Jerri M. Oehler

Nursery neurobiologic risk score : important factors in predicting outcome in very low birth weight infants

We developed a nursery Neurobiologic Risk Score (NBRS) based on potential mechanisms of brain cell injury in preterm infants and correlated it with developmental outcome at the corrected ages of 6, 15, and 24 months. The NBRS was determined at 2 weeks of age and at the time of discharge from intensive care in 58 preterm infants with birth weights less than or equal to 1500 gm. The NBRS correlated significantly with the Bayley Scales of Infant Development, Mental Development Index (MDI) (r = -0.61 to -0.40) and Psychomotor Development Index (PDI) (r = -0.59 to -0.46), and with abnormal neurologic examination findings (r = 0.59 to 0.73) at the three testing periods. Although 12 of the 13 items composing the NBRS individually correlated with one or more outcome variables, seven items (infection, blood pH, seizures, intraventricular hemorrhage, assisted ventilation, periventricular leukomalacia, and hypoglycemia) accounted for almost all of the explained variance. Logistic regression of individual items demonstrated intraventricular hemorrhage to be the most important item for predicting the MDI at 24 months; pH was the most influential item for predicting the PDI at every testing period. A shorter, revised NBRS that included only the seven significant items demonstrated as strong a correlation with developmental outcome as the original NBRS. A revised 2-week score of greater than or equal to 5 or a discharge score of greater than or equal to 6 demonstrated 100% specificity and had a 100% positive predictive value for an abnormal outcome at 24 months of age in this group of infants. We conclude that the NBRS identifies during the intensive care nursery stay those infants at highest risk for an abnormal outcome related to nursery events. In addition, analysis of NBRS items provides insight into the relative importance of individual factors for influencing mental, motor, and neurologic outcome.

Nursery neurobiologic risk score: levels of risk and relationships with nonmedical factors.

ABSTRACT. This study compares the Neurobiologic Risk Score (NBRS) with developmental outcome in 199 infants ≤1500 g birth weight to determine levels of risk and to investigate the relative contributions of the NBRS and nonmedical factors to developmental outcome. The NBRS correlated significantly (p < .0001) with the Bayley Mental (MDI) and Psychomotor (PDI) Indexes, and neurologic examination score (NS) at 6, 15, and 24 months. Three risk groups were identified: low, NBRS ≤4; intermediate, NBRS 5 to 7; and high, NBRS ≥8 with an incidence of major handicaps at 24 months of 7%, 32%, and 50%, respectively. Of eight factors considered, the NBRS accounted for the greatest variance: MDI, 14 to 27%; PDI, 25 to 29%; NS, 34 to 42%. Additional increments of variance were contributed by gender (MDI, PDI, NS), maternal intelligence and race (MDI), and maternal education (PDI). The NBRS is a useful tool for identifying risk for developmental abnormalities due to neonatal medical events. J Dev Behav Pediatr 14:375–380, 1993. Index terms: very low birth weight infants, developmental outcome, developmental follow-up, biologic risk, prematurity.

Maternal psychological adjustment to the birth of an infant weighing 1,500 grams or less**

Guided by a transaclional stress and coping model, within-group processes associated with the psychological adjustment of 90 mothers with a very low birthweight infant (VLBW; ≤ 1,500 gms) were assessed. The rates of significant psychological distress varied from 48% at the time of birth, to 33% at 3 to 6 weeks postpartum, to 41 % at 6 months corrected age. Furthermore, there was only 53% stability in the classification of mothers as high or low distress across the three assessment times. There was also considerable change in processes hypothesized to mediate maternal adjustment. Over the course of their infants first 6 months, mothers perceived less stress related to the infant but more stress associated with daily hassles and less family support and more conflict. In particular, support was provided for the mediational role of the stress of daily hassles, efficacy expectations, coping methods, and family functioning in maternal adjustments.

Premature newborns as social partners before term age

Abstract Very low birthweight (VLBW) newborns in simulated en face interaction prior to term age were assessed for their behavioral responsiveness to a female examiner who (a) simply maintained an en face position, (b) talked in motherese while maintaining an en face position, or (c) gradually added tactile stimulation to her talking. Talking led to increased eye opening and more time in an attentive state; the addition of touch to talking led to changes suggestive of distress— decreased eye opening and more facial grimacing. The 68 higher biological risk newborns (Neurobiologic Risk Score ≥ 10) showed the same patterns of responsiveness as the 96 lower risk newborns, but in a more exaggerated form. They responded to talking with even more prolonged eye opening and to the addition of touch with even more eye closing and facial grimacing, reflecting, perhaps, their greater reactivity and reduced abilities for self-regulation.

Developmental outcome of very low birth weight infants as a function of biological risk and psychosocial risk.

The relative contribution of biological and psychosocial risk factors to developmental outcome of 102 very low birth weight infants (<1500 g) was delineated through 24 months corrected age. Biological risk, assessed by the Neurobiologic Risk Score (NBRS), accounted for significant amounts of variance in Bayley Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at the 6-, 15-, and 24-month assessment points. Psychosocial risk, reflected in maternal appraisals of daily stress, accounted for a significant increment in cognitive outcome (MDI), over and above that accounted for by the NBRS, at each assessment point. Cognitive functioning at each assessment point differed as a function of biological risk and psychosocial risk status. The findings are discussed in terms of maternal stress as a marker of, and salient intervention target for, caregiving environments that can maximize or minimize the effects of biological vulnerability. J Dev Behav Pediatr 15:232–238, 1994. Index terms: very low birth weight infants, developmental outcome, biological risk, psychosocial risk.

Developmental Outcome of Very Low Birth Weight Infants at Four Years of Age as a Function of Biological Risk and Psychosocial Risk

The continuing contribution of early biological and psychosocial risk factors to developmental outcome of 55 very low birth weight infants (≤ 1500 g) was assessed at 4 years of age. Biological risk, assessed by the Neurobiologic Risk Score, accounted for significant portions of the variance in the perceptual-performance (17%) and motor (35%) dimensions of the McCarthy Scales of Childrens Abilities. Psychosocial risk, reflected in maternal appraisals of daily stress during the newborn period, did not account for a significant portion of variance in any of the McCarthy Scales. Maternal education level, however, another measure of psychosocial risk, accounted for significant portions of variance (from 6% to 34%) on each of the McCarthy Scales. Movement from low neurobiologic risk status to poor outcome status at 4 years of age was associated with a number of psychosocial variables, including maternal education and early levels of maternal daily stress. The findings are discussed in terms of early markers for very low birth weight infants who require careful follow-up and of potential intervention targets to promote developmental outcome.

The development prior to term age of very prematurely born newborns' responsiveness in en face exchanges

Very-low-birthweight newborns were assessed at 29–30, 31–32, 33–34, and 35–36 weeks postconceptional age in simulated en face interactions with an examiner who (a) simply maintained an en face position, (b) talked in motherese while maintaining an en face position, or (c) gradually added tactile stimulation to her talking. The development of attention and distress patterns of behavioral responsiveness was contrasted for higher versus lower biological-risk newborns. At the younger ages, the newborns seemed to respond with distress (eye closing) to all forms of social stimulation, with the higher risk newborns showing more pronounced distress from as early as they could be tested. More differentiated responsiveness emerged around 33 weeks postconceptional age, when both higher and lower risk newborns began to respond with increased attention to talking in motherese while continuing to show distress when tactile stimulation was combined with talking. Risk-group differences in attention emerged later (35–36 weeks), with higher risk newborns showing more attention to talking, perhaps as a result of differences in habituation processes.

Social stimulation and the regulation of premature infants' state prior to term age☆

Abstract Behavioral responsiveness to human speech and gentle stroking of the limbs was assessed in 15 very low birth-weight infants (VLBW:

Effect of Early Sibling Visitation in an Intensive Care Nursery

In an attempt to assess the effects of early sibling visitation in a neonatal intensive care unit, 31 siblings (ages 3-12) of the hospitalized infant were randomly assigned to either a visit group (during first week of neonatal life) or a comparison group who visited only after the study was completed 3 weeks after birth of the neonate. Parents of both groups of siblings completed the Missouri Behavioral Checklist (MBCL) and Family Environment Scale (FES) in the first few days after birth and, again, 3 weeks after birth. All siblings were interviewed 3 weeks after birth of the neonate. Neither group experienced any increase in negative behaviors following the new siblings birth. In fact, both groups showed some decrease in negative behaviors. In addition, the visitor group showed a significant decrease in negative behaviors on a specific subset of MBCL items. In addition, the visitor group was significantly more well informed about their sibling than the comparison group. J DevBehav Pediatr 11:7-12, 1990.

The process of scapegoating in a neonatal nurses' group

This paper reviews the literature on scapegoating, elaborating on the underlying mechanisms before describing the process of scapegoating as it occurred in a neonatal nurse support group. Illustrative vignettes are used to discuss how scapegoating was used by group members to avoid painful feelings arising from their care of extremely ill infants. Group process is related to the stages of the groups development as feelings were addressed more directly and the need to use scapegoating as a defense decreased.