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Home Environment, Brain Injury, & School Performance in LBW Survivors

Mahoney, Ashley Darcy PhD, RN, NNP-BC; Pinto-Martin, Jennifer PhD, MPH; Hanlon, Alexandra PhD

MCN: The American Journal of Maternal/Child Nursing: January/February 2014 - Volume 39 - Issue 1 - p 18–25
doi: 10.1097/01.NMC.0000437535.99514.95

Background: There has been substantial research on low birthweight (LBW) as a predictor of adverse educational and cognitive outcomes. LBW infants perform worse on cognitive battery tests compared to children born at normal birthweight; however, children exposed to similar risks do not all share the same experiences. The complex, interrelated factors responsible for poor cognitive and achievement performance vary for different populations, but researchers hypothesize that the home environment may influence the infants' long-term health outcomes.

Purpose: Examine the home environment as a moderator in the causal pathway from neonatal brain injury to school performance in a secondary analysis of a prospectively studied, geographically defined cohort from the Neonatal Brain Hemorrhage Study.

Method: The secondary analysis sample included 543 infants with birthweights of 501 to 2,000 g who were born consecutively in three community hospitals in New Jersey between 1984 and 1986. School performance at age 9 was measured by the Woodcock–Johnson Tests of Achievement. The home environment variables were tested and analyzed using multistep hierarchical regression modeling.

Results: A moderating effect between the variable neighborhood observations and brain injury was demonstrated for the outcome math score. The moderating relationship was found in the category of children without brain injury (β = 1.76, p = .005).

Conclusion: There were statistically significant and potentially clinical meaningful models when looking at the home environmental variables as they relate to reading and math scores. The findings suggest that at least one variable within a LBW child's socio-environmental milieu can moderate the effects of perinatal brain injury on school performance outcomes.

We send the LBW babies home, and then what happens?

Ashley Darcy Mahoney, PhD, NNP-BC, is an Assistant Professor, Neonatal Nurse Practitioner, Emory University, Nell Hodgson Woodruff School of Nursing, South Dade Neonatology, Atlanta, GA. She can be reached via email at

Jennifer A Pinto-Martin, PhD, MPH, Viola MacInnes/Independence Professor of Nursing, Chair, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA.

Alexandra L Hanlon, PhD is a Research Associate Professor of Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.