Maxwell Jessie R, Roberts Melissa H, Lowe Jean, Ma Xingya, Kotulski Jillian F, Salisbury Amy L, Bakhireva Ludmila
Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, USA.
Department of Neurosciences, University of New Mexico, Albuquerque, New Mexico, USA.
Alcohol Clin Exp Res (Hoboken). 2025 Apr;49(4):818-828. doi: 10.1111/acer.70013. Epub 2025 Mar 27.
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.
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.
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.
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.
产前酒精暴露（PAE）会对受影响个体产生终身影响，导致一系列身体、神经发育、学习和行为方面的不良后果。目前尚无方法在出生后不久识别有这些后果风险的儿童，从而导致诊断延迟和无法获得治疗方式。新生儿重症监护病房（NICU）网络神经行为量表第一版（NNNS-I）已证明在对接触物质的婴儿进行风险分层方面具有实用性，但此前尚未用于评估PAE婴儿。本研究的目的是评估NNNS-I在识别低至中度PAE婴儿方面的实用性。
乙醇、神经发育、婴儿和儿童健康（ENRICH-2）前瞻性队列研究包括孕期第二和第三个月的母亲评估以及出生时的婴儿评估。通过前瞻性、重复的时间线追溯访谈和一组全面的乙醇生物标志物评估PAE。在出生住院期间，经过认证的检查人员完成了NNNS-I评估，其中包括总结为12个汇总分数的婴儿神经行为组织。通过潜在类别分析（LPA）生成的汇总分数和概况在PAE组和无PAE组之间进行了比较。
该分析纳入了130对照顾者-婴儿二元组（71对有PAE，59对无PAE）。PAE组平均每天的酒精摄入量为0.08±0.11盎司，即每周约1.1标准杯。在多变量分析中，在控制了母亲心理健康、孕期大麻使用和家庭收入后，PAE与NNNS-I上较低的注意力（β=-0.79）和较高的嗜睡（β=-0.86）分数相关（p值<0.05）。LPA识别出三种神经行为概况，其中高风险概况显示婴儿自我调节能力差且注意力下降。
低至中度PAE与NNNS-I评估中可识别的神经行为结果相关，突出了其在出生后不久对PAE婴儿进行筛查和风险分层的潜在实用性。
