Background Infants born very preterm (VPT) and moderate-to-late preterm (MLPT) are at increased risk of long-term neurodevelopmental deficits, but how these deficits relate to early neurobehaviour in MLPT children is unclear. The aims of this study were to compare the neurobehavioural performance of infants born across three different gestational age groups: preterm <30 weeks’ gestational age (PT<30); MLPT (32–36 weeks’ gestational age) and term age (≥37 weeks’ gestational age), and explore the relationships between MRI brain abnormalities and neurobehaviour at term-equivalent age.
Methods Neurobehaviour was assessed at term-equivalent age in 149 PT<30, 200 MLPT and 200 term-born infants using the Neonatal Intensive Care UnitNetwork Neurobehavioral Scale (NNNS), the Hammersmith Neonatal Neurological Examination (HNNE) and Prechtl’s Qualitative Assessment of General Movements (GMA). A subset of 110 PT<30 and 198 MLPT infants had concurrent brain MRI.
Results Proportions with abnormal neurobehaviour on the NNNS and the HNNE, and abnormal GMA all increased with decreasing gestational age. Higher brain MRI abnormality scores in some regions were associated with suboptimal neurobehaviour on the NNNS and HNNE. The relationships between brain MRI abnormality scores and suboptimal neurobehaviour were similar in both PT<30 and MLPT infants. The relationship between brain MRI abnormality scores and abnormal GMA was stronger in PT<30 infants.
Conclusions There was a continuum of neurobehaviour across gestational ages. The relationships between brain abnormality scores and suboptimal neurobehaviour provide evidence that neurobehavioural assessments offer insight into the integrity of the developing brain, and may be useful in earlier identification of the highest-risk infants.
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Contributors ALE collected data, carried out the analyses, drafted the initial manuscript and reviewed and revised the manuscript. JMW collected data, drafted the initial manuscript and reviewed and revised the manuscript. JEO collected data and reviewed and revised the manuscript. RC critically reviewed and revised the manuscript. DKT, PJA, LWD, JLYC and AJS conceptualised and designed the study and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding This work was supported in part by the Australian National Health and Medical Research Council (NHMRC) (Project Grant ID 1028822); Centre of Clinical Research Excellence Grant ID 546519; Centre of Research Excellence Grant ID 1060733; Senior Research Fellowship ID 1081288 to PJA; Early Career Fellowship ID 1053787 to JLYC, ID 1053767 to AJS; Career Development Fellowship ID 1108714 to AJS; Australian Postgraduate Scholarship to JEO, Murdoch Children’s Research Institute, Clinical Sciences Theme Grant, the Victorian Government Operational Infrastructure Support Program.
Competing interests None declared.
Ethics approval The Royal Women’s Hospital Human Research Ethics Board and the Royal Children’s Hospital Human Research Ethics board.
Provenance and peer review Not commissioned; externally peer reviewed.
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