Behaviors of very preterm neonates as documented using NIDCAP observations.

PURPOSE: The purpose of this study was to describe the range and frequency of behaviors in neonates 24-30 weeks postconceptional age (PCA) using the Newborn Individualized Developmental Care Assessment Program (NIDCAP). DESIGN: A prospective design with convenience sampling was used. SAMPLE: Starting 24-72 hours postnatally and continuing through 30 weeks PCA, 8,144 two-minute observations of 85 NIDCAP behaviors were collected and analyzed from 42 neonates born at 24-29 weeks gestation. MAIN OUTCOME VARIABLE: The main outcome variables were the frequencies of the 85 neonatal behaviors measured by the NIDCAP. Frequencies were organized first by subsystem (autonomic, motor, or state) and were categorized further based on week of PCA. Comparisons of behavioral frequencies by number of weeks PCA were completed using correlation and regression analyses. RESULTS: The most frequently observed behaviors were irregular respirations, pink color, postured flexion of the extremities, immature light sleep, and drowsiness. Least frequently observed behaviors consisted of burps, bowel movement, grunting, smooth motor movements, cooing, and speech movement. Regression analysis illustrated that the pattern of behavior was significantly similar week to week.

The conceptualization, measurement, and validation of transient mechanical birth trauma.

An index of transient mechanical birth trauma (TMBT), consisting of the presence or absence of molding, cephalohematoma, subconjunctival hemorrhage, body bruising, facial bruising, petechiae, forceps marks, diminished arm movements, and sensitivity to sudden position changes, was measured on a convenience sample of 196 healthy newborns. Six dimensions of the Neonatal Behavioral Assessment Scale (NBAS) and other newborn measures also were assessed. Vaginally delivered newborns had more TMBT than those delivered by cesarean section and of newborns delivered vaginally, macrosomics had more TMBT than nonmacrosomics. TMBT positively correlated with range of state, individual reflex items of resistance to left and right arm movement, predominant state during the NBAS exam, and time to complete the NBAS exam. TMBT negatively correlated with newborn state instability and 1- and 5-minute Apgars. The results supported the measure's validity and are discussed in terms of implications for practice and further research to explore TMBT's usefulness.

Behavioral responses of newborns of insulin-dependent and nondiabetic, healthy mothers.

The purpose of this study was to compare the behavioral responses of term newborns of insulin-dependent diabetic mothers (NDMs) with newborns of nondiabetic, healthy mothers. The research design involved matched controls with repeated measures. Participants included 40 NDMs matched with 40 newborns of nondiabetic, healthy mothers. The main outcome measures were the seven dimensions of the Neonatal Behavioral Assessment Scale (NBAS) and the modal response score. The results showed that NDMs performed significantly poorer than their matched controls on motor processes and reflex functioning. For all newborns, motor processes, autonomic stability, reflex functioning, and the modal performance score were better on Day 2 than Day 1. It was concluded that although NDMs' behavioral responses improved by Day 2, their overall pattern of responses could be described as listless or sluggish. Due to their poorer motor and reflex responses, NDMs may require increased efforts to facilitate sensitive maternal responding during their first days of life.

A comparison of newborns' NBAS reflex responses using total and individual scores. Neonatal Behavioral Assessment Scale.

The purpose of this study was to compare results found using a total summative score of abnormal reflex responses with the results found using individual reflex scores. The 20 reflexes included as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS) were assessed on 196 neonates on the 1st and 2nd days postnatally. Differences due to of type of delivery, birth weight, whether their mothers were insulin-dependent diabetics or nondiabetics, and day of testing were assessed by using analysis of variance. The key results were that all effects found using the total reflex score were replicated with individual reflex scores and that individual reflex scores also revealed effects not shown using the total score. It was concluded that the individual reflex scores, rather than the total score, should be used when evaluating newborn reflex performance.

Newborn neurologic screening using NBAS reflexes.

The neurologic examination of the newborn infant is not easy. The nurse or physician must have technical skill in handling infants and be familiar with eliciting, scoring, and interpreting reflexes. Because it is too costly to conduct full neurologic exams on all newborns, a screening can be performed to help select infants for whom detailed examination is indicated. Given the trend to discharge term newborns within 12 to 24 hours following delivery and the importance of being sure that abnormalities have not been overlooked prior to discharge, completing a neurologic screen during this early time period is warranted. Although professionals have been trained and certified to conduct Neonatal Behavioral Assessment Scale (NBAS) exams for more than 20 years at NBAS Training Centers, the NBAS text does not adequately explain how to perform reflex assessments so they can be administered reliably across multiple examiners. This article describes how to perform these reflex assessments so they can be used consistently by nurses and physicians as a neurologic screen in a variety of settings.

Behavior of macrosomic and appropriate-for-gestational-age newborns.

OBJECTIVE: To compare the behavior of macrosomic newborns who were vaginally delivered of healthy mothers without diabetes with that of non-macrosomic, appropriate-for-gestational-age (AGA) newborns. DESIGN/SETTING: Newborns were recruited conveniently from a tertiary hospital. Newborns were examined at 12-24 and 36-48 hours of age, using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). PARTICIPANTS: Thirty macrosomic newborns who were delivered vaginally were matched with AGA newborns for ethnicity, maternal education, parity, and obstetric medications. MAIN OUTCOME MEASURES: Dimensions scores derived from the individual NBAS items measured reflex functioning, response decrement, orientation, motor processes, range of state, autonomic stability, and regulation of state. RESULTS: Macrosomic newborns performed weaker than AGA newborns on the reflex and motor dimensions. Both groups displayed improved motor scores on Day 2, but regulation of state scores were weaker. For orientation, AGA newborns scored higher on Day 1, and macrosomic newborns scored higher on Day 2. CONCLUSIONS: Increased head, limb, and body mass of macrosomic newborns, compared with adjacent and overall muscle strength, might have interfered with the execution of coordinated movements. Nurses can inform mothers of changes they can expect in their newborns' behavior.

Scholarly mission. Fostering scholarship in research, theory, and practice.

After the publication of Ernest Boyer's book on Scholarship Reconsidered in 1990, campuses across the nation began debating how scholarship is recognized and rewarded. The current system mainly recognizes and rewards faculty for their scholarly achievements in research. However, Boyer's book has called attention to the need for a paradigm for evaluating scholarship that better articulates with the world of an academician. According to Boyer (1990), it is time to recognize the full range of faculty talent that includes research as well as three other equally important areas of scholarship: teaching, integration, and application (practice). The emergence of nursing science as an independent academic discipline valued by society and health consumers parallels the professional and social demands to assume full responsibility for nursing decisions, actions, and outcomes. The scholarly mission of VUSN is based on the values shared by the faculty that excellence and innovation in preserving and advancing the science, art, philosophy, and history of nursing is accomplished through the components of theory, research, and practice. The faculty believe the interrelatedness of the three components forms the basis for the development of scholarliness in both its students and faculty.

Strategies useful in caring for macrosomic newborns.

Newborn macrosomia has been shown to be significantly related to weaker reflex functioning, poorer motor behavior, and decreased state regulation during the first 2 days of life. Macrosomic newborns' behavior patterns suggest that special strategies are indicated in order to decrease the effects that limb and body mass have on the execution of coordinated movements and spontaneous motor patterns. This article highlights techniques that have been found to be effective in handling, arousing, and quieting macrosomic newborns during interactions involving the Brazelton Neonatal Assessment Scale.