599 - Pre-eclampsia and neurobehavioral outcome in preterm infants at term equivalent age

Poster Number: 599
Publication Number: 599.309

Jennifer Check, Atrium Health Wake Forest Baptist, Brenner Children's Hospital, Winston-Salem, NC, United States; Elisabeth McGowan, Women & Infants Hospital of Rhode Island, Providence, RI, United States; Julie A. Hofheimer, University of North Carolina at Chapel Hill School of Medicine, Durham, NC, United States; Lynne Smith, Harbor-UCLA Medical Center, Torrance, CA, United States; Coral Shuster, Women & Infants Hospital of Rhode Island, Riverside, RI, United States; Marie Camerota, Brown University, Warren, RI, United States; Jennifer Helderman, Wake Forest Baptist Health - Brenner Children's Hospital, Clemmons, NC, United States; Brian S. Carter, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Michael O’Shea, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Howard Kilbride, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States; Charles R. Neal, University of Hawaii, John A. Burns School of Medicine, Kailua, HI, United States; Steven L. Pastyrnak, Helen DeVos Children's Hospital, Grand Rapids, MI, United States; Lynne Dansereau, Brown Center for Children, Providence, RI, United States; Sheri A. DellaGrotta, Women & Infants Hospital of Rhode Island, Providence, RI, United States; Barry Lester, The Warren Alpert Medical School of Brown University, Providence, RI, United States

Background: Both prematurity and pre-eclampsia (pE) have been associated with increased risk of neurodevelopmental impairment in early childhood. Neurodevelopmental and behavioral outcomes in preterm infants are also impacted by socioenvironmental factors which confound the primary association between pE and neurodevelopment. Neonatal neurobehavioral assessment at term adjusted age may give earlier insight into neurobehavioral outcomes of very preterm infants affected by pE before socioenvironmental factors do so.

Objective: We hypothesize that pE will be associated with adverse neurobehavioral findings at term adjusted age in very preterm infants.

Design/Methods: 704 infants born < 30 weeks gestation were enrolled in the multi-site Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study. 527 infants with complete data were included for analysis. NICU Network Neurobehavioral Scale (NNNS) assessments were completed prior to NICU discharge at a mean post-menstrual age (PMA) of 39 +/- 3.4 weeks. The NNNS assesses infant neurobehavioral performance including neurological integrity, behavioral functioning, and signs of stress/abstinence resulting in 12 summary scores. Maternal pE and infant intrauterine growth restriction (IUGR; birthweight < 10th percentile for gestational age) were extracted from medical records. Generalized estimating equations were conducted to examine the relationship between pE, IUGR, and NNNS outcomes, while nesting for site and multi-birth families. Regression coefficients (B) are reported below.

Results: 107 (19.9%) reported maternal pE; 47 (8.7%) infants had IUGR; and 21 (3.9%) had IUGR in the setting of maternal pE. Pre-term infants whose mothers had pE had a .640 increase in hypertonicity score (p = .002) compared to similar aged preterm infants whose mothers did not have it. Pre-term infants with IUGR had a .651 increase in hypertonicity score (p = .014). Conclusion(s): Preterm infants born to mothers diagnosed with pE are at increased risk of neonatal hypertonicity, an indicator of adverse development. Additionally, preterm infants who have IUGR are also at increased risk of neonatal hypertonicity. These conditions, independently, can inform the provision of developmental care choices in the NICU and help direct post-discharge Early Intervention Services. 
Characteristics of infants born to mothers with and without pE
Association of pE and IUGR with elevated hypertonicity score on the NNNS