Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Abstract

There has been a long-standing interest in the assessment of the neurobehavioral integrity of the newborn infant. The NICU Network Neurobehavioral Scale (NNNS) was developed as an assessment for the at-risk infant. These are infants who are at increased risk for poor developmental outcome because of insults during prenatal development, such as substance exposure or prematurity or factors such as poverty, poor nutrition or lack of prenatal care that can have adverse effects on the intrauterine environment and affect the developing fetus. The NNNS assesses the full range of infant neurobehavioral performance including neurological integrity, behavioral functioning, and signs of stress/abstinence. The NNNS is a noninvasive neonatal assessment tool with demonstrated validity as a predictor, not only of medical outcomes such as cerebral palsy diagnosis, neurological abnormalities, and diseases with risks to the brain, but also of developmental outcomes such as mental and motor functioning, behavior problems, school readiness, and IQ. The NNNS can identify infants at high risk for abnormal developmental outcome and is an important clinical tool that enables medical researchers and health practitioners to identify these infants and develop intervention programs to optimize the development of these infants as early as possible. The video shows the NNNS procedures, shows examples of normal and abnormal performance and the various clinical populations in which the exam can be used.

Infants’ early visual attention and social engagement as developmental precursors to joint attention.

“…The NNNS follows a standard sequence of administration that includes a pre-examination observation, neurologic and behavioral components, yielding item and summary scores (for detailed NNNS procedures see Lester, et al, 2004 and Lester, Andreozzi-Fontaine, Tronick, & Bigsby, 2014). In the present study, data for the Attention/Orientation scale items were of interest as a means of characterizing individual differences in infants’ early attention orienting.…”

Early prediction of typical outcome and mild developmental delay for prioritisation of service delivery for very preterm and very low birthweight infants: a study protocol

“…The NNNS is a non-invasive clinical tool developed to assess neurobehaviour of ‘at-risk’ infants and is suitable for use with very preterm/VLBW infants. 52 96 The assessment takes between 15 and 20 min to administer, ideally in a quiet, dimly lit room, 2 hours after feeding. The examination is state-dependent with a standardised format.…”

Cohort profile: the Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) cohort, a prospective preterm birth cohort in New York City

“…We propose to enrol 400 infants to achieve >80% power to detect differences in age-appropriate neurophenotypes. This number of participants was extrapolated from preliminary data on the relationship between NICU-based phthalate exposure on NNNS76 performance (table 3) as described in Stroustrup et al ,26 and pilot data on the relationship between phthalate exposure and performance on the Bayley Scales of Infant and Toddler Development77 or the Child Behavior Checklist 78. Four hundred participants is an ample size to allow separate analyses of boys and girls for those exposures/outcomes known to be sexually dimorphic, for accommodation of the non-independence among twins in our population, and to account for an estimated 20% loss to follow-up.…”