, Stephen J Sheinkopf²⁰, Lynne M Smith²¹, Xueying Zhang²², Barry M Lester^{17

13

3}

Affiliations

¹ Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. marie_camerota@brown.edu.
² Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA. marie_camerota@brown.edu.
³ Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA.
⁴ Departments of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA.
⁵ Albert Einstein College of Medicine, Bronx, NY, USA.
⁶ Division of Neonatology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.
⁷ Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
⁸ Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.
⁹ Department of Psychology, University of Utah, Salt Lake City, UT, USA.
¹⁰ Department of Psychology, Emory University, Atlanta, GA, USA.
¹¹ Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, MO, USA.
¹² Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
¹³ Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA.
¹⁴ Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹⁵ Department of Pediatrics, University of North Carolina and Chapel Hill School of Medicine, Chapel Hill, NC, USA.
¹⁶ Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹⁷ Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
¹⁸ Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA.
¹⁹ Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI, USA.
²⁰ Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, USA.
²¹ Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA.
²² Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Abstract

Background: Single-cohort studies have identified distinct neurobehavioral profiles that are associated with prenatal and neonatal factors based on the NICU Network Neurobehavioral Scale (NNNS). We examined socioeconomic, medical, and substance use variables as predictors of NNNS profiles in a multi-cohort study of preterm and term-born infants with different perinatal exposures.

Methods: We studied 1112 infants with a neonatal NNNS exam from the Environmental influences on Child Health Outcomes (ECHO) consortium. We used latent profile analysis to characterize infant neurobehavioral profiles and generalized estimating equations to determine predictors of NNNS profiles.

Results: Six distinct neonatal neurobehavioral profiles were identified, including two dysregulated profiles: a hypo-aroused profile (16%) characterized by lethargy, hypotonicity, and nonoptimal reflexes; and a hyper-aroused profile (6%) characterized by high arousal, excitability, and stress, with low regulation and poor movement quality. Infants in the hypo-aroused profile were more likely to be male, have younger mothers, and have mothers who were depressed prenatally. Infants in the hyper-aroused profile were more likely to be Hispanic/Latino and have mothers who were depressed or used tobacco prenatally.

Conclusions: We identified two dysregulated neurobehavioral profiles with distinct perinatal antecedents. Further understanding of their etiology could inform targeted interventions to promote positive developmental outcomes.

Impact: Prior research on predictors of neonatal neurobehavior have included single-cohort studies, which limits generalizability of findings. In a multi-cohort study of preterm and term-born infants, we found six distinct neonatal neurobehavioral profiles, with two profiles being identified as dysregulated. Hypo- and hyper-aroused neurobehavioral profiles had distinct perinatal antecedents. Understanding perinatal factors associated with dysregulated neurobehavior could help promote positive developmental outcomes.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Child
Cohort Studies
Female
Humans
Infant
Infant Behavior
Infant, Newborn
Male
Mental Disorders*
Mothers
Parturition*
Pregnancy
Wakefulness

Abstract

Publication types

MeSH terms

Grants and funding