Neonatal Behavioral Assessment Scale Research Articles

Prenatal particulate matter exposure is linked with neurobehavioural development in early life

BackgroundEarly life exposure to ambient particulate matter (PM) may negatively affect neurobehavioral development in children, influencing their cognitive, emotional, and social functioning. Here, we report a study on prenatal PM2.5 exposure and neurobehavioral development focusing on different time points in the first years of life. MethodsThis study was part of the ENVIRONAGE birth cohort that follows mother-child pairs longitudinally. First, the Neonatal Behavioral Assessment Scale (NBAS) was employed on 88 newborns aged one to two months to assess their autonomic/physiological regulation, motor organisation, state organisation/regulation, and attention/social interaction. Second, our study included 393 children between the ages of four and six years, for which the Strengths and Difficulties Questionnaire (SDQ) was used to assess the children's emotional problems, hyperactivity, conduct problems, peer relationship, and prosocial behaviour. Prenatal PM2.5 exposure was determined using a high-resolution spatial-temporal method based on the maternal address. Multiple linear and multinomial logistic regression models were used to analyse the relationship between prenatal PM2.5 exposure and neurobehavioral development in newborns and children, respectively. ResultsA 5 μg/m³ increase in first-trimester PM2.5 concentration was associated with lower NBAS range of state cluster scores (−6.11%; 95%CI: −12.00 to −0.23%; p = 0.04) in one-to-two-month-old newborns. No other behavioural clusters nor the reflexes cluster were found to be associated with prenatal PM2.5 exposure. Furthermore, a 5 μg/m³ increment in first-trimester PM2.5 levels was linked with higher odds of a child experiencing peer problems (Odds Ratio (OR) = 3.89; 95%CI: 1.39 to 10.87; p = 0.01) at ages four to six. Additionally, a 5 μg/m³ increase in second-trimester PM2.5 concentration was linked to abnormal prosocial behaviour (OR = 0.49; 95%CI: 0.25 to 0.98; p = 0.04) at four to six years old. No associations were found between in utero PM2.5 exposure and hyperactivity or conduct problems. ConclusionsOur findings suggest that prenatal exposure to PM may impact neurobehavioural development in newborns and preschool children. We identified sensitive time windows during early-to-mid pregnancy, possibly impacting stage changes in newborns and peer problems and prosocial behaviour in children.

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.

Prenatal particulate matter exposure is linked with neurobehavioral development in early life

Abstract Background Particulate matter (PM) is a major environmental health concern and there is growing evidence that early exposure to PM can have adverse effects on neurobehavioral development in children, including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). In this study, we hypothesized that prenatal PM2.5 exposure is linked with changes in neurobehavioral development in early life. Methods This study was part of the prospective ENVIRONAGE birth cohort and included 85 mother-newborn pairs. The Neonatal Behavioral Assessment Scale (NBAS) was administered to 1-2-month-olds to evaluate newborn's behavior. In addition, 392 children aged 4-6 years of the ENVIRONAGE cohort were included. The Strengths and Difficulties Questionnaire (SDQ) was used to assess the child's behavior. PM2.5 concentrations were determined by a high-resolution spatial-temporal method based on the maternal residential address. Multiple linear and multinomial logistic regression models were used to link prenatal PM2.5 exposure and neurobehavioral development in newborns and children, respectively. Results A 5 µg/m3 increase in PM2.5 concentration in early pregnancy was linked with lower scores for the NBAS range of state cluster (-0.22; 95% CI: -0.42 to -0.02; p = 0.03) in newborns aged 1-2 months old, as well as with higher odds of a child having peer problems (OR 3.90; 95% CI: 1.39 to 10.88; p = 0.01), higher total difficulties scores (OR 1.67; 95% CI: 1.01 to 2.78; p = 0.047), and abnormal prosocial behavior (OR 0.49; 95% CI: 0.25 to 0.98; p = 0.04) at age 4-6 years. Conclusions This study provides indications that prenatal PM2.5 exposure influences neurobehavioral development, both in newborns and in early childhood. This evidence suggests that reducing exposure to PM2.5 during pregnancy may be an important public health strategy for promoting optimal neurodevelopment in early life. Key messages • In utero PM2.5 exposure is related to changes in neurobehavior in newborns. • Prenatal PM2.5 exposure is linked with higher chances of abnormal behavior in children aged 4-6 years old.

Development of negative and positive emotionality in irritable and nonirritable neonates

ABSTRACT Objective The current study compares the development of negative and positive emotionality of irritable and nonirritable neonates. Background Research indicates that the first few months of life are marked by decreases in negative emotionality and increases in positive emotionality. Methods The Neonatal Behavioural Assessment Scale (NBAS) was administered twice to 111 neonates at 3 and 4 weeks of age to select a sample of irritable neonates and a comparison group of nonirritable neonates. Mothers completed assessments of negative and positive emotionality at 1, 2, 4, and 9 months of age. Results Both irritable and nonirritable neonates demonstrate a significant decrease in frustration and a significant increase in positive emotionality from 2 to 4 months of age. Irritable neonates also demonstrate a significant decrease in negative emotionality from 4 to 9 months of age. Both irritable and nonirritable neonates demonstrate considerable stability in negative and positive emotionality. Conclusion Implications of these results for parent education and early intervention are discussed.

Exploring the impact of COVID-19 on newborn neurodevelopment: a pilot study

The COVID-19 pandemic can seize the opportunity to explore the hypothesis of prenatal exposure to viral infections increases the risk for neurodevelopmental disorders. Advancing our knowledge in this regard would improve primary prevention of mental disorders in children. For this pilot study, six-week-old infants born to mothers exposed (n = 21) or unexposed (n = 21) to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were assessed in Santander-Cantabria (Spain) using the Neonatal Behavioral Assessment Scale (NBAS). Groups comparisons were performed to explore the effects that infection and timing of exposure (in terms of the three trimesters of pregnancy). The infants’ competencies and performances on the NBAS were generally similar in the exposed and unexposed to SARS-CoV-2 groups. The most significant difference found was a less optimally response to cuddliness (item on the state regulation domain) particularly in infants born to mothers exposed in the third trimester of pregnancy, and in pull-to-sit (item on the motor system domain). Although our interpretations must be careful, these preliminary results highlight the possible association between prenatal SARS-CoV-2 exposure and poorer development in motor skills and infant interactive behavior. Further longitudinal studies are needed to explore these relationships and disentangle the biological mechanisms implicated.

The Importance of Monitoring Neurodevelopmental Outcomes for Preterm Infants: A Comparison of the AIMS, GMA, Pull to Sit Maneuver and ASQ-3.

Clinicians and parents should closely monitor the neurodevelopment of very preterm infants. The aim of our study was to compare whether neurodevelopmental assessments completed by parents and those done by specialists yielded similar outcomes. We wanted to check whether the assessments completed by specialists and parents were comparable in outcomes to emphasize the important roles of early assessment of a child and of the parents in their child's treatment and medical care. Another aim was to check whether or not the pull to sit maneuver from the Neonatal Behavioral Assessment Scale (NBAS) is still a parable item in well-known scales of neurodevelopment. We assessed 18 preterm neonates in the fourth month of corrected age with scales such as the General Movement Assessment (GMA), the Alberta Infant Motor Scale (AIMS), and the pull to sit maneuver from the NBAS. Finally, we asked parents to complete the Ages and Stages Questionnaire, Third Edition (ASQ-3). We found that the respective assessments completed by specialists and parents are comparable in outcomes. We also found that the pull to sit item from the NBAS was still a valid test since it showed similar findings to those from the AIMS, the GMA, and the ASQ-3. The pull to sit item from the NBAS is an important item for assessment of very preterm infants. Specialists should also take into consideration the input and concerns of parents when planning for treatment and intervention.

Associations between maternal prenatal depression and neonatal behavior and brain function – Evidence from the functional near-infrared spectroscopy

BackgroundMaternal prenatal depression is a significant public health issue associated with mental disorders of offspring. This study aimed to determine if maternal prenatal depressive symptoms are associated with changes in neonatal behaviors and brain function at the resting state. MethodsA total of 204 pregnant women were recruited during the third trimester and were evaluated by Edinburgh Postpartum Depression Scale (EPDS). The mother-infant pairs were divided into the depressed group (n = 75) and control group (n = 129) based on the EPDS, using a cut-off value of 10. Cortisol levels in the cord blood and maternal blood collected on admission for delivery were measured. On day three of life, all study newborns were evaluated by the Neonatal Behavior Assessment Scale (NBAS) and 165 infants were evaluated by resting-state functional near-infrared spectroscopy (rs-fNIRS). To minimize the influences of potential bias on the rs-fNIRS results, we used a binary logistic regression model to carry out propensity score matching between the depressed group and the control group. Rs-fNIRS data from 21 pairs of propensity score-matched newborns were used for analysis. The associations between maternal EPDS scores, neonatal NBAS scores, and cortisol levels were analyzed using linear regressions and the mediation analysis models. ResultsCompared to the control group, the newborns in the depressed group had lower scores in the social-interaction and autonomic system dimensions of NBAS (P < 0.01). Maternal and umbilical cord plasma cortisol levels in the depressed group were higher (P < 0.01) than in the control group. However, only umbilical cord plasma cortisol played a negative mediating role in the relationship between maternal EPDS and NBAS in the social-interaction and autonomic system (β med = −0.054 [−0.115,−0.018] and −0.052 [−0.105,−0.019]. Proportional mediation was 13.57 % and 12.33 for social-interaction and autonomic systems, respectively. The newborns in the depressed group showed decreases in the strength of rs-fNIRS functional connections, primarily the connectivity of the left frontal-parietal and temporal-parietal regions. However, infants in the depressed and control groups showed no differences in topological characteristics of the brain network, including standardized clustering coefficient, characteristic path length, small-world property, global efficiency, and local efficiency (P > 0.05). The social-interaction Z-scores had positive correlations with functional connectivity strength of left prefrontal cortex-left parietal lobe (r = 0.57, p < 0.01)，prefrontal cortex-left parietal lobe - left temporal lobe (r = 0.593, p < 0.01) and left parietal lobe - left temporal lobe (r = 0.498, p < 0.01). Autonomic system Z-scores were also significantly positive correlation with prefrontal cortex-left parietal lobe (r = 0.509, p < 0.01)，prefrontal cortex-left parietal lobe - left temporal lobe (r = 0.464, p < 0.01), left parietal lobe - left temporal lobe (r = 0.381, p < 0.05), and right temporal lobe and left temporal lobe (r = 0.310, p < 0.05). ConclusionThis study shows that maternal prenatal depression may affect the development of neonatal social-interaction and autonomic system and the strength of neonatal brain functional connectivity. The fetal cortisol may play a role in behavioral development in infants exposed to maternal prenatal depression. Our findings highlight the importance of prenatal screening for maternal depression and early postnatal behavioral evaluation that provide the opportunity for early diagnosis and intervention to improve neurodevelopmental outcomes.

Neurobehavioural challenges experienced by HIV exposed infants: a study in South Africa

BackgroundThe newborn infant is a complexly organized, competent being, who plays an active role in shaping their environment through their increasing skills in autonomic regulation, motor control, regulation of state and social interaction. Infants born to HIV positive mothers, are exposed to HIV and antiretroviral therapy inutero, and may experience adverse effects from this.MethodsA cross-sectional study of 132 mother-infant dyads from a large public health hospital in South Africa. Infants were assessed using the Neonatal Behavioural Assessment Scale on day two of life, and mothers mental health assessed using the Edinburugh Postnatal Depression Scale. Medical and demographic data on mothers and infants was collected, including maternal age, HIV status, length of time on antiretrovirals, relationship status, employment status, gravid status, mode of delivery, infant anthropometrics and infant gender. Data was input into IBM SPSS statistics 21, where frequencies and percentages for descriptive analysis, and Chi-square and student’s two sample t-tests were run to compare data from HIV infected-exposed and HIV uninfected-unexposed mothers and infants.ResultsHIV exposed infants were smaller than HIV unexposed infants, even though low birth weight was an exclusion criteria. Statistically significant differences were found between HIV exposed and unexposed infants in neurobehavioiral items of social interaction (p = 0.00), motor system (p = 0.00) and state organization (p = 0.01), with HIV exposed infants performing less optimally in these domains. HIV exposed infants also presented with more abnormal reflexes. Infants born to depressed mothers showed superior motor skills, state organization and state regulation than infants born to mothers who did not score in the possibly depressed range.ConclusionsHIV exposed infants have inferior neurobehavioural functioning, which may affect their quality of life and ability to develop a reciprocal relationship with a primary caregiver. This may have an effect on development, behaviour and mental health in later childhood. HIV exposed infants shoud be monitored closely and their functioning in autonomic stability, motor control, resualtion of state and social interaction assessed regularly. Guidance for caregivers in incorporating strategies into the care of these infants is essential to buffer the possible long term negative effects on development.

The Influence of Parent Education on the Neurobehavior and Sucking Reflexes of Very Preterm Infants.

The diagnosis of neurobehavioral problems in very preterm neonates helps with planning and applying proper and direct therapeutic interventions. (1) Background: The aim of this study was to determine the direct impact of neurobehavior on the sucking reflex and eating abilities of neonates. (2) Methods: We assessed 18 preterm neonates twice hospitalized at the Gynecology and Obstetrics Clinical Hospital through the use of the Neonatal Behavioral Assessment Scale (NBAS). (3) Results: We found that that a neonate’s sucking ability positively correlated with the activity level item from the motor system cluster of the NBAS. (4) Conclusions: Neurobehavior should be closely assessed in very preterm neonates. Firstly, because assessments can detect fundamental problems and help a practitioner plan for early intervention. Secondly, the education of parents regarding the neurobehavior of their child can help in the facilitation of feeding skills and the planning of early rehabilitation.

Advantages of side-lying position. A comparative study of positioning during bottle-feeding in preterm infants (≤34 weeks GA).

BackgroundThe quality and safety of bottle-feeding in premature infants can be improved by optimal positioning. This study analysed the advantages of side-lying position (SLP) and semielevated position (SEP) during bottle-feeding in premature infants.Material and methodsA total of 42 neonates (n=42) born ≤34 weeks of gestational age were included in the study. Four feeding sessions—two in SLP and two in SEP— were analysed for each newborn. The level of saturation (SpO2) and heart rate, which are the parameters assessing the physiological stability, were measured in the studied newborns. The other factors that were examined to determine the quality of feeding included the total time of decline of SpO2 to ≤85%, level of the newborn’s alertness measured using the Neonatal Behavioral Assessment Scale, and the frequency of choking episodes. The proportion of milk consumed (volume of milk consumed relative to the volume expected) and the feeding duration as well as the total time of feeding session were recorded.ResultsSLP was safer in terms of the frequency of choking episodes. Choking episodes were more frequently observed with feeding in SEP (p<0.001). Moreover, the proportion of milk consumed by infants was statistically significantly higher in SLP (p<0.046) compared to SEP. No significant differences in the other tested parameters were noted in infants fed in SLP and infants fed in SEP.ConclusionsThis study demonstrated that SLP is effective in reducing the number of choking episodes during feeding. The proportion of milk consumed was better when the neonates were fed in SLP.

Childhood and recent maternal adverse experiences and mother-infant attachment influence early newborns’ neurobehavioural profiles

IntroductionMaternal stress during pregnancy influences fetal neurodevelopment, especially by the dysregulation of the HPA axis. However, less is known about whether maltreatment or stressful life experiences previous to pregnancy influence on developmental outcomes in the offspring.ObjectivesTo analyze newborns’ neurobehavioral profiles in a cohort of healthy pregnant women, according to 1) childhood and recent maternal adverse experiences and 2) mother-infant attachment.Methods150 women were followed during the three trimesters of pregnancy. CTQ and AAT tests were employed to evaluate childhood and recent experiences of maltreatment, while infant and recent adverse experiences were evaluated using ETI-SR and SRSS, respectively. Newborns neurobehavioral profiles were defined at 8 weeks using the Neonatal Behavioral Assessment Scale (NBAS) and their temperament was assessed with IBQ. PBQ and PAI scales were employed to assess mother-infant attachment. A linear regression model was performed, adjusting for possible confounders.ResultsMaternal childhood sexual abuse seems to be associated with greater difficulties in the newborns control of reactivity to external stimuli (β=0,517; p-value=0.001), while recent maternal stressful experiences are related to difficulties for states regulation (β=0,29; p-value=0,038). Regarding attachment, maltreated mothers tend to show ambivalent and avoidant styles. Interestingly, postnatal mother-infant attachment seems to modulate autonomous, motor and social-interactive abilities in the offspring (β=-0,227; p-value=0,033 // β=-0,329; p-value=0,006).ConclusionsNewborns from mothers exposed to maltreatment and negative life events previous to pregnancy show difficulties to organize and regulate the reactions to psychosocial stimuli. Future studies must disentangle whether maternal attachment style is a modulator of this association.DisclosureNo significant relationships.

EFFECT OF COMPREHENSIVE APPROACH ON FEEDING ABILITY OF INFANT WITH FACIAL NERVE PALSY &amp; MICROTIA GRADE 4: A CASE REPORT

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. it can be congenital or acquired. The unilateral facial paralysis can be suspected when, in absence of front and nasolabial groove motility, there is also asymmetry of the face with buccal deviation when crying. The custom-made Facial splint of low-temperature thermoplastic material can support the weak muscle &amp; prevent the deviation. The infant was referred to Occupational Therapy with facial palsy grade IV. The aim of our study is evaluating the immediate functional outcome, while using the custom-made splint. The patient was assessed twice (i.e. Baseline &amp; after 6 weeks) on Neonatal Behavioral Assessment scale (NBAS), Neonatal Oral Motor Assessment Scale (NOMAS), Nonnutritive sucking scoring system, Preterm Infant Feeding Readiness Assessment Scale &amp; Parent stress scale was used to track the feeding readiness &amp; parental stress respectively during intervention. On NBAS, Level 3 to level 5. On NNSS, infant scored 2 to 6 scoring system on non-nutritive sucking &amp; on NOMAS baby scored from 19 to 22. Her ability to initiate suck was improved considerably. Improvement in scores of Preterm Infant Feeding Readiness Assessment Scale at baseline &amp; after 6 weeks. Infant scored 65 to 57 on Parent Stress Scale. In this study, Family Centered approach &amp; the need-based intervention, a custom-made facial splint of low-temperature thermoplastic material along with face strap effective to facial palsy patient, along with conventional Occupational Therapy intervention.

The Comparison of Three Assessment Scales in a Neonatal Unit in Poland

Abstract The aim of this study was to analyse the relationship between the following three assessments: the Neonatal Behavioral Assessment Scale (NBAS), the Alberta Infant Motor Scale (AIMS), and the General Movement Assessment (GMA). 29 patients from the neonatal unit of the Gynecology and Obstetrics Clinical Hospital were examined. The study was conducted between feedings by a person properly trained in the use of the NBAS, the AIMS, and the GMA. The average postmenstrual age of the examined newborns was 35.6 weeks. The average week of gestation was the 29th, the average birth weight was 1469 g, and the Median Apgar score in the fifth minute of life was 7. A relationship was found between the AIMS and the NBAS. It was concluded that the Neonatal Behavioral Assessment Scale and the Alberta Infant Motor Scale may be used to determine the motor development of preterm infants. Moreover, it is advisable to use more than one assessment method in order to adjust the intervention.

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.

Increased maternal inflammation and poorer infant neurobehavioural competencies in women with a history of major depressive disorder from the psychiatry research and motherhood – Depression (PRAM-D) study

IntroductionStress in pregnancy is associated with adverse outcomes in offspring, and developmental programming is a potential mechanism. We have previously shown that depression in pregnancy is a valid and clearly defined stress paradigm, and both maternal antenatal and offspring stress-related biology is affected. This study aims to clarify whether maternal biology in pregnancy and offspring outcomes can also be influenced by a history of a prior depression, in the absence of depression in pregnancy. Our primary hypothesis is that, similarly to women with depression in pregnancy, women with a history of depression but who are not depressed in pregnancy will have increased cortisol secretion and markers of immune system function, and that their offspring will have poorer neuro-developmental competencies and increased cortisol stress response. MethodsA prospective longitudinal design was used in 59 healthy controls and 25 women with a past history of depression who were not depressed in pregnancy, named as ‘history-only’, and their offspring. Maternal antenatal stress-related biology (cortisol and markers of immune system function) and offspring outcomes (gestational age at birth, neonatal neurobehaviour (Neonatal Behavioural Assessment Scale, NBAS), cortisol stress response and basal cortisol at 2 and 12 months) and cognitive, language and motor development (Bayley Scales of Infant and Toddler Development (BSID)) were measured. ResultsCompared with healthy pregnant women, those with a history of depression who remain free of depression in pregnancy exhibit increased markers of immune system function in pregnancy: IL-8 (d = 0.63, p = 0.030), VEGF (d = 0.40, p = 0.008) and MCP-1 (d = 0.61, p = 0.002) and have neonates with lower neurobehavioural scores in most areas, reaching statistical significance in thesocial-interactive (d = 1.26, p = 0.015) cluster. However, there were no differences in maternal or offspring HPA axis function or in infant development at 12 months. ConclusionOur study indicates that pregnant women with a history of depression have increased markers of immune system function, and their offspring show behavioural alterations that may be the effects of in utero programming, epigenetic factors or genetic predisposition.

Antenatal and perinatal factors associated with newborn behavior: A prospective cohort study

The idea that the newborn is an uncharted and therefore pliable organism, which can be formed according to the will of its parents, has long been rejected, especially after the existence of rules of behavior not only in full-term but also in marginally premature newborns, which are affected by various both prenatal and perinatal factors. The ability of newborns to determine the rules of their behavior according to the stimuli they receive from internal and external factors, has been the subject of many years of research and has led pediatricians and other health professionals to develop a model for grading these newborn abilities. Thus, the Neonatal Behavioral Assessment Scale (NBAS) was created, and it has been used by researchers for more than 40 years. It is a research tool with wide application, as many of the points it addresses, can be integrated into other means of assessing the newborn’s abilities. This scale also has an ever-evolving application as a clinical tool in parental assessment.

Application of the Neonatal Behavioral Assessment Scale to Evaluate the Neurobehavior of Preterm Neonates.

Background: The neonatal behavioral assessment scale (NBAS) was primarily developed to aid in the assessment of full-term neonates. The aim of this study was to detect if the NBAS was also valuable in the assessment of preterm neonates. Materials and Methods: We assessed 112 infants at a neonatal unit using the NBAS, 4th edition. The inclusion criteria included an oxygen saturation level between 88–95% and a heartrate of 100–205 beats per minute. Infant neurobehavior was assessed using the NBAS. Results: For full-term and preterm neonates, we observed that the NBAS enabled us to assess both groups of infants and gave relevant information pertaining to them. We found a significant correlation between the average week of gestation and response to touch, sensory input, peak of excitement, cost of attention, hand-to-mouth, and quality of alertness. Conclusions: The NBAS is a valuable scale for evaluating the neurobehavior of preterm neonates. The week of gestation at birth affects certain aspects of neurobehavior, such as response to sensory input, putting hand to mouth, peak of excitement, and cost of attention. The NBAS as an individually structured assessment may help in planning for early rehabilitation and intervention for this vulnerable population.

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.

NEONATAL OUTCOMES IN POSTPARUM PSYCHOSIS

We aimed to examine neonatal behaviour and cortisol reactivity in neonates born to women at risk of postpartum psychosis (AR) who had a psychiatric relapse within 4 weeks post-delivery (AR-unwell), compared with neonates of women at risk who stayed well (AR-well) and those born to healthy women (HC). We assessed neonatal behaviour using the Neonatal Behavioral Assessment Scale (NBAS), performed on 105 neonates (AR-unwell=17; AR-well=27; HC=61). Neonatal cortisol was measured pre-, immediately post- and 30-minutes post-NBAS. Neonates born to AR women did not differ from those born to HCs in behaviour or cortisol reactivity. There was also no difference in behaviour between neonates born to AR-unwell women and those born to AR-well women. However, neonates born to AR-unwell women had significantly lower pre-NBAS cortisol compared with neonates of AR-well women (t(38)=2.3, p=.02). Neonates of AR-unwell women also had a greater increase in cortisol from pre- to post-NBAS, though the difference did not reach statistical significance (p=.12), and a greater increase from pre- to 30 minutes post-NBAS (t(32)=2.7, p=.01). Maternal postpartum symptoms appear to disrupt the stress response of neonates whose mothers are at risk of postpartum psychosis.

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.