Dissertation
A person-centered approach to neonatal risk factors for neurodevelopmental deficits
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Summer 2021
DOI: 10.17077/etd.005967
Abstract
Neonatal risk factors, such as preterm birth and low birth weight, have been robustly linked to neurodevelopmental deficits, yet significant heterogeneity in these association remains. The current study investigated the heterogeneity of neonatal risk factors for neurodevelopmental difficulties by including additional neonatal risks, specifically APGAR scores and diagnostic status on several neonatal morbidities, and by utilizing a person-centered approach (latent class analysis) to classify neonates into groups that are based on similar neonatal risk factors. Neonates who received neonatal care at a public hospital during an almost 10-year period (n = 19,951) were included in the latent class analysis. The five-class solution emerged as the best fitting model, and the classes were termed healthy, hypoxic, critically ill, minorly ill, and complicated delivery. The neonatal classes were used to examine differences in neurodevelopment at 18-months of age in a typically developing population. Overall, infants in the critically ill, minorly ill, and complicated delivery classes had lower scores on a parent-report measure of neurodevelopment. Although infants in the hypoxic class were not found to differ from infants in the healthy class as a whole, a significant sex difference emerged such that females in the hypoxic class performed lower than males in the hypoxic class on four out of five neurodevelopmental domains. In all other classes, males were rated lower than females, but the difference was much smaller. The neonatal classes were also used to examine neurodevelopment in longitudinal analyses of infants assessed in a high-risk infant clinic. Again, infants in the critically ill, minorly ill, and complicated delivery classes were found to have an increased probability of scoring in the unfavorable ranges over time, compared to healthy infants. Thus, infants experiencing neonatal risks similar to those observed in the critically ill, minorly ill, and complicated delivery classes are at higher risk for neurodevelopmental deficits.
Details
- Title: Subtitle
- A person-centered approach to neonatal risk factors for neurodevelopmental deficits
- Creators
- Allison M Momany
- Contributors
- Molly A Nikolas (Advisor)Kristian E Markon (Committee Member)Isaac Petersen (Committee Member)Jodie Plumert (Committee Member)Kelli K Ryckman (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Psychology
- Date degree season
- Summer 2021
- Publisher
- University of Iowa
- DOI
- 10.17077/etd.005967
- Number of pages
- xii, 139 pages
- Copyright
- Copyright 2020 Allison M. Momany
- Language
- English
- Description illustrations
- illustrations (some color)
- Description bibliographic
- Includes bibliographical references (pages 113-135)
- Public Abstract (ETD)
It is well-established that infants who are born preterm, low birth weight, or who suffer illnesses during the first few weeks of life are at higher risk for neurodevelopmental difficulties. Current characterization of neonatal risks for neurodevelopment largely examine neonatal risks in silo despite the high rate at which these risk factors co-occur. Thus, a better understanding of the cumulative effect of neonatal risk factors on neurodevelopment is needed.
Approximately 20,000 infants who received newborn care at a public hospital were included in an analysis that examined patterns in newborn risk factors. Analyses revealed five distinct groups of infants, with each group having a unique newborn profile. Overall, the five groups appeared to represent newborns who 1) were healthy, 2) experienced hypoxia (lack of oxygen), 3) were critically ill, 4) were minorly ill, and 5) experienced a complicated delivery. Differences in neurodevelopment were examined by group, and newborns in the critically ill, minorly ill, and complicated delivery groups were found to perform worse on neurodevelopmental tasks early in life. Notably, the complicated delivery group was mostly born at term and normal birth weight, and therefore is a group of infants largely ignored in previous research on neurodevelopment.
The current study extended the understanding of risk factors for neurodevelopment by including several medical conditions of newborns that are often over-looked, and by examining risk factors simultaneously. Future work should continue to examine risk factors, such as maternal health during pregnancy and medical interventions for newborns, in relation to newborn risks and neurodevelopment.
- Academic Unit
- Psychological and Brain Sciences
- Record Identifier
- 9984124270302771
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