PURPOSE: The purpose of this study was to examine the neurobehavioral organization of infants with intraventricular hemorrhage (IVH) Grades III and IV (IVH III–IV).

RATIONALE: Advances in perinatal and neonatal care have resulted in an increased rate of survival and associated disabilities, which in turn has led to efforts to accurately predict and improve the developmental outcome of high-risk preterm infants. Early diagnosis of developmental disability is important for identifying children who could benefit from treatment, so as to take advantage of early brain plasticity. The integrity of central nervous system function is a theoretical construct that cannot be observed directly, instead relying on observation of infant behavior and response to stimuli.

DESIGN: A repeated-measures descriptive study was performed.

METHOD: Ten infants with IVH III and IV, diagnosed by neonatal head ultrasound, were recruited and tested using the Assessment of Preterm Infants’ Behavior (APIB) at 36 and 40 wk postmenstrual age (PMA) to determine the effects of IVH on neurobehavioral functioning and maturation over time. APIB evaluations provide screening for neurological abnormalities, assessing newborns in their current strengths, vulnerabilities, prognosis, and recommendations for care.

ANALYSIS: Descriptive analysis revealed that APIB subsystems’ scores (i.e., autonomic, motor organizational, state, attention–interaction, self-regulation, and examiner facilitation) were mostly in the mid- to high range, indicating easily disorganized and poorly modulated behavioral regulation and very low threshold of disorganization and stress, at both ages. Paired T tests revealed that there was measurable maturation that correlated with the infants’ increasing PMA, with the younger and more fragile infants presenting poor motor behavior and needing more examiner facilitation for behavioral regulation. At both ages, the infants’ results were also compared with those of infants without reported IVH in the literature through independent T tests: Infants with IVH had significantly poorer neurobehavioral regulation than non-IVH infants at both ages.

CONCLUSION: Infants with IVH need more support from caregivers for optimal functioning, endorsing occupational therapists’ role in the neonatal intensive care unit environment: working with the infants, educating staff, and providing anticipatory guidance to parents to facilitate infants’ neurobehavioral regulation through contingent interactions. Intervention can ultimately facilitate the transition home and promote infants’ participation in family and community life. Absence of therapeutic intervention might further increase the behavioral disorganization, which could be developmentally costly.

IMPACT STATEMENT: This study allows better understanding of behavioral organization of infants with IVH and their clinical implications, allowing the development of specific interventions approaches to protect and foster brain development and enhance occupational performance early on.