Crying behavior and emotional-behavioral outcomes in high-risk very preterm infants: A prospective cohort study

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.