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

Pediatric Research volume 94, pages 762–770 (2023)Cite this article

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.

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Fig. 1: Means of NNNS summary scores by profile.

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Data availability

The datasets for this manuscript are not publicly available because, per the NIH-approved ECHO Data Sharing Policy, ECHO-wide data have not yet been made available to the public for review/analysis. Requests to access the datasets should be directed to the ECHO Data Analysis Center, ECHO-DAC@rti.org.

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Acknowledgements

The authors wish to thank our ECHO colleagues; the medical, nursing, and program staff; and the children and families participating in the ECHO cohorts. We also acknowledge the contribution of the following ECHO program collaborators: ECHO Components—Coordinating Center: Duke Clinical Research Institute, Durham, North Carolina: Smith PB, Newby KL; Data Analysis Center: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland: Jacobson LP; Research Triangle Institute, Durham, North Carolina: Catellier DJ; Person-Reported Outcomes Core: Northwestern University, Evanston, Illinois: Gershon R, Cella D. ECHO Awardees and Cohorts—Icahn School of Medicine at Mount Sinai, New York, NY: Teitelbaum SL; Emory University, Atlanta, GA: Dunlop A; University of Utah, Salt Lake City, UT: Stanford J.

Funding

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 (PRO Core), UH3OD023320 (J.A.), UH3OD023318 (Dunlop), UH3OD023275 (M.R.K.), UH3OD023347 (B.M.L.), UH3OD023249 (Stanford), UH3OD023348 (T.M.O.). M.C. was additionally supported by a career development award from the National Institute of Mental Health (NIMH), grant K01MH129510 (M.C.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA

    Marie Camerota, Cynthia M. Loncar & Barry M. Lester

  2. Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA

    Marie Camerota, Lynne M. Dansereau, Sheri A. DellaGrotta & Barry M. Lester

  3. Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA

    Elisabeth C. McGowan, Cynthia M. Loncar & Barry M. Lester

  4. Departments of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA

    Judy Aschner

  5. Albert Einstein College of Medicine, Bronx, NY, USA

    Judy Aschner

  6. Division of Neonatology, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, NY, USA

    Annemarie Stroustrup

  7. Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA

    Margaret R. Karagas

  8. Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA

    Elisabeth Conradt

  9. Department of Psychology, University of Utah, Salt Lake City, UT, USA

    Sheila E. Crowell

  10. Department of Psychology, Emory University, Atlanta, GA, USA

    Patricia A. Brennan

  11. Department of Pediatrics-Neonatology, Children’s Mercy Hospital, Kansas City, MO, USA

    Brian S. Carter

  12. Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Jennifer Check & Jennifer B. Helderman

  13. Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Todd M. Everson & Carmen J. Marsit

  14. Department of Pediatrics, University of North Carolina and Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Julie A. Hofheimer & Thomas Michael O’Shea

  15. Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Jordan R. Kuiper

  16. Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA

    Charles R. Neal

  17. Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI, USA

    Steven L. Pastyrnak

  18. Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, USA

    Stephen J. Sheinkopf

  19. Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA

    Lynne M. Smith

  20. Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Xueying Zhang

Authors
  1. Marie Camerota
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  2. Elisabeth C. McGowan
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  3. Judy Aschner
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  6. Elisabeth Conradt
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  9. Brian S. Carter
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  10. Jennifer Check
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  11. Lynne M. Dansereau
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  12. Sheri A. DellaGrotta
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  13. Todd M. Everson
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  23. Lynne M. Smith
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  24. Xueying Zhang
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  25. Barry M. Lester
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Contributions

Conception and design of study: M.C., B.M.L. Acquisition of data: J.A., A.S., M.R.K., E.C., S.E.C., P.A.B., B.S.C., J.C., S.A.D., J.B.H., C.R.N., S.L.P., L.M.S. Analysis and interpretation of data: M.C., J.R.K. Drafting the article: M.C., B.M.L. Revising article critically for important intellectual content: M.C., E.C.M., J.A., A.S., M.R.K., E.C., S.E.C., P.A.B., B.S.C., J.C., L.M.D., T.M.E., J.B.H., J.A.H., J.R.K., C.M.L., C.J.M., C.R.N., M.O.S., S.L.P., S.J.S., L.M.S., X.Z., B.M.L. Final approval of the version as submitted: M.C., E.C.M., J.A., A.S., M.R.K., E.C., S.E.C., P.A.B., B.S.C., J.C., L.M.D., S.A.D., T.M.E., J.B.H., J.A.H., J.R.K., C.M.L., C.J.M., C.R.N., M.O.S., S.L.P., S.J.S., L.M.S., X.Z., B.M.L.

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Correspondence to Marie Camerota.

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Camerota, M., McGowan, E.C., Aschner, J. et al. Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program. Pediatr Res 94, 762–770 (2023). https://doi.org/10.1038/s41390-023-02540-2

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