Patterns of Altered Neurobehavior in Preterm Infants within the Neonatal Intensive Care Unit - 26/02/13
, Tiong Han Tjoeng, MD, MPH 3, Claudine Vavasseur, MD 4, Hiroyuki Kidokoro, MD 2, Jeffrey J. Neil, MD, PhD 2, 5, 6, Terrie Inder, MD, PhD 2, 5, 6
Reprint requests: Roberta Pineda, Program in Occupational Therapy, Washington University School of Medicine, Campus Box 8116, 660 S Euclid Ave, St Louis, MO 63110.Abstract |
Objective |
To investigate differences in neurobehavior between preterm infants at term and full-term infants, changes in neurobehavior between 34 weeks postmenstrual age (PMA) and term equivalent in the preterm infant, and the relationship of neurobehavior to perinatal exposures.
Study design |
In this prospective cohort study, 75 infants were tested at 34 weeks PMA and again at term using the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Infants underwent magnetic resonance imaging at term equivalent. Regression was used to investigate differences in the scale’s domains of function across time and in relation to perinatal exposures.
Results |
At term equivalent, preterm infants exhibited altered behavior compared with full-term infants, with poorer orientation (P < .001), lower tolerance of handling (P < .001), lower self-regulation (P < .001), poorer reflexes (P < .001), more stress (P < .001), hypertonicity (P < .001), hypotonia (P < .001), and more excitability (P = .007). Preterm infants from 34 weeks PMA to term equivalent, demonstrated changes in motor functions with declining quality of movement (P = .006), increasing hypertonia (P < .001), decreasing hypotonia (P = .001), and changes in behavior with increasing arousal (P < .001), increasing excitability (P < .001), and decreasing lethargy (P < .001). Cerebral injury was associated with more excitability (P = .002). However, no associations were detected between any of the perinatal exposures and developmental change from 34 weeks PMA to term equivalent.
Conclusion |
Preterm infants have altered neurobehavior in a broad number of domains at term equivalent. Cerebral injury alters neurobehavior but does not appear to impair early neurobehavioral changes. Important neurobehavioral changes occur before term, and this provides an opportunity for interventions in the neonatal intensive care unit.
Le texte complet de cet article est disponible en PDF.Keyword : EGA, MRI, NEC, NICU, NNNS, PDA, PMA
Plan
| Supported by the National Institute of Health (R01 HD057098), the Washington University Intellectual and Developmental Disabilities Research Center (NIH/NICHD P30 HD062171), and the Doris Duke Foundation, none of which were involved in the study design, data collection, interpretation of data, writing the report, or in the decision to submit the paper for publication. The authors declare no conflicts of interest. |
Vol 162 - N° 3
P. 470 - mars 2013 Retour au numéro
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