Neonatal Behavioral Neurological Assessment Scores Research Articles

Risk factors of premature behavioral neurological assessment

Objective To analyze the characteristic of twenty-item premature behavioral neurological assessment,and to assess the risk factors of neonatal behavioral neurological assessment(NBNA) in premature infants. Methods Total two hundred and seventy-four premature infants hospitalized in Guangzhou Children's Hospital were assessed with the NBNA after correcting age 40 weeks,premature infants were divided into two groups:normal group (n =221 ) and abnormal group (n =53) according to NBNA. The birth history, mother pregnancy situation, the disease during neonatal period and results in hospital were reviewed,and the risk factors of NBNA in premature infants were assessed. Results There were significant differences in gestational age, birth weight, head circumference, body height, Apgar score, resuscitation time, hospitalization time and total gastrointestinal nutrition time between the two groups( P ＜ 0. 05 ). The incidences of superfoetation,hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease were different between the two groups( P ＜ 0. 05 ). There were no differences in gender, antenatal hormone use, anaemia, hypotension and evoked potential abnormality (P ＞0. 05 ). Multivariate logistic regression analysis showed that the risk factors of NBNA score in premature infants would include low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease. Conclusion Although the premature infants corrected age 40 weeks,but the capability and initiative muscular tension are still lower than term infant. Low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury ,severe infection ,hyperbilirubinemia,hypoglycemia and chronic lung disease are important risk factors related to premature behavioral neurological assessment. Key words: Behavioral neurological assessment; Risk factors; Infant,premature

Efficacy of remifentanil-propofol-atracurium combined anesthesia for caesarean section

Objective To investigate the efficacy of remifentanil-propofol-atracurium combined anesthesia for caesarean section. Methods Forty ASA Ⅰ or Ⅱ patients, aged 24-30 yr, weighing 60-89 kg, at 38-41 week gestation, scheduled for elective cesarean section under general anesthesia, were studied. Remifentanil 1 μg/kg was slowly injected iv and then infused iv at a rate of 0.15 μg·kg-1·min-1 until the end of operation. Propofol 1.5 mg/kg and atracurium 0.6 mg/kg were injected in turn 30 s after remifentauil injection. Mechanical ventilation was performed after tracheal intubation. Atracurium 0.3 mg/kg was intermittently injected iv. Blood samples were taken from umbilical artery (UA) within 1 min after the delivery of the baby for blood gas analysis. Blood samples were simultaneously drawn from UA, umbilical vein (UV), and maternal artery (MA) for determination of plasma remitentanil concentrations (CUA, CUV and CMA) using gas chromatography-mass spectrometry. Systolic blood pressure (SP), diastolic blood pressure (DP), MAP and HR were monitored and recorded before intubation, at the time of inserting the catheter, at skin incision, and at the time of extubation. The analepsia time and satisfactory rate of patients were also recorded. The patient's awareness during operation was noted after operation. Apgar score was performed at 1, 5 and 10 min after the delivery of the newborn. The neonatal behavioral neurological assessment (NBNA) was conducted 1 and 24 h after the delivery of the baby. Results The hemodynamics was stable and varied within the normal range at each time point in all the patients. The analepsia time was (5±4) min and no awareness during operation occurred after postoperative follow-up. The pH value, PaCO2, PaO2 and SaO2 were in the normal range in the neonatal umbilical arterial blood samples. The neonatal Apgar scores at 1, 5 and 10 min after the delivery of the baby were more than 7. NBNA scores were normal. CUV, CUA and CMA were (0.65±0.14), (0.22±0.09) and (0.86±0.25) ng/ml respectively. CUV/CMA and CUA/CUV were 0.7±0.4 and 0.35±0.11 respectively. Conclusion The remifentanil-propofol-atracurium combined anesthesia can produce good anesthetic effect in the patients undergoing cesarean section, with high safety. Key words: Piperidinos; Propofol; Atracurium; Cesarean section

Evaluation of Urinary S100B Protein Level and Lactate/Creatinine Ratio for Early Diagnosis and Prognostic Prediction of Neonatal Hypoxic-Ischemic Encephalopathy

Background: Early identification and prevention of hypoxic-ischemic encephalopathy (HIE) in newborns may reduce neonatal mortality and neurological dysfunction. Objective: To analyze the diagnostic and prognostic values of urinary S100B level and lactate/creatinine ratio in newborns with HIE. Methods: Seventy-eight full-term newborns with HIE and 25 normal newborns were enrolled. The Neonatal Behavioral Neurological Assessment (NBNA) and Developmental Screening Test were scored. The concentration of urinary S100B protein was determined using the S100B enzyme-linked immunosorbent assay and the levels of urinary lactate and creatinine were measured with the enzyme colorimetric method. Results: Urinary S100B level on days 1–3 after birth and lactate/creatinine ratio on day 1 were significantly higher in newborns with HIE than those in the control group. Both indexes were positively correlated with the clinical grading of HIE. A cutoff value for the S100B level of 0.47 μg/l on day 3 after birth had a sensitivity of 90% and specificity of 92% for prediction of HIE. A lactate/creatinine ratio of more than 0.55 on day 1 showed the highest sensitivity (92%) and specificity (90%). A combination of both indexes improved the sensitivity and specificity to 99 and 97%, respectively. A negative correlation of both lactate/creatinine ratio on day 1 and S100B level on days 1–3 after birth with the NBNA score was identified on days 3, 7 and 14 after birth. The Developmental Screening Test score of 36 newborns with HIE within 6 months after birth showed that 65% of infants with moderate and high HIE had an abnormal developmental quotient. Conclusion: These data suggest that early measurement of both S100B level and lactate/creatinine ratio in the urine of newborns with HIE is a practical convenient and sensitive way to improve diagnosis on the third day of life and prognostic prediction of HIE.

Placental transfer and neonatal effects of remifentanil as an adjuvant for cesarean section

Objective To investigate the placental transfer and neonatal effects of remifentanil as an adjuvant for cesarean section.Methods Forty ASA Ⅰ parturients at full term aged 26-32 yr weighing 70-90 kg undergoing elective cesarean section under combined spinal epidural anesthesia (CSEA) were randomly divided into 2 groups (n = 20 each): control group (C) and remifentanil group (R). The CSEA was performed at L3-4interspace and the upper spread of sensory block reached T6-8. Group R received TCI of remifentanil (target plasma concentration was set at 1.5 ng/ml) starting from performance of CSEA until blood samples were obtained. In group C equal volume of normal saline was infused instead of remifentanil. MAP, HR, RR, minute ventilation (MV), and OAA/S scores were recorded after the parturients had settled down for 5 min in the operating room (T0), at skin incision (T1), when the baby was being delivered (T2), uterus repaired (T3) and peritoneum closed (T4). Fetal heart rate (FHR) at T0 and immediately before skin disinfection, the duration between uterus incision and delivery of the baby (delivery time), body weight of the newborn, Apgar score at 1 min and 5 min after delivery and neonatal behavioral neurological assessment (NBNA) at 1 h and 24 h after delivery were also recorded.Adverse effects including hypotension, sinus bradycardia, raspiratory depression, muscle rigidity , nausea and vomiting were recorded. The middle segment of umbilical cord (about 10-15 cm long) was clamped at both ends with two clamps at delivery. Umbilical arterial (UA) and venous (UV) blood samples and maternal arterial (MA) blood samples were obtained within 3 min after delivery for blood gas analysis and determination of plasma remifentanil concentration using C,C-MS-SIM method. Results OAA/S scores were significantly lower at T1,2 in group R than in group C. There were no significant differences in MAP, HR, MY, RR, delivery time, FHR, blood gases, bedy weight of the newborn, Apgar scores and NBNA scores between the 2 groups. The plasma concentrations (C) of remifentanil were (0.85±0.31),(0.57±0.12) and (0.22±0.09) ng/ml respectively in maternal arterial, umbilical venous and arterial blood samples, CUV/CMA was 0.67±0.41 and CUA/CUV was 0.39±0.08. Conclusion Remifentanil given by TCI at a target plasma concentration of 1.5 ng/ml has no adverse effects on the newborn because of raid metabolism and redistribution of remlfentanil in the neonate after rapid placental transfer. Key words: Piperidines; Cesarean section; Infant, newborn; Placenta

Clinical observation of the effect of therapeutic touch intervention on neurobehavior in preterm infants

Objective To explore the effect of therapeutic touch(massage)on the neuTobehavior of preterm infants.Methods Sixty preterm infants( gestafional age in 31-36 weeks),through natural delivery or caesarean section were randomly assigned to therapeutic touch group(n=30)and control group(n=30).Both groups re-ceived routine pharmacothempy and nursing care and followed up for half a year from discharge.Touch group re-ceived additional whole-body massage.All subjects were evaluated with neonatal behavioral neurological assessment (NBNA)in one month after birth-and mental development index(MDI), psyehomotor development index(PDI)in 3 months and 6 months after birth.Results The NBNA scores(P<0.01),as well as MDI and PDI(P<0.05)were significantly higher in therapeutic touch group than the control.Conclusion Therapeutic touch intervention im-proves nervous system of preterm infants. Key words: Preterm infants; Touch intervention; Neurobehavioral

Influence factors of the neonatal behavioral neurological assessment in premature infant

Objective To explore the application of neonatal behavioral neurological assessment (NBNA) in premature infant and the influence factors.Methods One handred and twenty-three premature neonates hospitalized in our neonatal department from January 2006 to June 2007 were enrolled in the study.The NBNA was carried out at corrected conceptus age 40w.The influence of conceptus age,birth weight,mechanical ventilation and the ventilation time,high risk factors of brain damage in perinatal period,different delivery methods,and the Apgar score on the outcome of NBNA were analyzed.Results There were significant differences of the NBNA results among the premature infants with different conceptus age (<30w,～32w,and ～34w) and birth weight (<1250g,～1500g,and ～2000g) (P<0.01).The NBNA score was lower as the neonate was younger with conceptus age and lower with birth weight.The NBNA scores in the neonates with ventilation and ventilation time more than 7d were obviously lower than that without ventilation (P<0.01)and ventilation time less than 7d (P<0.05).Furthermore the NBNA scores were markedly lower when the neonates complicated with hemorrhagic and ischemic brain damage,conjugated bilirubin ≥256.5μmol/L,hypoglycemia (<2.6μmol/L) and infection(P<0.01).And the NBNA in neonates with breech position,obstetrical forceps and vaccum extraction delivery was obviously lower than that in the cesarean delivery and spontaneous delivery (P<0.01).The neonate with Apgar score between 0 and 3 has lower NBNA in compared with those with Apgar score 4-7 and ≥8 (P<0.01).Conclusion There are many factors affecting on the NBNA outcome,such as conceptus age,birth weigh,ventilation and ventilation time,abnormal delivery methods,and severe asphyxia.In order to find intracalvarium pathological changes and give early intervention,decrease additional damage and sequelae,the skull ultrasound should be carried out at 3 to 7d after birth for the premature neonate,especially those whose conceptus age less than 32w and birth weight no more than 1500g or with high risk factors of brain damage. Key words: Infant,premature; Neonatal behavioral neurological assessment; Brain damage

Monitoring of lead load and its effect on neonatal behavioral neurological assessment scores in Guiyu, an electronic waste recycling town in China

Guiyu is the major electronic waste (e-waste) recycling town in China. The primary purpose of this study was to measure the lead levels in neonates and examine the correlation between lead levels and neurobehavioral development. One hundred full-term neonates from Guiyu and fifty-two neonates from neighboring towns (control group) in the late summer of 2006 were selected for study. The lead levels in the umbilical cord blood (CBPb) and lead levels in meconium (MPb) of neonates were determined with atomic absorption spectrophotometry. The neonatal behavioral neurological assessment (NBNA) was conducted on all neonates. A questionnaire related to the exposure to lead of pregnant women was used as a survey of the neonates' mothers. Compared with the control group, neonates in Guiyu had significantly higher levels of lead (P < 0.01), and the mean CBPb and MPb were 113.28 microg L(-1) and 2.50 microg g(-1), respectively. The relatively high lead levels in the neonates of the Guiyu group were found to correlate with their maternal occupation in relation to e-waste recycling. Neonates with high levels of lead load have lower NBNA scores (P < 0.01). There was a statistically significant difference in NBNA scores between the Guiyu group and the control group by t test (P < 0.05). No correlation was found between CBPb and NBNA scores; however, a negative correlation was found between MPb and NBNA scores (P < 0.01). There is a correlation between relatively high lead levels in the umbilical cord blood and meconium in neonates and the local e-waste recycling activities related to lead contamination. This study suggests that environmental lead contamination due to e-waste recycling have an impact on neurobehavioral development of neonates in Guiyu.

Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: an experience from a single neonatal intensive care unit

The objective of this study was to determine the efficacy of mild hypothermia via selective head cooling as a neuroprotective therapy in term infants with perinatal asphyxia. Full-term newborns who had 5 min Apgar scores <6, first arterial blood gas pH<7.10 or BD>15 mEq/l, and with the clinical signs of encephalopathy were enrolled within 6 h after birth. Patients were randomized to receive mild hypothermia treatment via selective head cooling for a total of 72 h or receive routine treatment as a control. Brain hypoxic-ischemic injury was quantified based on the head computed tomographic scan (CT scan) at postnatal age 5-7 days and a Neonatal Behavioral Neurological Assessment (NBNA) score at 7-10 days of life. A total of 58 patients (30 hypothermia, 28 control) completed the study. Hypothermia was well tolerated in this study and attenuated the hypoxic-ischemic brain injury due to perinatal asphyxia. Head CT scan demonstrated moderate to severe hypoxic-ischemic changes in only 4/30 cases from the hypothermic group. In contrast, 18/28 cases in the control group showed moderate to severe hypoxic-ischemic changes (chi (2)=15.97, P<0.01). Brain hypothermia also significantly improved the NBNA score (32+/-2 in the hypothermic group vs 28+/-3 in the control group, P<0.01). Our results suggest that selective head cooling may be used as a neuroprotective therapy in term neonates with perinatal asphyxia. A long-term follow-up study is needed to further validate the results of this study.