The Assessment of Preterm Infants' Behavior (APIB): Furthering the understanding and measurement of neurodevelopmental competence in preterm and full‐term infants

Abstract

The Assessment of Preterm Infants' Behavior (APIB) is a newborn neurobehavioral assessment appropriate for preterm, at risk, and full-term newborns, from birth to 1 month after expected due date. The APIB is based in ethological-evolutionary thought and focuses on the assessment of mutually interacting behavioral subsystems in simultaneous interaction with the environment. The subsystems of functioning assessed include the autonomic (respiration, digestion, color), motor (tone, movement, postures), state organization (range, robustness, transition patterns), attention (robustness, transitions), and self-regulation (effort, success) systems as well as the degree of facilitation required to support reorganization and subsystem balance. The environment is represented by a sequence of distal, proximal, tactile, and vestibular challenges, derived from the BNBAS. The APIB conceptualizes infant competence as the degree of differentiation of subsystem function and degree of modulation of subsystem balance at any stage in infant development. Infants are understood as actively seeking their next differentiation, while counting on good enough environments to assure progressing developmental competence. In the case of interference such as premature birth, the mismatch of expectation and actual experience causes misalignment, which may become developmentally costly. The assessment is a finely tuned dialogue between examiner and infant, which requires training, skill and self-knowledge. The APIB has well established inter-rater-reliability, concurrent and construct validity, and is clinically relevant for behavioral intervention and individually appropriate and supportive care.

Sleep deprivation, pain and prematurity: a review study

“…Less fragmentation also increases stability due to fewer cardiac adverse stimuli, lower frequency and duration or severity of bradycardia, apnea and oxygen desaturation, lower physical demands, minimization of metabolic needs and increased QS 8,51 . Studies recording the differences between the sleep of premature neonates in standard NICU care and those cared for by NIDCAP show that the total amount of uninterrupted sleep in the NIDCAP group is larger, so both AS and QS increase 8,52,53,54,55 . Studies showing the actual effects of NIDCAP on sleep are scarce and controversial.…”

Programming the brain: Common outcomes and gaps in knowledge from animal studies of IUGR

“…168 169 One particular limitation of models of maternal nutrient restriction in rodents is that the restriction 170 is imposed only during earlier stages of neurodevelopment than are affected by IUGR in humans. 171 For example, if maternal undernutrition is imposed in rats only during gestation, this does not 172 impact the period of myelination, which occurs postnatally in rats, but commences prior to birth in 173 humans [ Figure 1,66]. This can be addressed by continuing maternal undernutrition postnatally 174 throughout lactation in the rat, but many studies do not do this.…”

Authors’ Response: NIDCAP: A Systematic Review and Meta-analyses of Randomized Controlled Trials

“…The weighted mean difference in the APIB scores range from 20.53 for "Attention system" to 20.88 for "Examiner facilitation." Although statistically significant, these differences between the groups of ,1 point on a 9-point scale 35 cannot be considered clinically important.…”