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Updated: Aug 2, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Behaviors of very preterm neonates as documented using NIDCAP observations
J L Pressler1, J T Hepworth, J M Helm
1College of Health and Human Development, Pennsylvania State University, University Park, USA. jlp16@psu.edu
Insights
This study observed neonatal behaviors in premature infants using the Newborn Individualized Developmental Care Assessment Program (NIDCAP). Findings show consistent behavioral patterns in neonates from 24-30 weeks postconceptional age.
Area of Science:
- Neonatal development
- Developmental pediatrics
- Infant behavior
Background:
- Premature infants exhibit a wide range of developmental trajectories.
- The Newborn Individualized Developmental Care Assessment Program (NIDCAP) is a tool used to assess infant behavior.
- Understanding typical behaviors is crucial for individualized care.
Purpose of the Study:
- To characterize the spectrum and frequency of behaviors in neonates between 24-30 weeks postconceptional age (PCA).
- To utilize the NIDCAP to systematically observe and record neonatal behaviors.
- To establish a baseline of behavioral development in extremely preterm infants.
Main Methods:
- A prospective study design was employed.
- 8,144 two-minute observations of 85 NIDCAP behaviors were collected from 42 neonates (24-29 weeks gestation).
- Behavioral frequencies were analyzed by subsystem (autonomic, motor, state) and correlated with postconceptional age.
Main Results:
- The most common behaviors included irregular respirations, flexion, and sleep states.
- Less frequent behaviors involved vocalizations and gastrointestinal functions.
- Regression analysis confirmed stable week-to-week behavioral patterns.
Conclusions:
- Neonatal behavior patterns demonstrate significant consistency across postconceptional weeks.
- The NIDCAP provides valuable data for understanding development in preterm infants.
- These findings support individualized developmental care approaches for neonates.
Purpose:
The purpose of this study was to describe the range and frequency of behaviors in neonates 24-30 weeks postconceptional age (PCA) using the Newborn Individualized Developmental Care Assessment Program (NIDCAP).
Design:
A prospective design with convenience sampling was used.
Sample:
Starting 24-72 hours postnatally and continuing through 30 weeks PCA, 8,144 two-minute observations of 85 NIDCAP behaviors were collected and analyzed from 42 neonates born at 24-29 weeks gestation.
Main Outcome Variable:
The main outcome variables were the frequencies of the 85 neonatal behaviors measured by the NIDCAP. Frequencies were organized first by subsystem (autonomic, motor, or state) and were categorized further based on week of PCA. Comparisons of behavioral frequencies by number of weeks PCA were completed using correlation and regression analyses.
Results:
The most frequently observed behaviors were irregular respirations, pink color, postured flexion of the extremities, immature light sleep, and drowsiness. Least frequently observed behaviors consisted of burps, bowel movement, grunting, smooth motor movements, cooing, and speech movement. Regression analysis illustrated that the pattern of behavior was significantly similar week to week.
