title: Defining the nature and implications of head turn preference in the preterm infant.
abstract: To determine the relationship of head turn preference in the preterm infant to: 1) perinatal medical factors, 2) neonatal neurobehavior, and/or 3) infant neurodevelopmental outcomes.
  
  
  
  Seventy preterm infants born ≤30weeks gestation were enrolled at birth. Detailed information regarding neonatal intensive care unit (NICU) medical course was compiled for each infant. Neurobehavioral testing was performed during NICU hospitalization. Head turn preference was quantified at term equivalent age using a newly developed scale. Infants returned at age two years for standardized developmental testing.
  
  
  
  All infants demonstrated a head turning preference, with most preferring the right side (n=51, 77%). Fifty-five infants (79%) had moderate to severe head turn preference. Head turn preference was associated with 1) medical severity (hours of inotrope use, p=0.02; oxygen requirement at 36weeks postmenstrual age, p=0.03), 2) worse neurobehavioral performance (decreased self-regulation, p=0.007; more sub-optimal reflexes p=0.006), and 3) worse developmental outcome at age two years (poorer fine motor, p=0.02).
  
  
  
  Medical factors in the NICU appear to be associated with the development of a head turn preference. Increased severity of head turn preference may be a marker for poor developmental outcome. Early identification may inform therapeutic interventions designed to minimize symptoms and optimize neurodevelopmental outcome.
authors.affiliation: Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States.
authors.forename: Sonya
authors.initials: S
authors.lastname: Dunsirn
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States; Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States; Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Smyser
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.
authors.forename: Steve
authors.initials: S
authors.lastname: Liao
authors.affiliation: Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Terrie
authors.initials: T
authors.lastname: Inder
authors.affiliation: Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.
authors.forename: Roberta
authors.initials: R
authors.lastname: Pineda
mesh_terms: D002657:Child Development; D005260:Female; D019416:Head Movements; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development / Q000502:physiology*; D008297:Male; D065886:Neurodevelopmental Disorders / Q000175:diagnosis / Q000453:epidemiology; D009460:Neurologic Examination / Q000379:methods / Q000592:standards
keywords: Head turn preference; child development; infant; infant positioning; neonatal intensive care unit