Brazelton Neonatal Behavioral Assessment Scale Research Articles

Effect of antenatal micronutrient or antidepressant exposure on Brazelton neonatal behavioral assessment scale (NBAS) performance within one-month of birth

BackgroundAntenatal depression is a risk factor for poor infant outcomes. Broad-spectrum-micronutrients (vitamins and minerals) have shown efficacy in treating psychiatric symptoms in non-pregnant populations and are associated with reduced incidence of adverse birth outcomes, and improvements in neonatal development. We investigated the effects of treatment of antenatal depression with micronutrients above the Recommended Dietary Allowance on infant development compared to treatment with antidepressant medications and controls. MethodOne-hundred-and-three infants were assessed using the Brazelton Neonatal Behavioral Assessment Scale (NBAS) within 28 days of birth: 37 exposed to micronutrients in-utero (50–182 days exposure), 18 to antidepressants in-utero (exposure for full gestation), and 48 controls whose mothers received neither treatment nor experienced depressive symptoms. ResultsControlling for gestational age and parity, there were significant group differences on habituation, orientation, motor, state regulation, autonomic stability and reflexes (p < .05). Micronutrient-exposed performed better than antidepressant-exposed and controls on habituation, motor and autonomic stability (p < .05), effect sizes ranged 1.0–1.7 and 0.5–1.0, respectively. Antidepressant-exposed performed significantly worse on orientation and reflexes compared to micronutrient-exposed and controls. Micronutrient-exposed had significantly better state regulation compared to antidepressant-exposed. There was an association between micronutrient exposure length and better habituation (r = 0.41, p = .028). Micronutrient exposure was generally identified as a stronger predictor of neonatal performance over maternal depression, social adversity, gestational age and infant sex. ConclusionIn-utero micronutrient exposure appears to mitigate risks of depression on infant outcomes showing positive effects on infant behavior, on par with or better than typical pregnancies and superior to antidepressants. Limitations include differential exposure to micronutrients/antidepressants and lack of group blinding.

The Effect of Fetus Stimulation Techniques on Newborn Behavior.

Background:Many factors affect fetal behavior, which can also affect the baby's capacity and change interaction with the caregiver. The aim of this study was to investigate the effect of performing fetal sensory systems stimulation techniques by mother during pregnancy on the neonate's habituation behavior.Materials and Methods:This semi-experimental study was conducted in 2019 in Isfahan, Iran. Mothers who referred to public comprehensive health centers in the 27th week of gestation and met the inclusion criteria were selected by convenience sampling method and randomly assigned to two groups of intervention and control. Fetal learning programs were held twice a day from the 27th week to the end of the pregnancy. The habituation domain of the neonate's behavior was assessed by the Brazelton's Neonatal Behavioral Assessment Scale (BNBAS) 3–5 days after the delivery. The mean score of habituation domain of BNBAS among 72 subjects in the intervention and control groups was compared by the Mann–Whitney test.Results:The habituation domain of all 72 newborns born approximately at the gestational age of 38 weeks was assessed. The Mann–Whitney test results indicated that the two groups were significantly different in terms of the total mean score of habituation domain 3–5 days after birth (z = –4.37, p < 0.001) and the score of the intervention group was higher than that of the control group.Conclusions:Generally, it can be concluded that the fetal stimulation techniques can positively affect the neonate's behaviors including the domain of habituation.

Impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates.

BackgroundThe aim of this study was to determine the impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates.MethodsWe examined 112 neonates. Inclusion criteria were: Saturations greater than 88%, and heart rates between 100–205 beats per minute.MeasurementsWe assessed several neurodevelopmental factors as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS), 4th edition, such as asymmetric tonic neck reflex (ATNR), motor maturity, response to sensory stimuli, habituation, and state regulation. Initial assessment parameters such as APGAR score and umbilical cord arterial pH were used to assess neonates.ResultsWe found a strong correlation between the presence of the sucking reflex and umbilical cord arterial pH (r = 0.32; p = 0.018981). Umbilical cord arterial pH was also correlated with the presence of asymmetric tonic neck reflex (r = 0.27; p = 0.047124), cost of attention (r = 0.31; p = 0.025381) and general motor maturity (r = 0.34; p = 0.011741).ConclusionsWe found that the sucking reflex may be affected in infants with low umbilical cord arterial pH values. Practitioners and parents can use the NBAS to help determine neurodevelopmental factors and outcomes in preterm infants, possibly leading to safer and more effective feeding practices and interventions.

Video-based neonatal state assessment method for timing of procedures.

Procedures should be performed when an infant is most receptive to disruptions in order to reduce the stress on the infant. However, frequent direct observations place a heavy burden on medical staff. There is therefore a need for a method for quantitatively and automatically evaluating the neonatal state. Ten infants in our hospital were enrolled in this study. The states of the infants were assessed by medical staff using the Brazelton Neonatal Behavioral Assessment Scale and were recorded on video at the same time. The recorded states were reclassified as activity levels, a new state classification method that includes middle activity, which is the appropriate time for a procedure. Using image analysis, motions of the infant were quantified as two indices: activity and pause time. Activity and pause time were compared for each activity level. The cutoff values of the indices were calculated, and the sensitivity and specificity of the middle activity were calculated. There was a significant difference between all groups of activity level (P<0.01). The maximum sensitivity and specificity of middle activity were 71.7% and 51.2%, respectively. The neonatal state of infants can be quantitatively and automatically evaluated using video cameras, and the activity level can be used to determine an appropriate time for procedures in infants. This will reduce the burden on medical staff and lead to less stressful procedures for infants.

A new look at neurobehavioral development in rhesus monkey neonates (Macaca mulatta).

The Brazelton Neonatal Behavioral Assessment Scale (NBAS) evaluates a newborn infant's autonomic, motor, state, temperament, and social-attentional systems, which can help to identify infants at risk of developmental problems. Given the prevalence of rhesus monkeys being used as an animal model for human development, here we aimed to validate a standardized test battery modeled after the NBAS for use with nonhuman primates called the Infant Behavioral Assessment Scale (IBAS), employing exploratory structural equation modeling using a large sample of rhesus macaque neonates (n = 1,056). Furthermore, we examined the repeated assessments of the common factors within the same infants to describe any changes in performance over time, taking into account two independent variables (infant sex and rearing condition) that can potentially affect developmental outcomes. Results revealed three factors (Orientation, State Control, and Motor Activity) that all increased over the 1st month of life. While infant sex did not have an effect on any factor, nursery-rearing led to higher scores on Orientation but lower scores on State Control and Motor Activity. These results validate the IBAS as a reliable and valuable research tool for use with rhesus macaque infants and suggest that differences in rearing conditions can affect developmental trajectories and potentially pre-expose infants to heightened levels of cognitive and emotional deficiencies.

Neurobehavior of mexican newborns in conditions of low perinatal risk

INTRODUCTION: The first hours of life are still a window of opportunity to identify at-risk newborns, but there are few studies focusing on early neonatal behavior.OBJECTIVE: Describe in a cross section the behavior of newborns born in conditions of low perinatal risk under 48 hours of extrauterine life and compare it with historical referents.METHOD: We studied 47 newborns with low perinatal risk, whose behavior was assessed using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). Scores were obtained by item and area, and then were compared with 7 historical referents.RESULTS: Low scores were found, both by item and by areas in up to 25% of the population. NBAS scores were related primarily with age of newborn, weight, and height. Significant differences were found in relation to referents for which higher scores were reported in the majority of cases.CONCLUSIONS: A pattern was found of behavior, in which the same areas or items caused greater or lesser difficulty in achieving higher scores or those which required a certain level of adaptation to the environment, which would lead us to believe that our newborns should attain the scores seen in other populations as they advance in age.

Effectiveness of Hammock Positioning in Reducing Pain and Improving Sleep-Wakefulness State in Preterm Infants.

Hammock positioning is now frequently used with preterm infants admitted to ICUs. However, few studies have investigated the extent to which hammock positioning reduces pain and improves the sleep-wakefulness state compared with traditional positioning. Twenty-six clinically stable newborns with gestational ages from 30 to 37 weeks who were breathing spontaneously were randomly assigned to 2 groups: a hammock-positioning group (n = 13), in which newborns were placed in hammocks in the lateral position, and a traditional-positioning group (n = 13), in which they were kept nested, also in the lateral position. The following variables were evaluated at the beginning and the end of the treatment: pain (with the Premature Infant Pain Profile, and Neonatal Facial Coding System), sleep-wakefulness state (with the Brazelton Neonatal Behavioral Assessment Scale), heart rate, breathing frequency, and peripheral SpO2 . The subjects in the hammock-positioning group showed an improvement in pain compared with the traditional-positioning group(Premature Infant Pain Profile score, 2.62 ± 1.89 vs 2.31 ± 1.97, ΔP = .008) and sleep-wakefulness state score (2.08 ± 0.64 vs 1.23 ± 0.44, Δ P < .001), reduced heart rate (151.69 ± 5.44 vs 142.77 ± 5.18 beats/min, Δ P < .001), breathing frequency (52.31 ± 4.05 vs 50.23 ± 2.55 beats/min, Δ P = .024), and increased peripheral SpO2 (94.69 ± 2.14 vs 98.00 ± 1.22%, Δ P < .001). Hammock positioning was an effective treatment option to reduce pain and improve sleep-wakefulness state. It also helped to reduce heart rate and breathing frequency, and to increase peripheral SpO2 , which made it a treatment option for preterm infants.

Neurobehavioral response to multisensory stimulation programme in high-risk neonates

Context High-risk neonates admitted to the neonatal intensive care unit (NICU) are suffering from lack of sensory experiences that are vital for normal brain development, rather are exposed to excessive or inappropriately timed stimulation in the NICU that leads to deleterious effects on premature infants whose brains are immaturely developed. Aim The aim of this study was to investigate the effect of multisensory stimulation programme on neurobehavioral development in high-risk neonates. Settings and design A prospective randomized controlled trial was conducted on 40 high-risk neonates, who were selected from NICUs, with mean gestational age of33±1.03 weeks according to new Ballard score and mean weight 1442±228.5 g. They were allocated into either the control group or the study group. Participants and methods The control group received routine medical and nursery care in the NICU, whereas the study group received the same programme given to the control group in addition to the multisensory stimulation programme given daily for 2 successive weeks. The outcomes were measured before and after the intervention by Morgan neonatal neurobehavioral examination and Brazelton neonatal behavioural assessment scale. Results There was a significant improvement in all measured variables in the study group after the intervention programme (P Conclusion Multisensory stimulation improved neurobehavioral development in high-risk neonates. This could be a vital part of the routine neonatal physiotherapy for preterm and high-risk neonates.

The Brazelton Neonatal Behavioral Assessment Scale: A validity and reliability study in a Turkish sample

Background/aim: The aim of the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) is to gather a comprehensive profile of neonatal functioning by describing the full range of neonatal behavior, including competencies and strengths, as well as difficulties or deviations. This instrument has proved to be of great clinical value by detecting infants at risk for later developmental problems. This work was conducted methodologically with the aim of a Turkish validity and reliability study of the BNBAS. Materials and methods: The study was conducted in a large tertiary hospital in Turkey. After establishing content and language validity, the BNBAS was applied to 380 newborns aged 1–3 days and test–retest analysis was performed for 60 newborns 52–55 days later in the first phase. The validity and reliability study of the BNBAS included behavior and support subscales, while reflex items were not included. Results: In the study, 5 items were excluded from the original BNBAS after the factor analysis. Cronbach alpha was found as 0.974 (30 items). The behavior subscale consisted of 23 items and the support subscale consisted of 7 items. Newborns showed good overall tone and activity level and low amounts of irritable behavior. Conclusion: It may be recommended to use the BNBAS as a valid and reliable measurement tool in neonatal behavioral evaluation by physicians and nurses.

Effects of hammock positioning in behavioral status, vital signs, and pain in preterms: a case series study

BackgroundThe hammock positioning within the incubators simulates the intrauterine environment, however, there is little evidence of its benefits and possible risks. ObjectivesThe aim of this study was to assess the effects of hammock positioning on behavioral status, vital signs, and pain in very low birth weight preterm newborns. MethodsThis is a quasi-experimental/case series study in which premature infants (<1500g) were positioned in supine for one hour in a hammock. The preterm newborns were assessed 10min before, during (2, 20, 40, and 60min), and 10min after hammock positioning with the Brazelton Neonatal Behavioral Assessment Scale, vital signs and pain by the Neonatal Facial Coding System. Results28 preterm infants between 28 and 36 weeks of gestational age were evaluated. Regarding the behavioral state, the preterm newborns progressively evolved to light or deep sleep during hammock positioning. There was a statistically significant reduction of the heart and respiratory rate from 2 to 60th minute in a hammock, which was maintained after the positioning. The oxygen saturation remained within normal values. No changes in pain scores were observed. ConclusionThe hammock positioning can be considered a safe method of positioning that can be used to reduce the stress levels in very low birth weight preterm newborns. We did not observe worsening in either pain or vital signs.

A pilot study of maternal exposure to organophosphate pesticides and newborn neurodevelopment in Thailand.

The objective of this study was to evaluate whether prenatal exposures to organophosphate (OP) pesticides from maternal agricultural use are associated with neonatal neurobehavioral effects. A pilot study conducted in three provinces in Thailand measured maternal urinary metabolites of OP pesticides in pregnant women at 7months gestation and at birth. Within 3days of birth, 82 newborns underwent neurobehavioral testing using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). Comparison of the NBAS test results with maternal OP metabolite levels found the neonates NBAS Habituation cluster score increased with maternal dimethylphosphate (DMP) levels (p=0.04) while the Range of State score increased with total diethylphosphate (DEP) levels (p=0.01). The Number of Abnormal Reflexes in the neonate also increased as maternal urinary total DEP levels increased (p=0.06). These preliminary findings suggest that pre-natal exposures to OP pesticides can impact newborn neurodevelopment and support the need for a longitudinal evaluation of childhood neurodevelopment in relation to pesticide exposures in Thailand.

Neurobehavioural and cognitive development in infants born to mothers with eating disorders

Although recent research has focused on the effects of maternal eating disorders (EDs) on children, little is known about the effect of maternal EDs on neurobiological outcomes in newborns and infants. This study is the first to investigate neurobehavioural regulation and cognitive development in newborns and infants of mothers with EDs. Women with an active and past ED and healthy controls were recruited to a prospective longitudinal study during their first trimester or second trimester of pregnancy. Newborns and infants of mothers with ED were compared with newborns and infants of healthy controls on (a) neurobehavioural dysregulation using the Brazelton Neonatal Behavioural Assessment Scale at 8days postpartum (active ED, n=15; past ED, n=20; healthy controls, n=28); and (b) cognitive development using the Bayley Scales of Infant and Toddler Development at 1-year postpartum (active ED, n=18; past ED, n=19; healthy controls, n=28). In order to maintain the largest possible sample at each time point, sample size varied across time points. Newborns of mothers with an active ED had worse autonomic stability when compared with newborns of healthy controls [B=-0.34 (-1.81, -0.26)]. Infants of mothers with a past ED had poorer language [B=-0.33 (-13.6, -1.9)] and motor development [B=-0.32 (-18.4, -1.3)] compared with healthy controls. Children of mothers with ED display neurobehavioural dysregulation early after birth and poorer language and motor development at 1year. These characteristics suggest evidence of early neurobiological markers in children at risk. Differential outcomes in children of women with active versus past ED suggest that active symptomatology during pregnancy might have an effect on physiological reactivity while cognitive characteristics might be more stable markers of risk for ED.

Home environment and cord blood levels of lead, arsenic, and zinc on neurodevelopment of 24 months children living in Chitwan Valley, Nepal

In a birth cohort living in Chitwan Valley, lowland Nepal, we have previously reported inverse associations between in utero levels of lead (Pb), arsenic (As) and neurodevelopment at birth measured by the Brazelton Neonatal Behavioral Assessment Scale, third edition (NBAS III). In the present paper, a follow-up of the same cohort was made on 24-month-old infants regarding the neurodevelopmental effects of these metals, taking the postnatal environment into account. In total, the same100 mother-infant pairs as the previous study, whose Pb, As, and Zn concentrations in cord blood were known, were recruited. Postnatal raising environment was evaluated using the Home Observation for Measurement of Environment (HOME) scale. Neurodevelopment of children at 24 months of age (n=74) was assessed using the Bayley Scale of Infant Development, Second Edition (BSID II). Multivariable regression adjusting for covariates was performed to determine the associations of in utero levels of toxic and essential elements and the home environment with neurodevelopment scores. Unlike the NBAS III conducted for newborns, none of the BSID II cluster scores in 24-month-old infants were associated with cord blood levels of Pb, As, and Zn. The total HOME score was positively associated with the mental development scale (MDI) score (coefficient=0.67, at 95% CI=0.03 to 1.31). In this cohort, a detrimental effect of in utero Pb and As on neurodevelopmental indicators observed at birth disappeared at 24 months, while an association between neurodevelopment and home environment continued.

Breast Milk versus Formula Milk and Neuropsychological Development and Sleep

A cohort study including 14000 newborns, about half of them were exclusively breast fed for the first four months of their lives, this percentage dropped down to about 4% by the end of the fourth month of age. One third of these babies were not breast fed at all; 9% of them were identified with a degree of gross motor delay, 6% with fine motor delay by the age of 9 months. The proportion of infants who acquired their milestones overtime increased with exclusivity of breastfeeding. Infants who had never been breastfed were 40-50% more prone to have some sort of motor delay than breast fed infants (10.7% vs 7.3%). These findings did not decrease with adjustment of other confounders, e.g. biological, socioeconomic or psychosocial factors [1]. Neuro-physiological outcomes in breast fed infants was evaluated through flash Visual Evoked Potential (VEP), Brainstem Auditory Evoked Potential (BAEP) and Somato-Sensory Evoked Potential (SSEP) and showed significant prolongation of P-100 wave latencies in formula fed infants, in addition to that, prolongation of absolute waves I, III, V wave latencies of BAEP was also seen in formula fed infants in comparison with breast fed infants. SSEP showed similar findings to VEP and BAEP. This concludes that maturation and brain myelination patterns in breast fed infants is more mature than formula fed infants [2]. Small for Gestational Age (SGA) born babies are at high risk for neuro-developmental delay. Studies have shown that enriched formula fed to term SGA infants improve their growth and their neuro-developmental outcome. A multicenter randomized controlled study in United Kingdom showed that there was no significant intergroup difference in Bayley Mental Development Index (MDI) or Psychomotor Development Index (PDI) scores at 18 months. Though, breast fed infants have significantly higher MDI and PDI scores than formula fed infants. Confounding factors accounted for one third of the resulted association with MDI score and none of the association with PDI score. It is previously reported that enriched formula do have significant effect on enhancing linear growth, though this was not correlated with neurodevelopmental benefit [3]. Breast feeding should be encouraged for best neurodevelopmental outcome in infants born SGA. Behavioral assessment of neonates was done for 83 neonates at their ninth day of life, though special assessment scale “Brazelton Neonatal Behavioral Assessment Scale”. 42 neonates were exclusively breast fed and 42 were formula fed, the study showed that breast fed infants exhibited fewer abnormal reflexes, signs of depression, and withdrawal. This proves that breast feeding

Impact of caste on the neurodevelopment of young children from birth to 36 months of age: a birth cohort study in Chitwan Valley, Nepal

BackgroundCaste, a proxy of socioeconomic position, can influence the neurodevelopment of children through several pathways, including exposure to toxic elements. Studies from developing countries where caste is represented by prevailing caste groups and people are highly exposed to toxic elements can provide useful insights into the mechanisms of neurodevelopmental inequities among children. This study aims to investigate the impact of caste on the neurodevelopment of children from birth to 36 months of age in Chitwan Valley, Nepal, where people are exposed to high levels of arsenic (As) and lead (Pb).MethodsParticipants (N = 94) were mother-infant pairs from the Chitwan district in Nepal. The neurodevelopment of the infants was assessed using the Brazelton Neonatal Behavioral Assessment Scale, Third Edition, (NBAS III) at birth and the Bayley Scales of Infant Development, Second Edition, (BSID II) at ages 6, 24, and 36 months. Caste was categorized based on surname, which, in Nepal generally refers to one of four caste groups. We also measured the concentrations of As and Pb in cord blood.ResultsCaste was positively associated with the state regulation cluster score of the NBAS III at birth after adjustment for covariates (p for trend < 0.01). Adding cord blood As levels attenuated the association (p for trend = 0.12). With regard to neurodevelopment at six months of age, the third-ranked caste group scored higher than the first-ranked caste group on the Mental Development Index (MDI) of the BSID II (coefficient = 3.7; 95% confidence interval (CI) = 1.3 to 6.0). This difference remained significant after adjustment for cord blood As levels and other covariates was made (coefficient = 3.9; 95% CI = 1.2 to 6.7). The remaining clusters of the NBAS III and BSID II at 6, 24, and 36 months were not significantly associated with caste group.ConclusionsCaste was positively associated with the state regulation cluster score of NBAS III at birth. This association was partially mediated by cord blood As levels. However, the negative impact of caste on neurodevelopment disappeared as the children grew. Furthermore, an inverse association between caste and MDI at six months of age was observed. Additional studies are needed to elucidate the mechanism of how caste affects neurodevelopment.

Home environment and prenatal exposure to lead, arsenic and zinc on the neurodevelopment of six-month-old infants living in Chitwan Valley, Nepal

BackgroundWe have previously reported the inverse associations between in utero levels of lead (Pb), arsenic (As) (i.e., toxic elements), and neurodevelopmental indicators (i.e., motor and state regulation cluster score) measured by the Brazelton Neonatal Behavioral Assessment Scale, third edition (NBAS III) in this cohort at birth. Using additional follow-up, this study investigated the effects of cord blood levels of Pb, As, and zinc (Zn) (an essential element) and the postnatal environment on the neurodevelopment of 6-month-old infants in Chitwan Valley, Nepal. MethodsIn total, 100 mother–infant pairs were recruited from Chitwan District, Nepal. Pb, As, and Zn concentrations in cord blood were measured. Postnatal raising environment (i.e., HOME score or home environment hereafter) was evaluated using the Home Observation for Measurement of Environment (HOME) scale. Neurodevelopment of infants at 6months (n=94) was assessed according to the Bayley Scale of Infant Development, second edition (BSID II). Multivariable regression adjusting for covariates was performed to determine the associations of in utero levels of toxic and essential elements and the home environment with neurodevelopment scores. ResultsCord blood levels of Pb, As, and Zn were not associated with any BSID II cluster scores in 6-month-old infants. The total HOME score was positively associated with the Psychomotor Development Index (PDI) score (coefficient=0.59, 95% confidence interval [CI]=0.04 to 1.13). ConclusionIn this cohort, detrimental effects of in utero Pb and As on neurodevelopmental indicators observed at birth did not persist at 6months of age, while it showed an association between the neurodevelopment and home environment.

Low Vitamin B12 Intake during Pregnancy and Lactation and Low Breastmilk Vitamin B12 Content in Rural Kenyan Women Consuming Predominantly Maize Diets

Vitamin B12 deficiency during pregnancy and lactation may negatively affect fetal growth, brain development, pregnancy outcome, and breastmilk vitamin B12 content. To examine associations between pregnant and lactating women's vitamin B12 intake and pregnancy outcomes, breastmilk vitamin B12 concentration, and growth and development of breastfed infants from birth to 6 months. One hundred thirty-eight Kenyan women were followed during pregnancy, with 98 followed through 6 months of lactation and providing 294 randomly collected breastmilk samples. Maternal hematologic analyses were performed for erythrocyte morphology, erythrocyte size, and serum vitamin B12 concentration. Women's and infants'food intake was assessed. Breastmilk vitamin B12 was measured by a competitive binding isotope dilution technique. Infant anthropometric data and the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) were assessed within 3 days after birth. The Infant Bayley Motor Scale was assessed at 6 months. Statistical analyses included simple regression and correlation analyses in relation to vitamin B12 status and gestational age. Intrauterine growth restriction and stillbirths were correlated with maternal macrocytic anemia and hypersegmented polymorphonuclear nuclei. Postpartum maternal vitamin B12 intake influenced breastmilk vitamin B12 levels 1 to 6 months postpartum. No associations were found between vitamin B12 intake during pregnancy or vitamin B12 levels in breastmilk and infant length, weight, or head circumference at birth or 6 months. Vitamin B12 intake during pregnancy was correlated with improved scores on infants' BNBAS reflex subscale (R = -0.19, p = .05) with adjustment for gestational age. Bayley Motor Scale results at 6 months were not significantly associated with breastmilk or supplemental feeding vitamin B12 content. Vitamin B12 deficiency may adversely affect pregnancy outcome, infant reflexes at birth, and breastmilk vitamin B12 content.

Association of cord blood levels of lead, arsenic, and zinc with neurodevelopmental indicators in newborns: A birth cohort study in Chitwan Valley, Nepal

In this study, we aimed to investigate the association between in utero toxic (lead [Pb] and arsenic [As]) and essential element (zinc [Zn]) levels and neurodevelopmental indicators after birth in Chitwan Valley, Nepal. We conducted a hospital-based birth cohort study with 100 pregnant women in Chitwan, Nepal. We measured Pb, As, and Zn concentrations in cord blood. We assessed 100 infants at 1 day after birth, using the Brazelton neonatal behavioral assessment scale, third edition (NBAS III). Multivariate regression was performed to adjust for mother's age, parity, educational level, and body mass index (BMI); family income; and newborn's birth weight, gestational age, and age in hours at the time of NBAS III assessment. Among the 7 clusters of NBAS III, the motor cluster score was inversely associated with the cord blood levels of Pb (coefficient=−2.15, at 95% confidence interval [CI]=−4.27 to −0.03). The cord blood levels of As were inversely associated with the state regulation cluster score (coefficient=−6.71, at 95% CI=−12.17 to −1.24). The cord blood levels of Zn were not associated with NBAS III scores. The cord blood levels of Pb and As, but not Zn, showed significant inverse association with the neurodevelopment of newborns. These results suggest that high levels of Pb or As exposure during the prenatal period may induce retardation during in utero neurodevelopment.

Maternal Music Exposure during Pregnancy Influences Neonatal Behaviour: An Open-Label Randomized Controlled Trial

Objective. This study evaluated the effect of antenatal music exposure to primigravida healthy mothers on the behaviour of their term appropriate-for-date newborns assessed using Brazelton Neonatal Behavioral Assessment Scale (BNBAS). Methods. This was a single-centre, randomized, open-label controlled trial. Primigravida mothers aged 19–29 years, free of chronic medical diseases or significant deafness, with singleton pregnancy, with a gestation of 20 weeks or less, were randomized to listen to a pre-recorded music cassette for approximately 1 hour/day in addition to standard antenatal care (intervention arm) or standard care only (control arm). Perinatal factors with adverse effect on neonatal behaviour were deemed as protocol violations. Outcome measure included scores on 7 clusters of BNBAS. Primary analysis was per protocol. The trial is registered with ClinicalTrials.gov (NCT01278329). Results. One hundred and twenty-six newborns in the music group and 134 in the control group were subjected to BNBAS assessment. The infants of mothers exposed to music during pregnancy performed significantly better on 5 of the 7 BNBAS clusters. The maximal beneficial effect was seen with respect to orientation (ES 1.13, 95% CI 0.82–1.44, P < 0.0001) and habituation (ES 1.05, 95% CI 0.53–1.57, P = 0.0001). Conclusion. Prenatal music exposure to mother significantly and favourably influences neonatal behaviour.

Delayed reactive cries demonstrate emotional and physiological dysregulation in newborns of depressed mothers

The purpose of the present study was to examine newborns’ behavioral and physiological reactions to the cry of another infant (labeled a reactive cry). 101 newborns of depressed (N=40) and non-depressed (N=61) mothers were assessed on the Brazelton Neonatal Behavioral Assessment Scale (NBAS, Brazelton and Nugent, 1995) and 89 of those infants also participated in an auditory task. Cardiovascular activity (heart period, parasympathetic tone, and recovery to basal activity) was obtained from a sub-sample of these infants (n=37). Vocal distress and regulatory behaviors were examined when newborns listened to another infant's cry and to a simulated sound (the control condition). ANOVAs indicated that newborns of depressed mothers showed lower basal parasympathetic tone. In addition, newborns of depressed mothers responded with less vocal distress to the cry sounds of another infant, and were delayed in physiological regulation following this sound. These findings suggest that newborns of depressed mothers show altered, possibly dysregulated, behavioral and physiological patterns during socio-emotional situations in comparison to newborns of non-depressed mothers.