Babette Steigelmann , Nienke H. Van Dokkum , Arend F. Bos , Elisabeth M.W. Kooi , Kirsten R. Heineman
{"title":"Crying behavior and emotional-behavioral outcomes in high-risk very preterm infants: A prospective cohort study","authors":"Babette Steigelmann , Nienke H. Van Dokkum , Arend F. Bos , Elisabeth M.W. Kooi , Kirsten R. Heineman","doi":"10.1016/j.earlhumdev.2025.106326","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Regulatory problems (RPs), including excessive crying (EC), sleeping, and feeding difficulties, affect 5–20 % of infants. Their association with later behavioral and emotional problems remains unclear, particularly in preterm populations at elevated neurodevelopmental risk.</div></div><div><h3>Methods</h3><div>This prospective observational study included 329 high-risk very preterm infants (gestational age <30 weeks and/or birthweight <1000 g). Parental reports of crying behavior (hours/day) were collected at three and six months corrected age. Emotional and behavioral outcomes were assessed using the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) at 12 months and the Child Behavior Checklist (CBCL) at 24 months. Univariable and multivariable linear regressions were conducted, correcting for perinatal risk factors and maternal trait anxiety.</div></div><div><h3>Results</h3><div>Among 329 infants (56 % male; mean gestational age 28 weeks), 42 (13 %) exhibited EC (≥3 h/day) at three months of age. Crying behavior was associated with higher BITSEA problem scores in univariable analysis (<em>β</em> = 0.187, <em>p</em> = 0.009), but not in multivariable analysis (<em>β</em> = 0.157, <em>p</em> = 0.215). No significant associations were observed between crying behavior and CBCL internalizing or externalizing scores in univariable (<em>β</em> = 0.066, <em>p</em> = 0.459; <em>β</em> = 0.038, <em>p</em> = 0.672) or multivariable analysis (<em>β</em> = 0.301, <em>p</em> = 0.052; <em>β</em> = 0.202, <em>p</em> = 0.222). Maternal trait anxiety was significantly associated with higher BITSEA problem scores (<em>β</em> = 0.353, <em>p</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>In very preterm infants, crying behavior was not associated with emotional or behavioral problems, offering reassurance to families. Further studies should explore its influence on other developmental domains.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"208 ","pages":"Article 106326"},"PeriodicalIF":2.2000,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Early human development","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0378378225001367","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose
Regulatory problems (RPs), including excessive crying (EC), sleeping, and feeding difficulties, affect 5–20 % of infants. Their association with later behavioral and emotional problems remains unclear, particularly in preterm populations at elevated neurodevelopmental risk.
Methods
This prospective observational study included 329 high-risk very preterm infants (gestational age <30 weeks and/or birthweight <1000 g). Parental reports of crying behavior (hours/day) were collected at three and six months corrected age. Emotional and behavioral outcomes were assessed using the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) at 12 months and the Child Behavior Checklist (CBCL) at 24 months. Univariable and multivariable linear regressions were conducted, correcting for perinatal risk factors and maternal trait anxiety.
Results
Among 329 infants (56 % male; mean gestational age 28 weeks), 42 (13 %) exhibited EC (≥3 h/day) at three months of age. Crying behavior was associated with higher BITSEA problem scores in univariable analysis (β = 0.187, p = 0.009), but not in multivariable analysis (β = 0.157, p = 0.215). No significant associations were observed between crying behavior and CBCL internalizing or externalizing scores in univariable (β = 0.066, p = 0.459; β = 0.038, p = 0.672) or multivariable analysis (β = 0.301, p = 0.052; β = 0.202, p = 0.222). Maternal trait anxiety was significantly associated with higher BITSEA problem scores (β = 0.353, p = 0.006).
Conclusion
In very preterm infants, crying behavior was not associated with emotional or behavioral problems, offering reassurance to families. Further studies should explore its influence on other developmental domains.
期刊介绍:
Established as an authoritative, highly cited voice on early human development, Early Human Development provides a unique opportunity for researchers and clinicians to bridge the communication gap between disciplines. Creating a forum for the productive exchange of ideas concerning early human growth and development, the journal publishes original research and clinical papers with particular emphasis on the continuum between fetal life and the perinatal period; aspects of postnatal growth influenced by early events; and the safeguarding of the quality of human survival.
The first comprehensive and interdisciplinary journal in this area of growing importance, Early Human Development offers pertinent contributions to the following subject areas:
Fetology; perinatology; pediatrics; growth and development; obstetrics; reproduction and fertility; epidemiology; behavioural sciences; nutrition and metabolism; teratology; neurology; brain biology; developmental psychology and screening.