Neurobehavioral outcomes in preterm, growth-restricted infants with and without prenatal advanced signs of brain-sparing.

OBJECTIVE: To evaluate the neurobehavioral outcomes of preterm infants with intrauterine growth restriction (IUGR), with and without prenatal advanced brain-sparing. METHODS: A cohort of IUGR infants (birth weight < 10(th) percentile with abnormal umbilical artery Doppler) born before 34 weeks of gestation was compared with a control group of appropriate-for-gestational age infants matched for gestational age at delivery. MCA pulsatility index was determined in all cases within 72 hours before delivery. Neonatal neurobehavior was evaluated at 40 weeks' ( ± 1) corrected age using the Neonatal Behavioral Assessment Scale. The effect of abnormal MCA pulsatility index (< 5(th) percentile) on each neurobehavioral area was adjusted for maternal smoking status and socioeconomic level, mode of delivery, gestational age at delivery, pre-eclampsia, newborn illness severity score and infant sex by multiple linear and logistic regression. RESULTS: A total of 126 preterm newborns (64 controls and 62 IUGR) were included. Among IUGR fetuses, the proportion of abnormal MCA Doppler parameters was 53%. Compared with appropriate-for-gestational age infants, newborns in the IUGR subgroup with abnormal MCA Doppler had significantly lower neurobehavioral scores in the areas of habituation, motor system, social-interactive and attention. Similarly, the proportion of infants with abnormal neurobehavioral scores was significantly higher in the IUGR subgroup with abnormal MCA Doppler parameters in the areas of habituation, social-interactive, motor system and attention. CONCLUSION: Abnormal MCA Doppler findings are predictive of neurobehavioral impairment among preterm newborns with IUGR, which suggests that this reflects an advanced stage of brain injury with a higher risk of abnormal neurological maturation.

Behavioral gender differences in the neonatal period according to the Brazelton scale.

The aim of the present study was to analyze gender differences in neonatal behavior. A sample of 188 healthy full-term newborns (88 boys and 100 girls) was assessed. The behavioral evaluations were performed using the Brazelton Neonatal Behavioral Assessment Scale (NBAS), when the infants were between 48 and 80 hours old. Girls had higher scores than boys in 4 out of the 34 behavioral items of the NBAS. These are the following: Orientation Animate Auditory (t=2.486; P=0.014), Alertness (t=2.546; P=0.012), Quality of Alertness (t=3.091; P=0.002), and State Regulation (t=2,343; P=0.020). Boys had higher scores in the Irritability item (t=-2.186; P=0.030). We have analyzed also the possible effects of the medication during delivery because mothers of boys were more likely to have used this medication but no differences have been found among the mentioned items. These results appear to confirm that similarities between boys and girls are much more the norm than differences related to gender, but even though they are quite subtle, differences do exist in the way newborn infants react and behave in the neonatal period.

[The effects of acute fetal distress on neonatal behavior measured by the Brazelton scale]. / Estudio del comportamiento neonatal en el sufrimiento fetal agudo mediante la escala de Brazelton.

OBJECTIVE: The purpose of this study was to evaluate the effects of fetal distress associated with metabolic acidosis (pH < 7.15 and BE < -8 in blood samples from umbilical artery) in neonatal behavior. PATIENTS AND METHODS: Infants were evaluated with the Brazelton Neonatal Behavioral Assessment Scale (NBAS) on the third day of life (60-84 hours) in the Clinic Hospital of Barcelona, Spain. Fifteen anoxic neonates (experimental group) were compared to a sample of eight-seven newborns (control group) with the same characteristics, but with normal pH and BE levels (pH > 7.25 and BE > -5). RESULTS: Statistically significant differences were found between the two groups. The control group performed much better than the experimental group in almost all of the NBAS clusters: habituation, orientation, autonomic, regulation of states and motor functioning. There were no differences between the groups in the cluster range of states. The anoxic newborns of this study showed more irritation, stress, hypersensibility and difficulties to modulate states than the neonates without this problem. CONCLUSIONS: The NBAS is a useful evaluation technique as a complement to the physical examination because it gives a detailed description of the newborn behavior and competence. Habituation (p = 0.002), orientation (p = 0.000) and autonomic (p = 0.000) are the clusters who discriminate best between the groups.