Adrenocortical activity and the Brazelton Neonatal Assessment Scale: moderating effects of the newborn's biomedical status

The Brazelton Neonatal Behavioral Assessment Scale with Kansas Supplement (NBAS-K) was administered midway between feedings to 60 newborns who were between 32 and 122 hours old. 35 of the newborns were classified as extremely healthy and normal (Subgroup I), whereas 25 (Subgroup II) were characterized by slight perinatal problems including gestational age 36-37 weeks or 42+ weeks, and fetal distress during labor. All of the newborns were healthy enough to be cared for in a healthy newborn, Level I nursery. Immediately following administration of the NBAS-K, a blood sample was obtained for plasma cortisol determination. Correlations between behavioral responding on the NBAS-K and levels of plasma cortisol revealed few significant relations for the sample as a whole. When the 2 subgroups were examined separately, a number of significant relations emerged. Newborns in Subgroup I who were more competent in their motor control and state regulation capacities as assessed by Lester's Cluster Scores for the NBAS-K exhibited higher levels of plasma cortisol. In contrast, newborns in Subgroup II who exhibited a greater adrenocortical response to the examination showed more behaviors indicative of high behavioral arousal and distress. This pattern of relations for Subgroup II appeared to be mediated by the number of hours that had elapsed since delivery. As postpartum time increased, the strength of the association between adrenocortical activity and behavioral arousal/distress decreased for Subgroup II. A systems theory approach is used to interpret the difference in patterns of correlations found for the 2 subgroups.