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

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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Citation

Published Version (Please cite this version)

10.1038/s41390-023-02540-2

Publication Info

Camerota, Marie, Elisabeth C McGowan, Judy Aschner, Annemarie Stroustrup, Margaret R Karagas, Elisabeth Conradt, Sheila E Crowell, Patricia A Brennan, et al. (2023). Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program. Pediatric research. 10.1038/s41390-023-02540-2 Retrieved from https://hdl.handle.net/10161/26697.

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Scholars@Duke

Conradt

Elisabeth D Conradt

Associate Professor in Psychiatry and Behavioral Sciences

As a clinical and developmental psychologist, my mission is to promote infant and early childhood mental health. My scientific focus is to better understand the intergenerational transmission of risk for mental health problems. In the CAN lab we document how exposures the pregnant person had throughout the lifespan can impact the pregnancy, preterm birth risk, newborn neurodevelopment, and susceptibility for psychopathology. Emotion dysregulation is a transdiagnostic, early-emerging marker of risk for a wide range of psychiatric outcomes, including ADHD, mood, and bipolar disorder. We study how emotion dysregulation – a modifiable intervention target – emerges early in development to inform preventive intervention efforts that begin prenatally and in the first year of life. Pregnant people with emotion dysregulation are also susceptible to a wide range of health risk behaviors, including substance use. Another line of research involves understanding how prenatal substance exposure, in combination with associated environmental exposures, affects neurodevelopment and mental health outcomes in early childhood. The overarching goal of my research is to leverage this science to prevent intergenerational transmission of mental health problems.

I am Associate Professor in Psychiatry, and adjunct Associate Professor of Pediatrics at Duke University. Before coming to Duke, I was Associate Professor in the Department of Psychology, and adjunct Associate Professor in the Departments of Obstetrics & Gynecology and Pediatrics at the University of Utah. I received my PhD in Clinical Psychology at the University of Oregon and completed my clinical internship in Early Childhood Mental Health at the Children’s Hospital of Philadelphia. I have been continuously funded by the NIH since 2011 when I was awarded an F32 postdoctoral fellowship to examine the biological embedding of early life stress in children with prenatal substance exposure at Brown University. My work has been covered in media outlets like NPR and I have received multiple national and international early career research awards.


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