title: Patterns of altered neurobehavior in preterm infants within the neonatal intensive care unit.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO 63110, USA. pineda_r@kids.wustl.edu
authors.forename: Roberta G
authors.initials: RG
authors.lastname: Pineda
authors.forename: Tiong Han
authors.initials: TH
authors.lastname: Tjoeng
authors.forename: Claudine
authors.initials: C
authors.lastname: Vavasseur
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kidokoro
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Neil
authors.forename: Terrie
authors.initials: T
authors.lastname: Inder
mesh_terms: D003072:Cognition Disorders / Q000175:diagnosis*; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D018730:Infant Behavior; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development* / Q000523:psychology; D007363:Intensive Care Units, Neonatal; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D011446:Prospective Studies; D012307:Risk Factors