Establishing the Reliability and Developmental Validity of a Neurobehavioral Assessment for Preterm Infants: A Methodological Process

The Neurobehavioral Assessment of the Preterm Infant was developed in 3 phases: a pilot study, an exploratory study, and a validation study. In the exploratory study, clusters characterized by conceptual cohesion and face validity were systematically subjected to statistical analyses to determine whether they also had high test-retest reliability and developmental validity. In the validation study, a shortened version of the test was used with an independent cohort of 290 preterm infants. A step-by-step methodological process was used to test whether the results from the exploratory study would generalize over cohorts, different versions of the test, different hospitals, and changes in examiners. This process yielded 7 highly stable, developmentally valid, and representative preterm neurobehavioral functions that generalized over the exploratory and the validation studies. These were: motor development and vigor, scarf sign, popliteal angle, alertness and orientation, percent asleep ratings, irritability, and vigor of crying.     

Fetal Neurobehavioral Development

The ontogeny of fetal autonomic, motoric, state, and interactive functioning was investigated longitudinally in a sample of 31 healthy fetuses from 20 weeks through term. Fetal heart rate and movement data were collected during 50 min of Doppler-based fetal monitoring at 6 gestational ages. Measures of fetal heart rate and variability, activity level and vigor, behavioral state, and reactivity were derived from these digitized data. Weighted least squares analyses were conducted to model the developmental patterns and to examine the role of maternal and fetal covariates. With advancing gestation, fetuses displayed slower heart rate, increased heart rate variability, reduced but more vigorous motor behavior, coalescence of heart rate and movement patterns into distinct behavioral states, and increasing cardiac responsivity to stimulation. Male fetuses were more active than female fetuses, and greater maternal stress appraisal was associated with reduced fetal heart rate variability. An apparent period of neurobehavioral transition exists between 28 and 32 weeks. Fetal research methods are evaluated.     

Neurobehavioral and Psychosocial Issues in Klinefelter Syndrome

Klinefelter Syndrome (KS) is a relatively common (1/500 to 1/1,000) genetic syndrome caused by an extra X chromosome in males, leading to an XXY karyotype. In most cases, the physical and neurobehavioral characteristics of KS are relatively mild, and KS is not usually associated with moderate or severe mental retardation. However, KS is often associated with significant language‐based learning disabilities and executive dysfunction, making it a plausible genetic model for understanding the neurobiology of these areas of cognition that are so fundamental to learning in a classroom. Additionally, the psychosocial aspects of KS, which can have a significant impact on school performance and learning, have been explored only on an anecdotal level. We have conducted pilot studies in a small group of KS adolescents and adults to begin to identify the social, emotional, and adaptive behavior issues facing KS subjects and have identified several areas for further research. This includes characterization of mild maladaptive behaviors, as well as significant strengths in other areas. Further work is needed to determine how the social‐emotional and cognitive features of the disorder interact or change over the lifetime of subjects and how the learning disabilities respond to hormonal or cognitive‐based therapy.     

Infants with illness

One of the prevalent concerns of day care workers is dealing with sick infants and toddlers. Many health problems can be treated early before complications develop if day care providers recognize symptoms or warning signs.Joyce F. Dillon is an Associate Professor in the School of Nursing at Georgia State University in Atlanta. Martha Wilson is a Graduate Student in the Nursing School.