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This exploratory paper describes associations between neonatal clinical data and behavioral outcomes among infants born with very low birth weight (VLBW) at 4 years of age. Statistical analysis of 24 VLBW infants was conducted using principal factor analysis (PFA). Multiple linear regressions were calculated to explore the relationship between identified risk factors (demographic and clinical data) and behavioral measures: the Battelle Developmental Inventory (2nd ed.) Screening Test (BDI-2 ST) and the Achenbach Child Behavior Checklist (CBCL). Gestational age was controlled for in the model. Exploratory PFA results indicated that two factors had greater ability to explain observed variations within the sample. The first factor significantly associated high-level neonatal care with aggressive behaviors (ß = -0.7477, p < 0.05). The first factor was also predictive of lower personal-social, communication, and cognitive scores. The second factor significantly associated cardiopulmonary complications with pervasive developmental problems (attention deficit hyperactivity disorder, anxiety, depression, and oppositional defiant disorder) (ß = 0.1977, p < 0.05). These results showed that behavioral consequences at 4 years of age were found among children born VLBW due to the severity of illness, the need of high-level care, and cardiopulmonary complications during the neonatal period. These findings suggest VLBW infants experience longer term effects from trauma early in life and warrant further study.
Key Words: Neuropsychology, behavior problems, infancy, pulmonary, developmental perspectives, NICU, prematurity.
Early childhood neurodevelopment refers to the development of neurological pathways that influence performance or functioning. In the newborn period, genetic factors, novel experiential inputs, and behavioral responses act on a still immature brain substrate to stimulate development of brain circuits (Tau & Peterson, 2010). The brain is sensitive to harmful exposures, such as toxins, drugs, nutritional deficiencies, infection, medical illness, and environmental stressors, throughout the life cycle (Tau & Peterson, 2010). For infants born preterm, a critical period of brain development continues outside the womb in a stimulation-rich environment that starkly contrasts the inutero environment. Physiological instability coupled with neurologic insults (i.e., intraventricular hemorrhage [IVH], pain, stress, oxidative stress) can lead to compromised brain functioning (Altimier & Phillips, 2018; Raffaeli et al., 2020). Ultimately, neural circuit health is demonstrated in cognitive, emotional, and behavioral functioning (Shonkoff et al., 2012; Tau & Peterson, 2010). Thus, it is not surprising that in addition to...