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A Model of Neurodevelopmental Risk and Protection for Preterm Infants

Pickler, Rita H. PhD; McGrath, Jacqueline M. PhD; Reyna, Barbara A. MS; McCain, Nancy PhD; Lewis, Mary BS; Cone, Sharon MS; Wetzel, Paul PhD; Best, Al PhD

doi: 10.1097/ANC.0000000000000022
Original Articles

The purpose of this article is to introduce a model of neurodevelopmental risk and protection that may explain some of the relationships among biobehavioral risks, environmental risks, and caregiving behaviors that potentially contribute to neurobehavioral and cognitive outcomes. Infants born before 30 weeks of gestation have the poorest developmental prognosis of all infants. These infants have lengthy hospitalization periods in the neonatal intensive care unit (NICU,) an environment that is not always supportive of brain development and long-term developmental needs. The model supports the premise that interventions focused on neuroprotection during the neonatal period have the potential to positively affect long-term developmental outcomes for vulnerable very preterm infants. Finding ways to better understand the complex relationships among NICU-based interventions and long-term outcomes are important to guiding caregiving practices in the NICU.

Department of Family and Community Health Nursing, School of Nursing (Drs Pickler and McGrath), VCU Health System (Mss Reyna, Lewis, and Cone), Department of Adult Health and Nursing Systems, School of Nursing (Dr McCain), Department of Biostatics, School of Medicine (Dr Best), Department of Biomedical Engineering, School of Engineering (Dr Wetzel), and Virginia Commonwealth University (Drs Pickler, McGrath, McCain, Wetzel, and Best), Richmond, Virginia.

Corresponding Author: Rita H. Pickler, PhD, RN, PNP-BC, FAAN, VCU School of Nursing, Box 980567, 1100 E Leigh St, Richmond, VA 23298 (

This work was supported in part by grants R01 NR00512 (R.H.P., PI), R15 NR09235 (J.M.M., PI), and P20 NR008988 (N.M., PI).

Reprinted with permission from Journal of Perinatal & Neonatal Nursing 2010;24(4):356–365.

Received June 28, 2010

Accepted September 06, 2010

© 2013 by The National Association of Neonatal Nurses