Clinical application of the Newborn Behavioral Observation (NBO) System to characterize the behavioral pattern of newborns at biological and social risk

Guimarães, Marina Aguiar Pires; Alves, Claudia Regina Lindgren; Cardoso, Ana Amélia; Penido, Márcia Gomes; Magalhães, Lívia de Castro

doi:10.1016/j.jped.2017.05.014

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Original articles • J. Pediatr. (Rio J.) 94 (3) • May-Jun 2018 • https://doi.org/10.1016/j.jped.2017.05.014 copy

Clinical application of the Newborn Behavioral Observation (NBO) System to characterize the behavioral pattern of newborns at biological and social risk^☆ ☆ Please cite this article as: Guimarães MA, Alves CR, Cardoso AA, Penido MG, Magalhães LC. Clinical application of the Newborn Behavioral Observation (NBO) System to characterize the behavioral pattern of newborns at biological and social risk. J Pediatr (Rio J). 2018;94:300-7. , ^☆☆ ☆☆ Study carried out at Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the behavior of preterm newborns and full-term newborns using the Newborn Behavioral Observation and to evaluate the mothers' experience when participating in this observation.

Method

This was a cross-sectional study performed at a referral hospital for high-risk births, involving mothers and neonates before hospital discharge. The mothers answered the sociodemographic questionnaire, participated in the Newborn Behavioral Observation session, and evaluated the experience by answering the parents' questionnaire at the end. The characteristics of the preterm newborn and full-term newborn groups and the autonomic, motor, organization of states, and responsiveness scores were compared. Linear regression was performed to test the association of the characteristics of mothers and neonates with the scores in the autonomic, motor, organization of states, and responsiveness domains.

Results

The Newborn Behavioral Observation was performed with 170 newborns (eight twins and 77% preterm newborns). Approximately 15% of the mothers were adolescents and had nine years of schooling, on average. The groups differed regarding weight for gestational age, age at observation, APGAR score, feeding, and primiparity. The linear regression adjusted for these variables showed that only prematurity remained associated with differences in the scores of the motor (p = 0.002) and responsiveness (p = 0.02) domains. No statistical difference was observed between the groups in the score attributed to one's own knowledge prior to the session (p = 0.10). After the session, these means increased in both groups. This increase was significantly higher in the preterm newborn group (p = 0.02).

Conclusions

The Newborn Behavioral Observation increased the mothers' knowledge about the behavior of their children, especially in mothers of preterm newborns, and identified differences in the behavior of preterm newborns and full-term newborns regarding the motor and responsiveness domains.

KEYWORDS
Behavior; Child development; Preterm; Newborn

Characteristics of neonates	Group		p
	Preterm (n = 131)	Full-term (n = 39)
Gender, n (%)
Male	64 (48.8)	22 (56.4)	0.14^a a Mann–Whitney's test.

Gestational age, weeks (mean ± SD)	33.1 (2.2)	39.4 (1.3)	0.001 ^a a Mann–Whitney's test.
(range)	(25.8–36.7)	(37–41.7)

Birth weight, g (mean ± SD)	1770.6 (521.3)	3170.7 (486.5)	0.001 ^a a Mann–Whitney's test.
(range)	(750–3225)	(1505–3900)

Weight for gestational age, n (%)
Small	45 (34.3)	4 (10.3)
Adequate	80 (61.1)	34 (87.1)	0.009 ^b b Chi-squared test.
Large	6 (4.6)	1 (2.6)

Days of life, days (mean ± SD)	16.9 (12.7)	5.7 (2.3)	0.001 ^a a Mann–Whitney's test.
(range)	(3–67)	(1–12)

Corrected age at the time of observation, n (%)
<37 weeks	112 (85.5)	–	–
PTN ≥ 37 weeks	19 (14.5)

Apgar 1st minute (mean ± SD)	7.7 (1.7)	8.4 (1.3)	0.005 ^a a Mann–Whitney's test.
(range)	(2–10)	(4–10)

Apgar 5th minute (mean ± SD)	8.9 (1.2)	9.5 (0.6)	0.002 ^a a Mann–Whitney's test.
(range)	(3–10)	(7–10)

Type of feeding, n (%)
Exclusive breastfeeding	101 (77.1)	34 (87.2)	0.002 ^b b Chi-squared test.
Complementary breastfeeding or formula	30 (22.9)	5 (12.8)

Alertness status at the time of observation, n (%)
Deep sleep	48 (36.6)	20 (51.3)
Light sleep/sleepy	52 (39.8)	7 (18.0)	0.06^b b Chi-squared test.
Quiet alert	29 (22.1)	10 (25.6)
Agitated alert/crying	2 (1.5)	2 (5.1)
Characteristics of mothers	Group		p
	Preterm (n = 123)	Full-term (n = 39)
Age, n (%)
<19 years	22 (17.7)	2 (5.1)	0.09^b b Chi-squared test.

Years of study, years (mean ± SD)	9.4 (2.9)	9.3 (2.7)	0.52^a a Mann–Whitney's test.
(range)	(2–18)	(4–16)

Marital status, n (%) ^c c 11 mothers without this information.
Married or common-law marriage	69 (57.0)	23 (62.1)	0.33^b b Chi-squared test.
Divorced, separated or single	52 (42.9)	14 (37.8)

Economic Classification Criteria, n (%) ^d d 27 mothers with no information.
A + B	21 (17.1)	5 (13.2)	0.26^b b Chi-squared test.
C + D/E	84 (82.9)	33 (86.8)

Parity, n (%)
Primiparous	73 (59.8)	16 (40.0)	0.04 ^b b Chi-squared test.

Variables	Autonomic			Motor			Organization			Responsiveness^a a These items were not observed in 21 children, due to alertness at the time of observation.
	n	Median	p ^b b Mann–Whitney's test.	n	Median	p ^b b Mann–Whitney's test.	n	Median	p ^b b Mann–Whitney's test.	n	Median	p ^b b Mann–Whitney's test.
Prematurity
Yes	131	2	0.8	131	2.5	0.002	131	2.3	0.9	115	2.2	0.02
No	39	2		39	2.6		39	2.2		34	2.5

Weight/gestational age
Small	49	2		49	2.4		49	2.3		44	2.2
Adequate	114	2	0.7	114	2.5	0.17	114	2.3	0.5	98	2.2	0.6
Large	7	2		7	2.6		7	2.7		7	2.4

Corrected age ^c c At the time of the observation.
<37 weeks	112	2		112	2.5		112	2.3		98	2.2
PTN with >37 weeks	19	2	0.7	19	2.5	0.01	19	2.4	0.9	17	2.4	0.07
≥37 weeks	93	2		93	2.6		93	2.2		34	2.5

Feeding ^c a These items were not observed in 21 children, due to alertness at the time of observation.
Exclusive breastfeeding	35	2	0.5	35	2.4	0.05	35	2.3	0.7	31	2.0	0.10
Complementary breastfeeding/formula	135	2		135	2.5		135	2.3		118	2.2

Apgar 1st minute
<7	22	2	0.3	22	2.3	0.18	22	2.3	0.8	17	2.6	0.7
≥7	144	2		144	2.5		144	2.3		129	2.2

Apgar 5th minute
<7	12	2	0.8	12	2.3	0.4	12	2.2	0.4	10	2.2	0.60
≥7	154	2		154	2.5		154	2.3		136	2.2

Parity
Primiparous	92	2	0.6	92	2.5	0.9	92	2.2	0.6	80	2.2	0.30
Multiparous	78	2		78	2.5		78	2.4		69	2.2

	Preterm (n = 122) Median (range)	Full-term (n = 39) Median (range)	p ^d d Mann–Whitney's test.
During the observation session, how much did you learn about...
...your baby's skills (What is he/she able to do now)?^a a Questions answered on a 4-point Likert scale, with 1 corresponding to a lot; 2, enough; 3, little; 4, nothing.	1 (1; 3)	1 (1; 2)	0.90
...how can your baby communicate with you through behavior?^a a Questions answered on a 4-point Likert scale, with 1 corresponding to a lot; 2, enough; 3, little; 4, nothing.	1 (1; 3)	2 (1; 3)	0.02
...how you can respond to your baby's behavior?^a a Questions answered on a 4-point Likert scale, with 1 corresponding to a lot; 2, enough; 3, little; 4, nothing.	1 (1; 3)	1 (1; 3)	0.28
...how you can help your baby when he/she is crying?^a a Questions answered on a 4-point Likert scale, with 1 corresponding to a lot; 2, enough; 3, little; 4, nothing.	1 (1; 3)	1 (1; 3)	0.83
...how to interact with your baby?^a a Questions answered on a 4-point Likert scale, with 1 corresponding to a lot; 2, enough; 3, little; 4, nothing.	1 (1; 3)	1 (1; 3)	0.61

Overall, how much would you say the NBO helped you...
...to feel closer to your baby?^b b Questions answered on a 4-point Likert scale, with 1 corresponding to very little; 2, a little; 3, enough; 4, a lot.	4 (1; 4)	4 (3; 4)	0.89
...to feel more confident as a parent?^b b Questions answered on a 4-point Likert scale, with 1 corresponding to very little; 2, a little; 3, enough; 4, a lot.	4 (1; 4)	4 (3; 4)	0.90
...to get to know your baby better?^b b Questions answered on a 4-point Likert scale, with 1 corresponding to very little; 2, a little; 3, enough; 4, a lot.	4 (1; 4)	4 (3; 4)	0.76
...to communicate and connect with the person who conducted the observation?^b b Questions answered on a 4-point Likert scale, with 1 corresponding to very little; 2, a little; 3, enough; 4, a lot.	4 (1; 4)	4 (2; 4)	0.14

How do you assess the NBO session as a learning experience? ^c c Questions answered on a 4-point Likert scale, with 1 corresponding to weak; 2, fair; 3, good; 4, excellent.	4 (3; 4)	4 (2; 4)	0.07

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[1] * Corresponding author. E-mail:marinapguimaraes@gmail.com (M.A. Guimarães).