Abstract
BACKGROUND: Prenatal alcohol exposure (PAE) has lifelong consequences on affected individuals, with a range of physical, neurodevelopmental, learning, and behavioral adverse outcomes. There is no method to identify children at risk of these outcomes shortly after birth, resulting in delayed diagnosis and access to therapeutic modalities. The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale, First Edition (NNNS-I), has demonstrated utility in the risk stratification of substance-exposed infants but has not been previously used to assess infants with PAE. The purpose of this study was to assess the utility of NNNS-I in the identification of infants with low-to-moderate PAE. METHODS: The Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH-2) prospective cohort included maternal assessments in the second and third trimesters of pregnancy and infant assessments at birth. PAE was evaluated by prospective, repeated Timeline Follow Back interviews and a comprehensive panel of ethanol biomarkers. During the birth hospitalization, certified examiners completed the NNNS-I assessment, which included infant neurobehavioral organization summarized into 12 summary scores. Summary scores and profiles, generated by latent profile analysis (LPA), were compared between PAE and no-PAE groups. RESULTS: This analysis included 130 caregiver-infant dyads (71 with PAE and 59 with no-PAE). The absolute alcohol ounces per day in the PAE group were 0.08 ± 0.11, on average, or ~1.1 standard drinks per week. In multivariable analysis, PAE was associated with lower attention (β = -0.79) and higher lethargy (β = -0.86) scores (p's < 0.05) on NNNS-I after controlling for maternal mental health, marijuana use during pregnancy, and family income. LPA identified three profiles of neurobehavior, with a high-risk profile demonstrating poor infant self-regulation and decreased attention. CONCLUSION: Low-to-moderate PAE was associated with neurobehavioral findings identifiable on the NNNS-I assessment, highlighting its potential utility for screening and risk stratification of infants with PAE shortly after birth.