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Characterizing Early State Regulation in Preterm Infants

Litt, Jonathan S., MD, MPH, ScD*; Ho, Timmy, MD, MPH*; Obregon, Evelyn, MD*; Patel, Palak, BA*; Ziyeh, Tiglath, BA*; McCormick, Marie C., MD, ScD*,†

Journal of Developmental & Behavioral Pediatrics: May 2019 - Volume 40 - Issue 4 - p 293–300
doi: 10.1097/DBP.0000000000000659
Original Article

Objectives: To characterize state regulation and behavior of preterm infants after discharge from the neonatal intensive care unit (NICU).

Methods: We recruited singleton infants born at ≤35 weeks of gestational age (GA) before NICU discharge. Parents completed surveys at discharge and 1, 3, and 6 months after discharge. Infant medical history was gleaned from the medical record. Surveys captured sociodemographic information and measures of infant state regulation (Baby Pediatric Symptom Checklist [BPSC]) and feeding behaviors. We calculated the median BPSC subscale scores at each time point and the proportion of infants with scores in the problem range (≥3/5). We explored longitudinal and cross-sectional correlates of BPSC scores.

Results: Fifty families completed the discharge questionnaire, and 42 (84%) completed the 6-month questionnaire. The median GA at birth was 34 weeks (IQR 30.1, 34.4 weeks); the median birth weight was 1930 g (IQR 1460, 2255 g). The median scores were above population norms for irritability and difficulty with routines. Twenty-one infants (40%) had irritability subscale scores in the problem range at 1 month, and 20 (38%) had problem scores on difficulties with routines. Only 9 infants (17%) had problem scores on the inflexibility subscale. Scores in all 3 domains showed different patterns from population norms from 1 to 6 months. BPSC scores were correlated with infant feeding behaviors at 1, 3, and 6 months.

Conclusion: Scores for irritability and difficulty with routines among preterm infants were high compared with population norms and differed from normative values through 6 months after discharge. Preterm infants demonstrate problems with state regulation after NICU discharge that may require directed intervention.

*Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA;

Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA.

Address for reprints: Jonathan S. Litt, MD, MPH, ScD, Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rose 3, Boston, MA 02215; e-mail:

Disclosure: The authors declare no conflict of interest.

Received May 01, 2018

Accepted December 26, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.