NEUROBEHAVIORAL ASSESSMENT OF WELL & ILL PREMATURES OF ≤32 WEEKS GESTATION

Abstract

The Brazelton Neonatal Behavioral Assessment Scale, adapted for very premature infants, was used to assess the neurobehavioral status of 46 infants of ≤ 32 weeks gestation at age ≤3 days. There were 14 cases of uncomplicated prematurity (PBLC). The remaining 32 sustained complications such as respiratory distress syndrome, intracranial hemorrhage, hyperbilirubinemia, or sepsis; of these 13 died. The exam comprised standard reflex items, asessments of tone, color, posture, and Brazelton's behavioral items, eg, orientation and adaptation to repeated stimuli. PBLCs differed from the ill survivor group by displaying greater ability to adapt to repeated stimuli. PBLCs showed better orientation to, and following of, rattle, face, and voice. Their level of spontaneous and elicited activity was higher than that of ill survivors. PBLCs demonstrated more sustained alertness and were more easily brought to an alert state. Nonsurvivors attained lowest scores on items assessing orientation to light, rattle, and face. Nonsurvivors also exhibited lowest scores on the activity and alertness scales, were more difficult to bring to an alert state, were relatively hypoirritable, and tended to achieve a lower peak of arousal than the surviving prematures. Gross muscle tone did not distinguish reliably between the PBLCs and the nonsurvivor group. These results help define normal neurobehavioral function in very premature infants and thus identify abnormal findings with implications for clinical management.

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