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Background: Among preterm infants, risk of poor outcomes has been linked to neonatal medical illness and neurobehavior. The combined contribution of neonatal medical morbidities and neonatal neurobehavior to 2 year outcomes has yet to be studied.

Objective: To determine associations between NICU Network Neurobehavioral Scale (NNNS) profiles, medical risk, and 2 year developmental outcomes.

Design/Methods: Multi-center study of 704 infants born <30 weeks gestation enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study. NNNS were completed prior to NICU discharge and six profiles of neonatal neurobehavior were calculated by latent profile analysis. Two profiles (5 and 6) were considered atypical. Medical risk included brain injury, CLD, ROP, and NEC/sepsis. Outcomes at 2 years were Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores and Child Behavior Checklist (CBCL) T-scores. Generalized estimating equation (GEE) models were used to test the associations among NNNS profiles, neonatal medical risk, and 2 year developmental outcomes. GEE models accounted for multiple births. Covariates were research site, maternal socioeconomic status (SES), race or ethnicity, maternal primary language, partner status, maternal psychopathology, and infant sex.

Results: Follow-up data were available for 556/704 (78.9%) infants, of which 157 (28.2%) were Profile 5-6. Mother of Profile 5-6 infants were more likely to be non-English speaking and lower SES compared to Profiles 1-4 mothers (Table 1). In a model that included both atypical NNNS and number of medical risks, each independently predicted cognitive and motor composite scores <1 (mild delay) and <2 SDs (moderate delay) below the mean (Table 2). Medical risk alone predicted language composite scores <1 SD. Atypical NNNS patterns alone predicted CBCL internalizing and total problems in the clinical range (Table 2).

Conclusion(s): Neonatal medical risk remains a consistent concern for poor cognitive, language, and motor performance. Atypical neonatal neurobehavioral patterns predicted both adverse developmental outcomes and significant behavioral problems at 2 years, thereby offering an early predictive clinical tool to identify atypical neurobehavior and target NICU and post-discharge interventions.

Presented at the 2021 PAS Virtual Conference

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Presented at the 2021 PAS Virtual Conference

Neonatal Neurobehavior, Medical Risk, and 2-year Developmental Outcomes in Infants Born <30 Weeks>Gestation

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