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Book review: The Neonatal Behavioral Assessment Scale


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Review of the book The Neonatal Behavioral Assessment Scale

T Berry Brazelton and J Kevin Nugent

Fourth Edition, Clinics in Developmental Medicine No. 190

2011 Mac Keith Press

This is the Fourth edition of the Neonatal Behavioral Assessment Scale (NBAS), coming about 28 years after the first edition, the period during which there has been learnt so much. Since that time, the scale was recognized as Brazelton scale. There are 8 Chapters, each containing valuable information and instruction how to perform the assessment.

In the first Chapter, the history, background and the conceptual basis of the NBAS are thoroughly presented, stressing the issue of the importance of the neonatal behavior, describing the shift in thinking that these features are not passive ones, but active participants in then life. Some information have been changed meanwhile, and nowadays it is shown that the newborn can see, could orient towards a sound as early as 8 hours of age, and could respond differently to positive and negative stimuli. All these have put new light to the neonatal behavior. The NBAS items cover four domains of neurobehavioral functioning:

• Autonomic/physiological regulation

• Motor organization

• State organization and regulation

• Attention/social interaction.

It is important to note that the presented NBAS can be used in different cultural settings that make it useful and applicable. Having all these in mind, it could be easily suggested that NBAS could play a key role in the emerging field of cognitive neuroscience.

Chapter 2 works out the Standard administration of NBAS. Although it was developed as an empirical instrument to assess the behavior of the neonate, it was shown that performing the NBAS require experienced examiner, and his thorough preparation. The ability to perform the NBAS contains two phases: preparatory/training phase and reliability phase. Not only the examiner, there is a need for special preparation of the environment for conducting the NBAS, as for example: midway between feedings, quiet, semi-darkened room, room temperature 22-27 C, clean content of kit with cleansing pads, etc. The Summary of Habituation, Reflex and Motor Items administrations are presented very clearly, explicitly, and pretty possibly applicable.

In the Chapter 3 there are presented some general guidelines for scoring the NBAS, and the keys to successful scoring. These guidelines are crucial for drawing out the infants’ best performance during the examination.

Not only as clinical observational method, the NBAS can be used as a research tool in many different ways, thus enabling to be studied all additional factors affecting the neonatal behavior, as prenatal maternal influences, including social factors, pregnancy, labor and child birth, and early postnatal period as well.

In this Chapter (4) are presented all discovered differences in the neonatal behavior related to the maturity of the infant. All information is presented in terms of the possibility to predict long-term outcomes and continuities from NBAS data collected in the neonatal period.

The Psychological context of the NBAS is a topic of the Chapter 5. Very colorfully is described the state of “becoming a mother”. The “motherhood constellation” is described in four major themes, each of them describing the requirements and responsibilities of this new role. The comparison is presented between the mother and the father, and the process of preparation for parenthood is perfectly described.

As a good point is the author’s remark that the NBAS is designed to serve as a basis for new advances in the study of motor behavior in preterm and term infants, as they behave differently due to their difference in maturity. The Chapter 6 presents the repertoire of the fetal motor achievements. The fetal period is crucial in the further model of neonatal behavior.

The important point is given to the inter-relationship between the examiner, infant and parents in the use of the NBAS, presented in the next Chapter. This interaction is a kind of emotional communication, counter-transference, and examiner’s emotional response.

The final, Chapter 8, is a summary of different reports regarding training experience while conducting the NBAS. Those presented models and case studies can help in designing setting-specific modules for training, performance, data collection, analysis and reporting the results. The last Chapter enriches the book at all with real experience.

The Appendix contains the NBAS scoring form, helpful for each individual and group dedicated to observation of the neonatal and infant behavior.

And the last unavoidable part is the rich spectrum of literature based on broad knowledge, experience, research activities and information.

An overall summary: it was great pleasure reviewing the Neonatal Behavioral Assessment Scale book written by T Berry Brazelton and J Kevin Nugent. The information, research news, clinical guidelines extracted out of it and used during the clinical job are of tremendous importance for anyone who deals with newborns, either preterm, high-risk or healthy term infants, because inside the both covers lye rich experience of almost three decades observation of the neonatal behavior.

Prof d-r Elizabeta Zisovska

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