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Neurodevelopmental and behavioral outcomes of very preterm infants: latent profile analysis in the Environmental influences on Child Health Outcomes (ECHO) Program

Pediatric Research volume 95, pages 377–385 (2024)Cite this article

Abstract

Background

Very preterm infants are at high risk for neurodevelopmental impairments. We used a child-centered approach (latent profile analysis [LPA]) to describe 2-year neurobehavioral profiles for very preterm infants based on cognitive, motor, and behavioral outcomes. We hypothesized that distinct outcome profiles would differ in the severity and co-occurrence of neurodevelopmental and behavioral impairment.

Methods

We studied children born <33 weeks’ gestation from the Environmental influences on Child Health Outcomes Program with at least one neurobehavioral assessment at age 2 (Bayley Scales of Infant and Toddler Development, Child Behavior Checklist, Modified Checklist for Autism in Toddlers, cerebral palsy diagnosis). We applied LPA to identify subgroups of children with different patterns of outcomes.

Results

In 2036 children (52% male; 48% female), we found four distinct neurobehavioral profiles. Most children (~85%) were categorized into one of two profiles characterized by no/mild neurodevelopmental delay and a low prevalence of behavioral problems. Fewer children (~15%) fell into one of two profiles characterized by severe neurodevelopmental impairments. One profile consisted of children (5%) with co-occurring neurodevelopmental impairment and behavioral problems.

Conclusion

Child-centered approaches provide a comprehensive, parsimonious description of neurodevelopment following preterm birth and can be useful for clinical and research purposes.

Impact

  • Most research on outcomes for children born very preterm have reported rates of impairment in single domains.

  • Child-centered approaches describe profiles of children with unique combinations of cognitive, motor, and behavioral strengths and weaknesses.

  • We capitalized on data from the nationwide Environmental influences on Child Health Outcomes Program to examine these profiles in a large sample of children born <33 weeks gestational age.

  • We found four distinct neurobehavioral profiles consisting of different combinations of cognitive, motor, and behavioral characteristics.

  • This information could aid in the development of clinical interventions that target different profiles of children with unique developmental needs.

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Fig. 1: The means and percentages of outcome variables by latent profile.

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Data availability

De-identified data from the ECHO Program are available through NICHD’s Data and Specimen Hub (DASH) (https://dash.nichd.nih.gov). DASH is a centralized resource that allows researchers to access data from various studies via a controlled-access mechanism. Researchers can now request access to these data by creating a DASH account and submitting a Data Request Form. The NICHD DASH Data Access Committee will review the request and provide a response in approximately 2–3 weeks. Once granted access, researchers will be able to use the data for 3 years. See the DASH Tutorial for more detailed information on the process (https://dash.nichd.nih.gov/resource/tutorial).

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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 ECHO program collaborators.

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 with co-funding from the Office of Behavioral and Social Science Research (PRO Core), UH3OD023320 (Aschner), UH3OD023347 (Lester), UH3OD023348 (O’Shea). M.C. was additionally supported by a career development award from the National Institute of Mental Health (NIMH), grant K01MH129510 (Camerota). 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, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Marie Camerota & Barry M. Lester

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

    Marie Camerota, Lynne M. Dansereau & Barry M. Lester

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

    Elisabeth C. McGowan & Barry M. Lester

  4. Department 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 Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    T. Michael O’Shea, Julie A. Hofheimer & Genevieve Taylor

  8. Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA

    Robert M. Joseph

  9. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Rashelle Musci

  10. Department of Pediatrics, Children’s Mercy-Kansas City, Kansas City, MO, USA

    Brian S. Carter

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

    Jennifer Check, Semsa Gogcu & Jennifer B. Helderman

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

    Charles R. Neal

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

    Steven L. Pastyrnak

  14. Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, CA, USA

    Lynne M. Smith

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

    Carmen J. Marsit

  16. Coordinating Center: Duke Clinical Research Institute, Durham, NC, USA

    P. B. Smith & K. L. Newby

  17. Data Analysis Center: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    L. P. Jacobson

  18. Research Triangle Institute, Durham, NC, USA

    D. J. Catellier

  19. Person-Reported Outcomes Core: Northwestern University, Evanston, IL, USA

    R. Gershon & D. Cella

  20. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    S. L. Teitelbaum

  21. Baystate Children’s Hospital, Springfield, MA, USA

    R. Vaidya

  22. Beaumont Children’s Hospital, Royal Oak, MI, USA

    R. Obeid

  23. Boston Children’s Hospital, Boston, MA, USA

    C. Rollins

  24. East Carolina University, Brody School of Medicine, Greenville, NC, USA

    K. Bear

  25. Michigan State University College of Human Medicine, East Lansing, MI, USA

    M. Lenski

  26. Tufts University School of Medicine, Boston, MA, USA

    R. Singh

  27. University of Chicago, Chicago, IL, USA

    M. Msall

  28. University of Massachusetts Chan Medical School, Worcester, MA, USA

    Frazier Jo

  29. Yale School of Medicine, New Haven, CT, USA

    A. Montgomery

  30. Boston Medical Center, Boston, MA, USA

    K. Kuban, L. Douglass & H. Jara

Authors
  1. Marie Camerota
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  2. Elisabeth C. McGowan
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  3. Judy Aschner
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  4. Annemarie Stroustrup
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  5. T. Michael O’Shea
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  6. Julie A. Hofheimer
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  7. Robert M. Joseph
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  8. Rashelle Musci
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  9. Genevieve Taylor
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  10. Brian S. Carter
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  11. Jennifer Check
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  12. Lynne M. Dansereau
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  13. Semsa Gogcu
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  14. Jennifer B. Helderman
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  15. Charles R. Neal
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  16. Steven L. Pastyrnak
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  17. Lynne M. Smith
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  18. Carmen J. Marsit
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  19. Barry M. Lester
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Consortia

on behalf of program collaborators for Environmental influences on Child Health Outcomes

  • ECHO Components

    • P. B. Smith
    • , K. L. Newby
    • , L. P. Jacobson
    • , D. J. Catellier
    • , R. Gershon
    •  & D. Cella

  • ECHO Awardees and Cohorts

    • S. L. Teitelbaum
    • , R. Vaidya
    • , R. Obeid
    • , C. Rollins
    • , K. Bear
    • , M. Lenski
    • , R. Singh
    • , M. Msall
    • , Frazier Jo
    • , A. Montgomery
    • , K. Kuban
    • , L. Douglass
    •  & H. Jara

Contributions

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

Corresponding author

Correspondence to Marie Camerota.

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Competing interests

The authors declare no competing interests.

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This study was approved by local Institutional Review Boards, and participants gave informed consent.

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Camerota, M., McGowan, E.C., Aschner, J. et al. Neurodevelopmental and behavioral outcomes of very preterm infants: latent profile analysis in the Environmental influences on Child Health Outcomes (ECHO) Program. Pediatr Res 95, 377–385 (2024). https://doi.org/10.1038/s41390-023-02814-9

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