INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Majestic Complex (Posters 61-120) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #71 The Risk of Care: Impact of NICU Length of Stay on Infant Cognitive Development at 12 Months of Age Molly O'Reilly, Antioch University New England, Keene, United States Kelsea Marschall, Dartmouth-Hitchcock Medical Center, Lebanon, United States Tyler Hartman, Dartmouth-Hitchcock Medical Center, Lebanon, United States Nina Sand-Loud, Dartmouth-Hitchcock Medical Center, Lebanon, United States Kathryn Richards, Dartmouth-Hitchcock Medical Center, Lebanon, United States Jonathan Lichtenstein, Dartmouth-Hitchcock Medical Center, Lebanon, United States Jennifer Amato, Dartmouth-Hitchcock Medical Center, Lebanon, United States Category: Prenatal/Perinatal Factors/Prematurity Keyword 1: child development (normal) Keyword 2: perinatal factors Keyword 3: prematurity Objective: Medical and neonatal intensive care unit (NICU) advances allow infants born at earlier gestational ages, lower birth weights, and with significant medical complications to survive longer. While studies have investigated various neonatal complications and psychosocial developmental risk factors, these variables alone do not fully explain neurodevelopmental trajectories. Length of stay (LOS) in the NICU has been shown to predict cognitive outcomes at 12 months corrected age. Although longer LOS may signify complex medical needs of the infant, the neurodevelopmental implications associated with prolonged hospitalization and atypical newborn experiences (e.g., caregiver separation, sensory stimulation, invasive and intrusive procedures) are not well understood. This study aims to consider gaps in the literature by examining LOS with known risk factors for poor neurodevelopment, including pregnancy complications, neonatal medical complications, and Social Determinants of Health (SDOH), to better understand neurodevelopmental outcomes at 12 months of age in infants requiring NICU stay. Participants and Methods: A sample of 75 infants (50% female, 69% white mothers) was taken for preliminary analysis from a larger retrospective study. Newborns were admitted to a rural academic medical center NICU post-birth and seen for NICU follow-up at 12 months. Gestational ages ranged from 24-40 weeks (SD=3.77) and birth weights from 560-4350 grams (SD=734.11). Average NICU LOS was 55.36 days (SD=41.51). All participants completed the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) at 12 months; the average cognitive standard score was 89.39 (SD=13.31). Maternal education varied: high school education/equivalent (26.7%), college credit (20%), or bachelor’s degree (14.7%). Insurance type was majority Medicaid (38.7%) and private (34.7%). Pearson’s correlation coefficients were conducted to examine the relationships between variables. A stepwise regression analysis was performed to determine cognitive score predictions. Results: Significant negative correlations were found between gestational age and NICU LOS, r(73)= -.51, p<.001, and birth weight and NICU LOS, r(73)= -.48, p<.001. Gestational age and frequency of medical complications represented a significant, negative correlation, r(73)= -.38, p<.001, and birth weight and frequency of medical complications also shared a significant, negative relationship, r(73)=-.29, p=.01. Cognitive standard scores were negatively correlated with NICU LOS, r(73)=-.26, p=.02. While accounting for gestational age and birth weight, as well as SDOH factors including maternal education and insurance type, the full regression model to predict Bayley-III cognitive scores was statistically significant when adding NICU LOS, R²= .250, F(5, 52)= 3.475, p=.009; adjusted R² =.178. Conclusions: Although it is well established that infants born at earlier gestational ages and low birth weights are expected to experience greater medical complications, and thus, be admitted to the NICU, these factors alone do not explain neurodevelopmental outcomes. Consistent with previous literature, our analysis shows that cognitive development at 12 months is significantly impacted not only by neonatal factors such as weight, gestational age, and medical complications, but also NICU LOS. In fact, NICU LOS significantly helped to predict Bayley-III cognitive standard scores above and beyond what might be expected for other well established risk factors. Further research is needed to understand the implications of NICU LOS on developmental trajectories of preterm babies.

Poster

02/17/2024
09:00 am - 10:15 am
Room: Majestic Complex (Posters 61-120)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #71

The Risk of Care: Impact of NICU Length of Stay on Infant Cognitive Development at 12 Months of Age

Molly O'Reilly, Antioch University New England, Keene, United States
Kelsea Marschall, Dartmouth-Hitchcock Medical Center, Lebanon, United States
Tyler Hartman, Dartmouth-Hitchcock Medical Center, Lebanon, United States
Nina Sand-Loud, Dartmouth-Hitchcock Medical Center, Lebanon, United States
Kathryn Richards, Dartmouth-Hitchcock Medical Center, Lebanon, United States
Jonathan Lichtenstein, Dartmouth-Hitchcock Medical Center, Lebanon, United States
Jennifer Amato, Dartmouth-Hitchcock Medical Center, Lebanon, United States

Category: Prenatal/Perinatal Factors/Prematurity

Keyword 1: child development (normal)
Keyword 2: perinatal factors
Keyword 3: prematurity

Objective:

Medical and neonatal intensive care unit (NICU) advances allow infants born at earlier gestational ages, lower birth weights, and with significant medical complications to survive longer. While studies have investigated various neonatal complications and psychosocial developmental risk factors, these variables alone do not fully explain neurodevelopmental trajectories. Length of stay (LOS) in the NICU has been shown to predict cognitive outcomes at 12 months corrected age. Although longer LOS may signify complex medical needs of the infant, the neurodevelopmental implications associated with prolonged hospitalization and atypical newborn experiences (e.g., caregiver separation, sensory stimulation, invasive and intrusive procedures) are not well understood. This study aims to consider gaps in the literature by examining LOS with known risk factors for poor neurodevelopment, including pregnancy complications, neonatal medical complications, and Social Determinants of Health (SDOH), to better understand neurodevelopmental outcomes at 12 months of age in infants requiring NICU stay.

Participants and Methods:

A sample of 75 infants (50% female, 69% white mothers) was taken for preliminary analysis from a larger retrospective study. Newborns were admitted to a rural academic medical center NICU post-birth and seen for NICU follow-up at 12 months. Gestational ages ranged from 24-40 weeks (SD=3.77) and birth weights from 560-4350 grams (SD=734.11). Average NICU LOS was 55.36 days (SD=41.51). All participants completed the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) at 12 months; the average cognitive standard score was 89.39 (SD=13.31). Maternal education varied: high school education/equivalent (26.7%), college credit (20%), or bachelor’s degree (14.7%). Insurance type was majority Medicaid (38.7%) and private (34.7%). Pearson’s correlation coefficients were conducted to examine the relationships between variables. A stepwise regression analysis was performed to determine cognitive score predictions.

Results:

Significant negative correlations were found between gestational age and NICU LOS, r(73)= -.51, p<.001, and birth weight and NICU LOS, r(73)= -.48, p<.001. Gestational age and frequency of medical complications represented a significant, negative correlation, r(73)= -.38, p<.001, and birth weight and frequency of medical complications also shared a significant, negative relationship, r(73)=-.29, p=.01. Cognitive standard scores were negatively correlated with NICU LOS, r(73)=-.26, p=.02. While accounting for gestational age and birth weight, as well as SDOH factors including maternal education and insurance type, the full regression model to predict Bayley-III cognitive scores was statistically significant when adding NICU LOS, R²= .250, F(5, 52)= 3.475, p=.009; adjusted R² =.178.

Conclusions:

Although it is well established that infants born at earlier gestational ages and low birth weights are expected to experience greater medical complications, and thus, be admitted to the NICU, these factors alone do not explain neurodevelopmental outcomes. Consistent with previous literature, our analysis shows that cognitive development at 12 months is significantly impacted not only by neonatal factors such as weight, gestational age, and medical complications, but also NICU LOS. In fact, NICU LOS significantly helped to predict Bayley-III cognitive standard scores above and beyond what might be expected for other well established risk factors. Further research is needed to understand the implications of NICU LOS on developmental trajectories of preterm babies.