Preterm Infant Behavior Research Articles

Assessment of Preterm Infant's Behavior: Insights and projections for the future

Assessment of Preterm Infant's Behavior: Insights and projections for the future

Competency based performance of mothers on preterm neonatal care through Neonatal Integrative Developmental Care (NIDC) interventions: An interventional pilot project

BackgroundFamily-centered care and developmentally supportive care are the current norms in Neonatal Intensive Care Units (NICU). In this study, interventions are derived from the seven core measures of the Neonatal integrative developmental care (NIDC) model designed by Altimier and Phillips (2016) which strive towards protection of premature brains while in the NICU. This study involved mothers in the care of their preterm neonates. Neonatal outcomes and competency levels in the care delivered by the mothers when handling their preterm infants were observed. Materials and methodsA quasi experimental time series design study with repeated interventions was undertaken. The pilot study was conducted among 60 mothers with 30 in the interventional group and 30 in the control group at two private hospitals, Mangaluru, Karnataka, India. The tool consisted of a baseline proforma, competency based performance rating scale, biophysiological parameters checklist, preterm infant behavior scale by D'Souza et al. (2014) and Preterm Infant Breastfeeding Behavior Scale by Nyqvist et al. (1999) validated by 10 experts. Purposive sampling technique was used to select the samples. ResultsThe findings of the study showed that the competencies delivered by mothers in the interventional group were statistically significant (p = 0.000). Neonatal biophysiological parameters improved in terms of oxygen saturation (p = 0.007) and respiratory rate (p = 0.002) in the experimental group, and weight gain (p = 0.001) was noted in both the groups respectively. Preterm infant behavior (p = 0.001) and PIBBS scores (p = 0.001) also improved in both groups simultaneously with no significant difference in behavioral states but the PIBBS scores were significantly better in the interventional group (p = 0.001). ConclusionsOur study findings revealed the need for supportive care interventions that can be performed through simple measures, such as helping mothers and care-givers become a part of their neonate's life by participating in their care while in the NICU.

Day II: Friday, March 24, 2023; 9.00 AM Plumeria 3: Physiotherapy in Pediatric/ Neonatal conditions: AB No: 75 Sit Down and Play Intervention on Neuromotor Outcome and Parenting Behavior in Preterm Low Birth Weight Infants- Randomized Controlled Trial

Day II: Friday, March 24, 2023; 9.00 AM Plumeria 3: Physiotherapy in Pediatric/ Neonatal conditions: AB No: 75 Sit Down and Play Intervention on Neuromotor Outcome and Parenting Behavior in Preterm Low Birth Weight Infants- Randomized Controlled Trial

The effect of breast milk temperature on feeding intolerance in tube-fed preterm infants: A randomized controlled study

AimThe aim of this study was to evaluate different methods of warming breastmilk in tube-fed preterm infants hospitalized in the neonatal intensive care unit. MethodThis was a parallel, prospective and randomized-controlled study. The study sample comprised 48 preterm infants aged 30–34 weeks, including 24 infants in each group. The effects of two different methods of warming breastmilk on the variables related to feeding behavior, discharge time, and weight gain in tube-fed preterm infants were compared. ResultsThere were statistically significant differences between the groups regarding the infants' discharge days and gastric residuals (p < 0.05). The logistic regression analysis found significant relationships between the method of warming breastmilk and the infants' discharge times and gastric residual frequencies. The infants who were given conventionally warmed milk were found 2.4 times as likely to have a gastric residual as those given device-warmed milk (Exp(B)/OR = 2.405, CI = 1.66–2.98). ConclusionIt was determined that the infants in the interventional group had lower rates of gastric residual and were discharged more quickly. Therefore, it is necessary and beneficial to warm breast milk to a specific temperature.

Behavior of weight z-score in preterm infants who are small for gestational age.

Introduction: the follow-up of small for gestational age (SGA) preterm infants is critical due to their differentiated postnatal growth pattern. Objective: to investigate the weight z-score behavior in SGA preterm infants during a four-week stay in a Neonatal Intensive Care Unit. Methods: a retrospective longitudinal study with data from nutritional anamneses of 190 preterm infants admitted to a Neonatal Intensive Care Unit between January/2017 and December/2019, classified according to nutritional status at birth as either SGA or appropriate for gestational age (AGA). Linear regression was used to verify association between weight z-score with gestational age, birth weight, initiation of enteral nutrition and relative amount of energy and protein administered. Results: SGA preterm infants accounted for 23 % of the study participants. In SGA, the difference in weight score was observed at week 1 when compared to admission (p < 0.05), while in AGA there was a difference sustained during the whole period (p < 0.05). In SGA, the linear regression analysis showed that the change in z-score was explained by time to start of enteral nutrition (p = 0.033), gestational age (p = 0.003) and birth weight (p = 0.001). In AGA the change was explained by gestational age (p = 0.000) and birth weight (p = 0.000). Conclusion: the weight z-score behavior in preterm infants was downward compared to admission, stable at the end of 4 weeks, and different according to nutritional status at birth. In the AGA group the decline in nutritional status was not recovered throughout hospitalization and in the SGA group the unfavorable nutritional status was maintained.

Comparison of the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants: a randomized clinical trial

BackgroundOral feeding problems will cause long-term hospitalization of the infant and increase the cost of hospitalization. This study aimed to compare the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants.MethodsThis single-blind randomized controlled clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. 150 preterm infants with the gestational age of 31 to 33 weeks were selected and were divided into three groups of 50 samples using randomized block method, including non-nutritive sucking on mother’s finger (A), pacifier (B) and control (C). Infants in groups A and B were stimulated with mother’s finger or pacifier three times a day for five minutes before gavage, for ten days exactly. For data collection, demographic characteristics questionnaire and preterm infant breastfeeding behavior scale were used.ResultsThe mean score of breastfeeding behavior in preterm infants in the three groups of A,B,C was 12.34 ± 3.37, 11.00 ± 3.55, 10.40 ± 4.29 respectively, which had a significant difference between the three groups (p = 0.03). The mean rooting score between three groups of A, B, and C was 1.76 ± 0.47, 1.64 ± 0.48, and 1.40 ± 0.90 (p < 0.001) respectively. Also, the mean sucking score in groups of A, B and C was 2.52 ± 0.76, 2.28 ± 0.64 and 2.02 ± 0.74 respectively, which had a significant difference (p = 0.003), but other scales had no significant difference between the three groups (P > 0.05). The mean time to achieve independent oral feeding between the three groups of A, B, C was 22.12 ± 8.15, 22.54 ± 7.54 and 25.86 ± 7.93 days respectively (p = 0.03), and duration of hospitalization was 25.98 ± 6.78, 27.28 ± 6.20, and 29.36 ± 5.97 days (p = 0.02), which had a significant difference. But there was no significant difference between the two groups of A and B in terms of rooting, sucking, the total score of breastfeeding behavior and time of achieving independent oral feeding (P > 0.05).ConclusionConsidering the positive effect of these two methods, especially non-nutritive sucking on mother’s finger, on increasing oral feeding behaviors, it is recommended to implement these low-cost methods for preterm infants admitted to neonatal intensive care unit.Trial RegistrationTrial Registration: IRCT, IRCT20191116045460N1. Registered 11 January 2020- prospective registered.

Effect of Contingency Paradigm-Based Interventions on Developmental Outcomes in Young Infants: A Systematic Review.

The purpose of this systematic review was to identify controlled trials evaluating the efficacy of contingency paradigm-based interventions to improve feeding, motor, or cognitive outcomes during the first year of life. Seventeen studies, including 10 randomized controlled trials, incorporating contingency paradigm-based interventions were identified. Three of 3 trials reported improvements in nutritive sucking using pacifier-activated lullaby in preterm infants before term age. Seven of 12 trials reported improvements in reaching, manual exploration, and kicking behaviors in term and preterm infants; and 6 of 10 trials reported gains in early cognition using sticky mittens and contingent toys. Contingency paradigm-based interventions can improve feeding outcomes in the neonatal intensive care unit in very preterm infants, and increase reaching, and perceptual-cognitive behaviors in term infants. Future research is needed to establish contingency paradigms as an effective early intervention strategy. This review synthesizes a body of literature on contingency paradigm-based interventions and highlights its potential paradigm-based interventions to improve developmental outcomes in infants.

Comparison of Feeding Behaviors in Term and Preterm Infants at Six Months Corrected Age

Background and Objectives: This study compares feeding behaviors and problems of in term Infants and preterm infants at 6 months corrected age. Subjects and Methods The study was of observational-sectional type (descriptive and analytic) and sampling was one-step cluster probability of the available population in the form of the whole number. Feeding behaviors of 90 infants, including 60 term infants and 30 preterm infants, were assessed by speech and language pathologists through interviews with parents and recorded in a questionnaire. The information in this questionnaire includes feeding behaviors, feeding problems, feeding period, infant weight at 2, 4, 6 months and the age of the child to start complementary feeding, SPSS software version 24 was used to analyze the data. In all the present study, P-value less than 5% was considered as a significant level. Results The results showed that the two groups were significantly different in the mean score of feeding behavior (P= 0.001), feeding problems (P= 0.047) and weight gain (P&lt;0.001). While in feeding duration (P= 0.53) and Frequency of feeding (P= 0.1) there was no significant difference. Of the 90 infants studied, more than 80% of them started feeding in the form of puree in the age group of 4-6 months. Conclusion Premature infants have more feeding problems and less weight gain than normal infants. It is recommended that the speech and language pathologist evaluate and intervene appropriately for oral skills and nutrition of premature infants admitted to the neonatal intensive care unit.

Comparing the effects of education through compact disk and social media on knowledge and practice regarding the assessment of preterm infant behavior among nurses in neonatal intensive care units

Background: Nurses in neonatal intensive care units (NICUs) need adequate professional knowledge and skills for providing quality developmental care to premature newborns. Objectives: This study aimed to compare the effects of education through compact disk (CD) and social media (SM) on knowledge and practice regarding the assessment of preterm infant behavior (APIB) among nurses in NICUs. Methods: This quasi-experimental study was conducted on fifty NICU nurses. They were randomly allocated to a CD and a SM group. The intervention for both the groups was the same and consisted of education about APIB. Participants' APIB-related knowledge and practice were assessed before and after the intervention using a researcher-made knowledge questionnaire and the APIB checklist, respectively. Data were analyzed through the Chi-square, the independent-samples t, and the paired-samples t-tests as well as the analysis of covariance. Results: The pretest mean scores of knowledge and practice were, respectively, 9.72 ± 4.95 and 207.64 ± 109.49 in the SM group and 9.16 ± 5.94 and 209.88 ± 110.46 in the CD group. After the study intervention, these values significantly increased to 14.80 ± 1.80 and 361.96 ± 38.24 in the SM group (P 0.05), the posttest mean scores of knowledge and practice in the SM group were significantly greater than the CD group (P < 0.05). Conclusion: SM-based education is more effective than CD-based education in improving APIB-related knowledge and practice among NICU nurses.

Effect of Nesting on Extensor Motor Behaviors in Preterm Infants: A Randomized Clinical Trial

Background: The aim of this study was to investigate the effect of bedding preterm infants in nests on their motor behaviors in a neonatal intensive care unit (NICU) in Iran.Methods: In this randomized controlled trial, 44 clinically stable preterm infants, admitted to the NICU, were recruited and randomly divided into two groups of control and intervention. The routine of the unit was to take care of infants on a flat mattress. The intervention was a U-shaped cloth nest in which the intervention group was bedded for 7 days. The control group consisted of infants who were normally cared without any boundaries. All infants were videotaped before and on the last day of the intervention. The motor behaviors, as defined in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) sheet, were analyzed in each of the films.Results: To compare the number of total extensor motor behaviors between the two groups, the change score in each group was calculated and compared between the two groups. The mean change scores in the intervention and control groups were -21.36±13.5 and 2.32±7.9, respectively. Accordingly, nesting significantly reduced the occurrence of unstable behaviors in the intervention group, compared to that in the control group (P<0.001).Conclusion: According to the findings, supporting the preterm infant body even by accessible materials could enhance their neurodevelopmental strengths and motor behavior stabilities.

Live Maternal Speech and Singing Increase Self-Touch and Eye-Opening in Preterm Newborns: A Preliminary Study

Although evidence is available about preterm newborns’ spontaneous behavioral repertoire during the first weeks of life in the neonatal intensive care unit (NICU), studies on infant behavioral responses to external social stimuli are scarce. The main aim of this study was to analyze preterm infant behaviors in response to the maternal voice, speaking or singing, in the NICU, compared with a control condition when the mother was not present. We hypothesized that the infants’ self-touch, eye-opening, and oral behaviors would increase in the singing and speaking conditions. The neonates’ behavior was video recorded and then coded by using the System for Coding Perinatal Behavior. Preterm newborns showed increased self-touch and eye-opening behaviors during maternal-directed speech and songs in the NICU. Oral movements were modulated differently by the singing and speaking conditions: the singing condition was specifically associated with infants’ rhythmical sucking behaviors and smiles, whereas maternal speech was associated with non-rhythmical mouth movements. In both speaking and singing conditions, yawning occurred more frequently than in the control condition. The findings of this pilot study suggest that preterm newborns from 32 weeks’ postmenstrual age respond to social and contingent stimuli with a general activation of self-touch and eye-opening behaviors. However, they respond to live maternal speech versus songs by showing different oral behaviors. The differential responses and clinical implications of the findings are discussed.

AN ASSESSMENT OF KANGAROO MOTHER CARE FOR PRETERM LOW-BIRTHWEIGHT INFANTS: A CROSS-SECTIONAL STUDY IN VIETNAM

Introduction: In Vietnam, kangaroo mother care (KMC) has been applied to preterm low-birthweight infants as far back as the late of 1990s. Despite the effectiveness of KMC at promoting mothers’ health and infants’ development, there have been no previous studies on this method conducted in Vietnam. The objective of this study is to assess the effect of KMC intervention upon the physical heath and breastfeeding behavior of preterm infants of low birthweight. Method: This is a cross-sectional study conducted at Tu Du Hospital in Ho Chi Minh City. A total sampling method was applied to enroll all preterm cases from July 2017 to July 2018 that met the criteria. The KMC interventions were divided into three groups: early, medium, and late KMC. Weight, height and head circumference were measured immediately after delivery and at the age of 40 weeks. Microsoft Excel and SPSS were used for descriptive statistics, t-tests, and chi-square tests. Result: Infants subjected to early KMC gained more weight, height, and head circumference compared to those subjected to medium or late intervention. Early KMC also promoted a higher percentage of breastfeeding and a lower percentage of rehospitalization at the age of 40 weeks. Conclusion: KMC is an effective intervention for preterm low-birthweight infants that should be more considered for the future healthcare.

Online Video-based Supplement for Assessment of Preterm Infant Behavior (APIB) and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Education

In response to repeated requests for enhanced educational mate-rials for NIDCAP and APIB training, NIDCAP Federation In-ternational (NFI) members were asked in October 2016 to share photos and videos for the creation of a photographic library.

Innate immunity ascertained from blood and tracheal aspirates of preterm newborn provides new clues for assessing bronchopulmonary dysplasia.

AimThe study aimed to establish how granulocytes, monocytes and macrophages contribute to the development of bronchopulmonary dysplasia (BPD).Materials and methodsStudy A: samples of blood and tracheal aspirates (TAs) collected from preterm newborn infants during the first 3 days of life were investigated by flow cytometry, and testing for white blood cells (WBCs), neutrophils and neutrophil extracellular traps (NETs). Maternal blood samples were also collected. Study B: data from previously-tested samples of TAs collected from preterm newborn infants were re-analyzed in the light of the findings in the new cohort.ResultsStudy A: 39 preterm newborn infants were studied. A moderate correlation emerged between maternal WBCs and neutrophils and those of their newborn in the first 3 days of life. WBCs and neutrophils correlated in the newborn during the first 8 days of life. Decision rules based on birth weight (BW) and gestational age (GA) can be used to predict bronchopulmonary dysplasia (BPD). Neutrophil levels were lower in the TAs from the newborn with the lowest GAs and BWs. Study B: after removing the effect of GA on BPD development, previously-tested newborn were matched by GA. Monocyte phenotype 1 (Mon1) levels were lower in the blood of newborn with BPD, associated with a higher ratio of Monocyte phenotype 3 (Mon3) to Mon1. Newborn infants from mothers with histological chorioamnionitis (HCA) had lower levels of classically-activated macrophages (M1) and higher levels of alternatively-activated macrophages (M2) in their TAs than newborn infants from healthy mothers.ConclusionImmune cell behavior in preterm newborn infants was examined in detail. Surprisingly, neutrophil levels were lower in TAs from the newborn with the lowest GA and BW, and no correlation emerged between the neutrophil and NET levels in TAs and the other variables measured. Interestingly, monocyte phenotype seemed to influence the onset of BPD. The rise in the ratio of Mon 3 to Mon 1 could contribute to endothelial dysfunction in BPD.

Early Feeding Behaviors in Preterm Infants and Their Relationships to Neurobehavior

Abstract Date Presented 04/06/19 The findings of a recent study highlight the importance of a comprehensive approach to rehabilitation that considers oral motor and neurobehavioral alterations to address feeding challenges associated with premature birth. This presentation will reveal these results and help to elucidate relationships between early feeding skills and key neurobehavioral components. Understanding such relationships can lead to early identification of adverse outcomes and optimize outcomes for preterm infants. Primary Author and Speaker: Molly Grabill Additional Authors and Speakers: Kylie VanRoekel Contributing Authors: Roberta Pineda

Cardiorespiratory behavior of preterm infants receiving continuous positive airway pressure and high flow nasal cannula post extubation: randomized crossover study.

BackgroundNasal continuous positive airway pressure (NCPAP) and high flow nasal cannula (HFNC) are modes of non-invasive respiratory support commonly used after extubation in extremely preterm infants. However, the cardiorespiratory physiology of these infants on each mode is unknown.MethodsProspective, randomized crossover study in infants with birth weight ≤1250 g undergoing their first extubation attempt. NCPAP and HFNC were applied randomly for 45 min each, while ribcage and abdominal movements, electrocardiogram, oxygen saturation, and fraction of inspired oxygen (FiO2) were recorded. Respiratory signals were analyzed using an automated method, and differences between NCPAP and HFNC features and changes in FiO2 were analyzed.ResultsA total of 30 infants with median [interquartile range] gestational age of 27 weeks [25.7, 27.9] and birth weight of 930 g [780, 1090] were studied. Infants were extubated at 5 days [2, 13] of life with 973 g [880, 1170] and three failed (10%). No differences in cardiorespiratory behavior were noted, except for longer respiratory pauses (9.2 s [5.0, 11.5] vs. 7.3 s [4.6, 9.3]; p = 0.04) and higher FiO2 levels (p = 0.02) during HFNC compared to NCPAP.ConclusionsIn extremely preterm infants studied shortly after extubation, the use of HFNC was associated with longer respiratory pauses and higher FiO2 requirements.

Characterizing Early State Regulation in Preterm Infants.

To characterize state regulation and behavior of preterm infants after discharge from the neonatal intensive care unit (NICU). We recruited singleton infants born at ≤35 weeks of gestational age (GA) before NICU discharge. Parents completed surveys at discharge and 1, 3, and 6 months after discharge. Infant medical history was gleaned from the medical record. Surveys captured sociodemographic information and measures of infant state regulation (Baby Pediatric Symptom Checklist [BPSC]) and feeding behaviors. We calculated the median BPSC subscale scores at each time point and the proportion of infants with scores in the problem range (≥3/5). We explored longitudinal and cross-sectional correlates of BPSC scores. Fifty families completed the discharge questionnaire, and 42 (84%) completed the 6-month questionnaire. The median GA at birth was 34 weeks (IQR 30.1, 34.4 weeks); the median birth weight was 1930 g (IQR 1460, 2255 g). The median scores were above population norms for irritability and difficulty with routines. Twenty-one infants (40%) had irritability subscale scores in the problem range at 1 month, and 20 (38%) had problem scores on difficulties with routines. Only 9 infants (17%) had problem scores on the inflexibility subscale. Scores in all 3 domains showed different patterns from population norms from 1 to 6 months. BPSC scores were correlated with infant feeding behaviors at 1, 3, and 6 months. Scores for irritability and difficulty with routines among preterm infants were high compared with population norms and differed from normative values through 6 months after discharge. Preterm infants demonstrate problems with state regulation after NICU discharge that may require directed intervention.

Emotion Attribution in Nonverbal Vocal Communication Directed to Preterm Infants

The first weeks of life for preterm babies are critical for bonding and attachment. Early vocal contact, as a family based intervention, engages mothers to speak and to sing to their preterm infants in the incubators. This study tested the emotional and smiling content of the mother’s speaking and singing voice in a context of early contact with her newborn preterm infant in the neonatal intensive care unit (NICU), and it examines which acoustic parameters are associated with emotion attributed to the mother’s voice. The main hypothesis is that the emotional content of maternal speech and song, when directed to their preterm infants placed in incubators, is modulated by the infants’ behaviors. Thirty-two blocks of vocal extracts in the presence and absence of preterm infants’ displays and in the 5 s preceding each display were presented to 31 adult naive listeners who were asked to rate the degree of emotion and smile in the mother’s voice. The present results show that when infants open the eyes or smile, the maternal voice is perceived as more emotional and more smiling than it is in the absence of any facial display. This effect is particularly evident in the maternal speech. The maternal voice is rated as more smiling in the presence of the infant’s smile than when preterm infants opened the eyes. The main acoustical features of the infant-directed voice—mean pitch and perceived sound pressure level—are positively associated with smiling attribution while only the mean pitch is associated with emotional intensity. These findings extends prior evidences by showing that maternal ID speech and songs, even in at-risk conditions such as prematurity, are not only related to preterm infant behavior, but also bear emotional content. Early face-to-face interactions between mothers and preterm infants need to be encouraged in the NICU and investigated, especially neural correlates, to assess the impact of emotional infant-directed voices on preterm infants’ brain development.

Shifting of the body center of gravity in low-risk preterm infants: A video-pedoscope study

AimTo evaluate whether there is any developmental course of the shifting of the center of gravity (COG) in healthy preterm infants. MethodsEleven healthy preterm infants were assessed on a computerized pedoscope from early preterm to term age. Data from the pedoscope and the videorecorder were analyzed with a special software for the assessment of the COG shifting. Infants were placed on the pedoscope in supine position for 5 min. We scored the positions of the COG during its shifting, the body parts most frequently involved in its shifting and the shifting' amplitude at each epoch. We scored the frequency of the COG shifting in head, trunk and bottom, its direction and amplitude using a semi-quantitative scale. ResultsA developmental course of the COG shifting from preterm throughout post-term ages was demonstrated, with COG position displaced from head to bottom. The shifting amplitude decreased with increasing age. Lateral shifting were never observed. InterpretationThe developmental course of the COG shifting suggests the maturation of postural behaviour in healthy preterm infants. The displacement of the COG from head to bottom and the reduced amplitude of the COG shifting from preterm to post-term age indicates a more stable body position.

Triagem neurológica de recém-nascidos pré-termo com hemorragias peri e intraventriculares: estudo transversal observacional

Introdução: Recém-nascidos pré-termo (RNPT) com menos de 27 semanas de idade gestacional apresentam vulnerabilidade para o desenvolvimento de hemorragias peri e intraventriculares (HPIV), o que pode afetar a mielinização e organização do córtex cerebral, acarretando possíveis prejuízos ao desenvolvimento. Objetivo: Avaliar o comportamento neurológico de RNPT acometido por HPIV com e sem sepse segundo a versão resumida do Método Dubowitz, delimitar a presença de itens desviantes da avaliação e comparar com as respostas obtidas pelo grupo controle (sem HPIV). Métodos: Estudo transversal realizado no Hospital Municipal Universitário de São Bernardo do Campo (SP). Os RNPT foram divididos em três grupos, sendo dois estudos (HPIV e HPIV + sepse) e um controle. Os participantes foram avaliados com idade correspondente ao termo. A versão resumida do método, utilizada como triagem para recém-nascidos de risco neurológico é constituída por 12 itens. As análises foram realizadas segundo pontuações desviantes nestes itens e comparadas com as pontuações esperadas para a normalidade. Os dados obtidos foram comparados na pontuação resumida e na pontuação da versão íntegra. Resultados: A frequência de RNPT com pontuações atípicas foram: 40% no grupo HPIV + sepse, 10% no grupo HPIV e 15% no controle. Conclusão: A HPIV de forma isolada não parece ser um fator significante para presença de itens desviantes no Método Dubowitz resumido. A presença de HPIV em graus mais severos esteve associada à presença de sepse. Os RNPT com HPIV associada à sepse obtiveram pior desempenho neurológico.