Level of NICU Quality of Developmental Care and Neurobehavioral Performance in Very Preterm Infants

Montirosso, Rosario; Prete, Alberto Del; Bellù, Roberto; Tronick, Ed; Borgatti, Renato

doi:10.1542/peds.2011-0813

Cited by 154 publications

(115 citation statements)

References 29 publications

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“…This is concurrent with other findings using the NNNS assessment, where different NNNS summary scores have been associated with unique and specific epigenetic patterning 10,11,13,41,42 or factors from the prenatal environment. [20][21][22][23][24][25][26][27] Quality of movement and infant attention were associated with methylation of genes involving neurological development and function, including neurotransmitter uptake, dopamine uptake involved in synaptic transmission, and dendritic spine organization. The placenta is an endocrine organ that expresses similar neuropeptides to the human brain, 43 and previous studies have identified associations between methylation of genes that are expressed within the human brain, such as the serotonin receptor HTR2A.…”

Section: Discussionmentioning

confidence: 99%

“…16 This assessment has established validity in identifying high-risk infants and predicting later life health outcomes. [17][18][19][20][21][22][23][24][25][26][27][28] The cohort examined in this study represents a relatively healthy population, and the maternal environment experienced by these infants is likely similar to the population at large. These results suggest that there is an underlying level of variation in behavioral phenotypes as well as a level of epigenetic variation in the placenta of otherwise healthy infants, and that in some cases the variation in the placenta is related to the variation observed in neurobehavioral outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…16 The NNNS has established validity in evaluating and predicting cognitive and behavioral outcomes in both healthy infants, 17 preterm infants, [18][19][20] and infants that have been exposed to some degree of in utero adversity. [21][22][23][24][25][26][27][28] Specific newborn characteristics that are quantified within the NNNS assessment, including newborn attention, quality of movement, lethargy, and arousal, have been repeatedly linked to methylation of genes involved in the serotonin response, 13 the development and regulation of the HPA axis, [10][11][12]14,15 and leptin regulation. 29 It is likely that additional genes and pathways, beyond those candidate genes, can be implicated in the development of complex neurobehavioral phenotypes.…”

Section: Introductionmentioning

confidence: 99%

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Regions of variable DNA methylation in human placenta associated with newborn neurobehavior

et al. 2016

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(2016) Regions of variable DNA methylation in human placenta associated with newborn neurobehavior, Epigenetics, 11:8, 603-613, DOI: 10.1080/15592294.2016 ABSTRACTThe placenta regulates the in utero environment and functionally impacts fetal development. Candidate gene studies identified variation in placental DNA methylation is associated with newborn neurologic and behavioral outcomes including movement quality, lethargic behavior, attention, and arousal. We sought to identify novel regions of variable DNA methylation associated with newborn attention, lethargy, quality of movement, and arousal by performing an epigenome-wide association study in 335 infants from a US birth cohort. Methylation status was quantified using the Illumina HumanMethylation450 BeadChip array and associations to newborn outcomes assessed by the NICU Network Neurobehavioral Scales (NNNS) were identified while incorporating established bioinformatics algorithms to control for confounding by cell type composition. Methylation of CpGs within FHIT (cg15970800) and ANKRD11 (cg16710656) demonstrated genome-wide significance (P < 1.8 £ 10 ¡7 ) in specific associations with infant attention. CpGs whose differential methylation was associated with all 4 neurobehavioral outcomes were common to 50 genes involved in biological processes relating to cellular adhesion and nervous system development. Comprehensive methylation profiling identified relationships between methylation of FHIT and ANKRD11, which have been previously linked to neurodevelopment and behavioral outcomes in genetic association studies. Subtle changes in DNA methylation of these genes within the placenta may impact normal variation of a newborn's ability to alter and track visual and auditory stimuli. Gene ontology analysis suggested that those genes with variable methylation related to these outcomes are overrepresented in biological pathways involved in brain development and placental physiology, supportive of our hypothesis for a key role of the placenta in neurobehavioral outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Regions of variable DNA methylation in human placenta associated with newborn neurobehavior

et al. 2016

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“…28 Better developmental care in the NICU (Neonatal Intensive Care Unit) improves developmental outcome on the NNNS in preterm infants when they are discharged from the hospital. 29 In addition, NNNS findings in preterm infants shortly before NICU discharge are more positive when there is more family centered care, developmental care and parent satisfaction and less maternal depression and parenting stress. 30 The NNNS may be useful in implementing developmental models of care in the NICU and identifying infants who may be at high risk for poor developmental outcome even without medical problems.…”

Section: Researchmentioning

confidence: 99%

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Lester

Andreozzi-Fontaine

Tronick

et al. 2014

JoVE

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There has been a long-standing interest in the assessment of the neurobehavioral integrity of the newborn infant. The NICU Network Neurobehavioral Scale (NNNS) was developed as an assessment for the at-risk infant. These are infants who are at increased risk for poor developmental outcome because of insults during prenatal development, such as substance exposure or prematurity or factors such as poverty, poor nutrition or lack of prenatal care that can have adverse effects on the intrauterine environment and affect the developing fetus. The NNNS assesses the full range of infant neurobehavioral performance including neurological integrity, behavioral functioning, and signs of stress/abstinence. The NNNS is a noninvasive neonatal assessment tool with demonstrated validity as a predictor, not only of medical outcomes such as cerebral palsy diagnosis, neurological abnormalities, and diseases with risks to the brain, but also of developmental outcomes such as mental and motor functioning, behavior problems, school readiness, and IQ. The NNNS can identify infants at high risk for abnormal developmental outcome and is an important clinical tool that enables medical researchers and health practitioners to identify these infants and develop intervention programs to optimize the development of these infants as early as possible. The video shows the NNNS procedures, shows examples of normal and abnormal performance and the various clinical populations in which the exam can be used.

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“…During the period of hospitalization in the Neonatal Intensive Care Unit (NICU), neonates are exposed to numerous stressors, including painful stimuli, sleep disruption, excessive noise, high light levels, frequent handling associated with nursing procedures and maternal separation (2) . On average, they are subjected to 16 painful procedures per day, the majority of which occur without analgesia (3) , which highlights the need for changes in the practice of care to reduce stress and pain and to promote improved clinical and adequate neurobehavioral development for the neonates.…”

Section: Introductionmentioning

confidence: 99%

Analgesia e sedação durante a instalação do cateter central de inserção periférica em neonatos

Costa

Bueno

Oliva

et al. 2013

Rev. esc. enferm. USP

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Objetivou-se caracterizar as estratégias de analgesia e sedação em neonatos submetidos à instalação do cateter central de inserção periférica (CCIP) e relacioná-las ao número de punções venosas, duração do procedimento e posicionamento da ponta do cateter. Estudo transversal com coleta prospectiva de dados, realizado em uma unidade de cuidados intensivos neonatais de um hospital privado na cidade de São Paulo, no período de 31 de agosto de 2010 a 01 de julho de 2011, em que foram avaliadas 254 inserções do CCIP. A adoção de estratégias analgésicas ou sedativas ocorreu em 88 (34,6%) instalações do cateter e não esteve relacionada ao número de punções venosas, duração do procedimento ou posicionamento da ponta do cateter. As estratégias mais frequentes foram a administração endovenosa de midazolam em 47 (18,5%) e fentanil em 19 (7,3%) inserções do cateter. Recomenda-se maior adoção de estratégias analgésicas antes, durante e após o procedimento.

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Level of NICU Quality of Developmental Care and Neurobehavioral Performance in Very Preterm Infants

Abstract: Very preterm infant neurobehavior was associated with higher levels of developmental care both in ICC and in IPM, suggesting that these practices support better neurobehavioral stability.

Cited by 154 publications

References 29 publications

Regions of variable DNA methylation in human placenta associated with newborn neurobehavior

Regions of variable DNA methylation in human placenta associated with newborn neurobehavior

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Analgesia e sedação durante a instalação do cateter central de inserção periférica em neonatos

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