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The Neonatal Behavioral Assessment Scale

Hidenobu Ohta, S. Ohgi
Published 2013 · Medicine

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This is the latest update of the Neonatal Behavioral Assessment Scale (NBAS) manual, the previous (3rd) edition of which was published in 1995. The NBAS has been widely used for almost four decades internationally as a standard tool for research into the behavior of term and preterm infants. The scale has also enabled academic and clinical professionals to demonstrate to parents the remarkable abilities of newborns to communicate behaviorally and has helped researchers and clinicians objectively describe the neurobehavioral characteristics of newborns. Like the previous edition, the new release contains a manual for scoring NBAS items and also offers an improved section on the standard administration of the NBAS, including new guidelines and refinements to administration methods. The fourth edition also continues to recommend initial supervised training and periodic refreshers in the use of the tool for research and clinical purposes. Each examination item on the scale is categorized under one of four technical packages – habituation, reflex & motor, social interaction, or consoling maneuvers – in order to assess four domains of neurobehavioral functioning, (1) autonomic/physiological regulation, (2) motor organization, (3) state organization & regulation, and (4) attention/social interaction. The authors also provide a new series of selected topics of research conducted since 1995 which employ the NBAS in fields such as psychological preparation for parenthood, emotional communication among examiner, infant and parent, newborn infant risk factors, postpartum depression, and effects of breastfeeding on parenthood. Particularly useful new sections compare the NBAS and other neurobehavioral assessment methods such as Prechtl’s Assessment of General Movements (GMs), Milani Comparetti’s examination, and the Physical and Behavioral Newborn Examination (PEBE). These methods each have functional features in common with the NBAS, indicating how widely the NBAS has stimulated researchers and clinicians to try to understand the neuromotor development of infants and make them seek for the most suitable assessment scale for their own research and clinical needs. The NBAS is no longer the only the instrument available for evaluating the neurobehavioral characteristics of newborns. During the past 40 years, particularly in the field of neuromotor assessment for preterm infants, several neonatal examination tools, such as the Dubowitz Neurological Assessment of the Preterm and Full-term Infant (Dubowitz), the Assessment of Preterm Infants’ Behavior (APIB), the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS), the Test of Infant Motor Performance (TIMP), Prechtl’s Assessment of General Movements (GMs), the Neurobehavioral Assessment of the Preterm Infant (NAPI), and the Neuromotor Behavioral Assessment (NMBA) have all been developed. All these neonatal assessments, however, have been strongly influenced by the early work of Brazelton and Prechtl, with respect to scoring of neurobehavior, spontaneous movements and arousal levels (“behavioral states”). Moreover, due to the refinement of brain imaging techniques using ultrasound, CT, and MRI, we now rarely perform neurological evaluation of young infants just using traditional neurobehavioral assessment scales. Instead we know that a combination of clinical neurobehavioral assessments and brain imaging at appropriate stages (for instance, MRI imaging at term and at around 18 gestational months of age) is considered more reliable for predicting the developmental outcome of infants. Nevertheless, the NBAS has made a tremendous impact on the approaches of research and on medical examination methods. One of the reasons for this is that the scale sets out to examine the interactive and emotional capabilities of newborns. This concept quite differs from Prechtl’s approach, which avoids any interpretation of psychological factors, instead requiring examiners to systematically evaluate the various neurological responses of neonates by objectively documenting any deviations in these responses. In contrast, the NBAS assumes that the newborn is a social organism, predisposed to interact with her caregiver from the beginning and able to elicit the kind of care giving necessary for her species-specific survival and adaptation. The philosophy of the NBAS is to observe and emphasize the positive aspects of the infant’s behavior. A series of studies have shown that, using the NBAS, professionals and parents learn how to observe, assess, and interpret infant behavior in order to enhance interaction
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