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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.

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.

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.