Tomitaro Akiyama

Effect of an early intervention programme on low birthweight infants with cerebral injuries

Objective:  To determine the effect of an early intervention programme (EIP) on low birthweight infants with cerebral injuries.

Neonatal behavioral assessment scale as a predictor of later developmental disabilities of low birth-weight and/or premature infants

The purpose of this study was to evaluate the usefulness of the Neonatal Behavioral Assessment Scale (NBAS) as a tool to assess the risk of later developmental disabilities. The study subjects were 209 low birth-weight and/or premature infants admitted to the NICU at the Nagasaki University Hospital, Nagasaki, Japan. These infants were examined using the NBAS at 36-38 (NBAS36), 40-42 (NBAS40) and 44-46 weeks (NBAS44) of postmenstrual age, and their developmental outcome was measured using standardized assessments at 5 years of age. Based on the results of diagnosis at 5 years of age, subjects were classified into three groups: Normal, Mild Disability and Severe Disability groups. Multinomial logistic regression analysis showed that lower Motor cluster scores for all assessment periods and lower Orientation cluster scores in the NBAS40 and NBAS44 were significantly associated with an increased risk of both Mild and Severe Disability. Also, the Range of State cluster scores for the NBAS44 were significantly related to the risk of Mild Disability, and the Reflexes cluster scores in the NBAS40 and NBAS44 were the best predictor of Severe Disability. In outcome prediction using the estimated regression coefficients, 94-97% of the subjects in the Normal group, 50-78% in the Mild Disability group and 71-85% in the Severe Disability group were correctly classified. The NBAS could help clinicians to develop a management protocol for infants at risk for developmental disabilities as well as to identify neonates at risk of developmental disabilities.

Neonatal Behavioral Characteristics and Later Behavioral Problems

The purposes of this study were (1) to evaluate the usefulness of the Neonatal Behavioral Assessment Scale (NBAS) as a tool to assess the risk of later behavioral problems, (2) to analyze the relationship between neonatal behavioral characteristics and behavioral problems in childhood. Subjects were 77 very-low-birth-weight infants admitted to the NICU at the Nagasaki University Hospital, Nagasaki, Japan. The results suggest that behavioral characteristics such as poor motor performance, poor state regulation, and poor interaction ability in the neonatal period are risk factors for behavioral problems in childhood. The NBAS could help clinicians to identify neonates at risk of later behavioral problems.

Neurobehavioural profile of low‐birthweight infants with cystic periventricular leukomalacia

Twenty‐three low‐birth weight infants (17 males, six females) diagnosed with cystic periventricular leukomalacia (PVL; median gestational age 30wks, postmenstrual age range 25 to 36wks; median birth weight 1365g, range 680 to 2010g) were evaluated and compared with 209 comparison infants (117 males, 92 females; median gestational age 33wks, postmenstrual age range 25 to 39wks; birth weight 1771g, range 670 to 2460g). There were three assessment times: 36 to 38 weeks (preterm), 40 to 42 weeks (term), and 44 to 46 weeks (post‐term); the Neonatal Behavioral Assessment Scale (NBAS) was used for assessment. Outcome at 2 years was assessed on the basis of a neurological examination, magnetic resonance imaging, computerized tomography, electroencephalography, and the Mental and Psychomotor Development Indices of the Bayley Scales of Infant Development. All infants in the PVL group were found to have evidence of cerebral palsy, whereas all infants in the comparison group were normally developing. Infants with PVL performed more poorly on all elements of the NBAS examination at all three assessment times compared with the comparison group. They demonstrated poorer motor control, less responsiveness to environmental stimuli, less regulatory capacity, and more abnormal reflexes compared with the comparison group. These results suggest that LBW infants with PVL show dysfunction and/or disorganization in their neurobehavioural systems in the neonatal period. Assessment of neonatal neurobehavioural characteristics using the NBAS may assist clinicians in identifying LBW infants with PVL, and in formulating plans for the developmental care of these infants.

Neonatal behavioural profile and crying in premature infants at term age

Aim: To analyse behavioural characteristics of infants who cried more versus those who cried less, in a sample of low‐risk premature infants. Methods: Participants were 63 low‐risk healthy premature infants. At term age, the Neonatal Behavioral Assessment Scale (NBAS) was administered, and a 1‐d diary for crying was recorded starting on the following day. Infants were categorized into two groups: those with “high level of crying” (≥75th percentile) and those with “less crying” (<75th percentile), based on the total amount of crying time. Results: Some individual NBAS scores and “habituation” and “regulation of state” cluster scores were lower in the high‐level‐of‐crying group. Infants in the group with a high level of crying had lower thresholds for response in the “peak of excitement”, “rapidity of build‐up”, “irritability” and “general irritability” items. Logistic regression analysis revealed that lower “habituation” and “regulation of state” cluster scores were significantly associated with lower thresholds for crying.