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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\u2010I), has demonstrated utility in the risk stratification of substance\u2010exposed infants but has not been previously used to assess infants with PAE. The purpose of this study was to assess the utility of NNNS\u2010I in the identification of infants with low\u2010to\u2010moderate PAE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH\u20102) 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\u2010I 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\u2010PAE groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This analysis included 130 caregiver\u2010infant dyads (71 with PAE and 59 with no\u2010PAE). The absolute alcohol ounces per day in the PAE group were 0.08\u2009\u00b1\u20090.11, on average, or ~1.1 standard drinks per week. In multivariable analysis, PAE was associated with lower <jats:italic>attention<\/jats:italic> (<jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u22120.79) and higher <jats:italic>lethargy<\/jats:italic> (<jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u22120.86) scores (<jats:italic>p<\/jats:italic>'s\u2009&lt;\u20090.05) on NNNS\u2010I after controlling for maternal mental health, marijuana use during pregnancy, and family income. LPA identified three profiles of neurobehavior, with a high\u2010risk profile demonstrating poor infant self\u2010regulation and decreased <jats:italic>attention<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Low\u2010to\u2010moderate PAE was associated with neurobehavioral findings identifiable on the NNNS\u2010I assessment, highlighting its potential utility for screening and risk stratification of infants with PAE shortly after birth.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.70013","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T10:01:39Z","timestamp":1743328899000},"page":"818-828","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Abnormal neurobehavior profiles observed in the newborn period following low\u2010to\u2010moderate prenatal alcohol exposure"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8990-7239","authenticated-orcid":false,"given":"Jessie R.","family":"Maxwell","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of New Mexico  Albuquerque New Mexico USA"},{"name":"Department of Neurosciences University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa H.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Substance Use Research and Education (SURE) Center, College of Pharmacy University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Lowe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingya","family":"Ma","sequence":"additional","affiliation":[{"name":"Substance Use Research and Education (SURE) Center, College of Pharmacy University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian F.","family":"Kotulski","sequence":"additional","affiliation":[{"name":"Substance Use Research and Education (SURE) Center, College of Pharmacy University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Salisbury","sequence":"additional","affiliation":[{"name":"School of Nursing Virginia Commonwealth University  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9877-0211","authenticated-orcid":false,"given":"Ludmila","family":"Bakhireva","sequence":"additional","affiliation":[{"name":"Substance Use Research and Education (SURE) Center, College of Pharmacy University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"5","article-title":"CDC's \u201clearn the signs. 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