Training and Employment Orientation Presentation

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Observation of the Newborn

presented by Ariadna and Antonia

October 18, 2024

presentation by Ariadna and Antonia

Administration of NBAS

Fetal Observation

Presenting the infant and the mother

Introduction to NBAS

Signs of maturity

Research

Alicia

• born on October 5, 2024 at 11am
• at the time of observation not even 48 hours old
• born at 39 weeks
• born by cesarean section
• labour 24 hours

clara

• mother of Alicia
• 36 year old
• works in a restaurant as a cook
• first pregnancy
• her partner is a 44 year old bus driver
• during pregnancy running the risk having a premature birth
• visited 2 times the hospital to reduce the risk of a premature birth

The observation

• October 4
• interview of the mother
• NBAS
• Post-discussion of the observation

• The mother appeared very curious, cooperative, and provided positive responses
• Alicia demonstrated continuous improvement throughout the examination
• Alicia was highly attentive while the mother spoke

Hospital visit

Our experience

• assessment of newborns' neurological development, behavior, and reflexes, often evaluated to determine their general well-being and developmental maturity.

Introduction to NBAS

• Neonatal Behavioral Assessment Scale

Objectives of NBAS

Assessing Neurological FunctionNBAS evaluates the newborn’s motor control, reflexes, and sensory processing, helping to identify potential neurological abnormalities or developmental delays.

Evaluating Behavioral Responses: It examines how the newborn interacts with the environment, including responses to stimuli (e.g., light, sound) and their ability to regulate sleep, alertness, and crying.

Screening for Early Developmental Issues: NBS identifies signs of possible developmental or behavioral challenges that may require early intervention, such as difficulties with self-regulation, feeding, or bonding.

Supporting Parent-Infant Interaction: The assessment can provide valuable feedback to parents, helping them understand their newborn’s behavior and needs, which promotes bonding and care.

The NBAS items cover these four domains of neurobehavioral functioning:

NBAS

• What does the scale mesure?

Autonomic/physiological regulation: the infant’s homeostatic adjustments of the central nervous system as reflected in color change, tremors and startles.

Motor organization: the quality of movement and tone, activity level and the level of integrated motor movements.

State organization and regulation: infant arousal and state lability, and the infants’ ability to regulate their state in the face of increasing levels of stimulation.

Attention/social interaction: the ability to attend to visual and auditory stimuli and the quality of overall alertness.

Brazelton, T. B. (1973). Neonatal Behavioral Assessment Scale.

ADMINISTRATION SEQUENCE OF THE ITEMS

Over the first few weeks, babies begin tracking objects and showing curiosity about their surroundings. These early cognitive signs provide insight into the infant’s developmental trajectory.

A newborn's reactions to light, sound, and touch help assess sensory maturity. For instance, being startled by a loud noise or focusing on faces indicates that sensory pathways are functioning properly.

Eye contact, smiling, and turning towards sounds or voices are early social behaviors that suggest maturity. Babies also start responding to familiar faces and voices, which shows their cognitive and social growth.

Head control and the ability to engage in spontaneous movement are early motor indicators.

Newborns demonstrate reflexes like sucking, grasping, and the Moro (startle) reflex. The presence and gradual integration of these reflexes signal healthy brain development.

Signs of maturity in newborns

Motor Skills:

Social Interaction:

Sensory Responses:

Cognitive Milestones:

Neurological Reflexes:

Baby seemed to be in state 2 (shallow sleep) after the observation of the initial state, and she awakened as the habituation package progressed.

administration of the nbas

observation of the initial state

Baseline for measuring the baby’s capacity to shut out negative stimuli. Observing her spontaneous behavior, respirations, eye movements, startles and responses to concurrent spontaneous events in the environment.

the HABITUATION PACKAGE

Response decrement to light: light presented 4 times, at first she responded moving the legs and with subtle arm movements too. Shutdown of body movements after 4 presentations of the stimuli

Response decrement to sound-rattle: Rattle sound presented 5 times. Shutdown of body movements after 5 presentations of the stimuli

Response decrement to sound-bell: first the baby kept the hands near her face and moved her legs to her belly slightly. After the third presentation, transition to state 3 (drowsy)

Uncover: the state did not change before and after being uncovered https://share.icloud.com/photos/01fCdDbCY7bp6-hb1sPk7XeEQ

Babinski reflex: when the lateral part of the foot is stimulated, she moved her toes apart

Sucking reflex: She sucked hard, and then she opened the mouth

the MOTOR-ORAL PACKAGE

Plantar grasp: In the right foot we observed the flexion of the toes since the first presentation, but in the left foot it took 3 times to observe it. At first we can observe the moro reflex

Passive tone in legs: when the teacher pulled her legs down, she rapidly brought them to her belly again, and then she extended them

Passive tone in arms: When the teacher pushed her arms down, the girl quickly pulled them forward again

Rooting response: The baby repeatedly tried to bring her hands to her mouth, so the professor held them. The baby opened her mouth slightly

the truncal PACKAGE

Undressing: while undressing, the baby moved the legs and the arms repeatedly and moaned without starting to cry. She also moved her hands into the face to regulate herself

Palmar grasp: we observed a strong and sustained grasp as the teacher put his finger to her hand

Pull-to-sit: after being pulled by her hands, she managed to sit well and brought her head through midline easily. She can maintain head control without apparent stress

the truncal PACKAGE ii

Stepping reflex: she was able to do the stepping movements. She moaned more, so maybe she was a little stressed

Crawling reflex: after being put in in supine position, she moved her head to one side to breathe properly and moved her arms. As she didn’t move the feet in a crawling motion, the professor pressed the thumbs up against the soles of her feet to stimulate this response

Cuddlines: the baby calmed down even more but she was still paying attention to the mother

the vestibular PACKAGE

Asymetric tonic neck reflex: strong on the left side, but on the right side it happened to be delayed. On both sides we could observe the arms always close to the face

Defensive movement: when the bodysuit was put over her eyes, we observed general quiety of the baby, maybe because she wasn’t in alert state

Moro reflex: the teacher held the baby suspended midway between the horizontal and vertical, and then he slightly released her. She opened the legs and the arms, and then flexed them again near the trunk to protect himself

the social interactive PACKAGE

Inanimate visual orientation (red ball): she followed the ball with her eyes and her head in all the presented directions

Inanimate auditory orientation: the teacher shook the object out of the baby’s rang of vision, and she turned her head to the stimuli on both sides, while moving the hands

Inanimate visual and auditory orientation: she seems very interested in following the ball with her head and her eyes

the social interactive PACKAGE ii

Animate auditory orientation: when the professor used his voice, the baby could easily locate it and turned her head to him

Animate visual orientation: the baby followed the professor’s head with interest

Animate visual and auditory orientation: the baby seems curious and follows the professor head and voice

Pitcher, J. B., Schneider, L. A., Drysdale, J. L., Ridding, M. C., & Owens, J. A. (2011). Motor system development of the preterm and low birthweight infant. Clinics in perinatology, 38(4), 605–625. https://doi.org/10.1016/j.clp.2011.08.010

Contrast in the behavior of preterm and full-term infants

Research

Motor system development of the preterm and low birthweight infant

- Preterm birth disrupts brain development, especially in motor and sensory areas. - Motor system vulnerability - Motor and cognitive development are linked: Reduced motor cortex excitability in preterm infants can increase the risk of learning difficulties. - Early diagnosis and intervention are crucial to help improve outcomes for preterm infants with motor system damage

Peralta-Carcelen, M., Schwartz, J., & Carcelen, A. C. (2018). Behavioral and Socioemotional Development in Preterm Children. Clinics in perinatology, 45(3), 529–546. https://doi.org/10.1016/j.clp.2018.05.003

Contrast in the behavior of preterm and full-term infants

Research

Behavioral and Socioemotional Development in Preterm Children

- Prematurity is a significant risk factor for impaired neurodevelopmental outcomes (motor, cognitive, language, behavioral, and socioemotional competence) - The vulnerability of the preterm brain during critical periods of development contributes to behavioral and socioemotional problems in preterm children - Early detection of this problems would enable timely early intervention to improve long-term functional outcomes

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