When a baby is born, new parents often wonder, "Will he be the next President of the United States?" or "Could she be the one to find a cure for cancer?" But the underlying question for many specialists is, "Is this child 'at risk' for developmental issues?"
Until now, an answer to this question has been elusive. A newborn exam, developed by a team led by Barry Lester, PhD, director of the Brown Center for the Study of Children at Risk at Women & Infants Hospital of Rhode Island and The Warren Alpert Medical School of Brown University, will be featured in the December 7 issue of Pediatrics, the official journal of the American Journal of Pediatrics. The exam, called the NICU (neonatal intensive care unit) Network Neurobehavioral Scale (NNNS), was created to identify newborns who may have problems with school readiness and behavior at age four. This opens up the possibility of early intervention to prevent these problems.
"There has long been interest in the use of newborn neurobehavior to forecast the future development of children," said Dr. Lester. "Many babies are considered 'at risk' for having behavioral, emotional or cognitive problems, especially as they reach school age, because of prenatal factors such as prematurity or substance exposure and postnatal factors like poverty or violence."
Dr. Lester explained that the problem has been that not all babies who are identified as "high risk" will actually go on to have problems, and there has been no way to tell which high-risk infants will have problems and which will not. "If we could identify these babies at birth or shortly thereafter, we could develop preventive interventions to eliminate or minimize later developmental problems," he explained.
Previous attempts to develop newborn neurobehavioral exams that predict later development were not very successful. The NNNS exam was developed under a contract for the National Institutes of Health and has been studied extensively through a large, multi-site study entitled the Maternal Lifestyle Study" (MLS) that is headquartered at Women & Infants Hospital under the leadership of Dr. Lester.
"Over a period of two years, the NNNS exam was administered to more than 1,200 babies in four locations (Detroit, Memphis, Miami and Providence). We identified five distinct neurobehavioral profiles on the exam that ranged from normal performance to poor performance," continued Dr. Lester.
At three to four and one half years of age, infants with poor performance were more likely to have behavior problems (age three), school readiness problems (age four) and low IQ (age four and one half). Forty percent of these infants had clinically significant problems externalizing (impulsivity and acting out), internalizing (anxiety, depression, withdrawn personalities), and with school readiness (delays in motor, concepts and language skills), and 35% had low IQ.
Dr. Lester said, "One of the reasons that it has been so difficult to use tests on infants to predict later development is that infancy is a period of rapid change. We're measuring a moving target. Many children appear 'normal' as babies but develop problems later on, and many children who appear worrisome as babies go on to develop normally."