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Updated: Jan 12, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurobehavioral Profiles in Low-Risk Infants: Associations With Prenatal Maternal Biobehavior and Birth
Sarah E Maylott1, Madeleine Bruce1, Anna M Zhou2,3
1Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Insights
Maternal emotion regulation and autonomic function during pregnancy predict infant neurobehavioral patterns. Lower maternal stress and flexible autonomic responses are linked to better infant regulation.
Area of Science:
- Developmental Psychology
- Neuroscience
- Maternal-Fetal Medicine
Background:
- Newborn neurobehavior is a key indicator of early development.
- Perinatal factors can influence infant neurobehavioral outcomes.
- Understanding these predictors is crucial for early intervention.
Purpose of the Study:
- To examine perinatal predictors of neurobehavioral patterns in healthy, low-risk infants.
- To identify distinct infant neurobehavioral profiles using the NICU Network Neurobehavioral Scale (NNNS).
- To explore associations between maternal emotion dysregulation and autonomic function (respiratory sinus arrhythmia - RSA) and infant neurobehavioral profiles.
Main Methods:
- Latent profile analysis of NNNS data from 385 mother-infant dyads.
- Maternal self-reported emotion dysregulation and RSA data collected during the third trimester.
- Infant neurobehavior assessed ~24 hours after birth.
Main Results:
- Three NNNS profiles were identified: high-attention/moderate-regulation (P1), low-arousal/high-lethargy (P2), and high-arousal/high-stress (P3).
- Infants in P3 showed more dysregulated neurobehavior.
- Lower maternal emotion dysregulation was associated with infants in P3 (vs. P2).
- More flexible maternal RSA responses were linked to infants in P1 and P2 (vs. P3).
Conclusions:
- The NNNS reliably identifies neurobehavioral profiles in healthy, term infants.
- Maternal emotional wellbeing and autonomic flexibility during pregnancy are associated with specific infant neurobehavioral patterns.
- Findings highlight the complex interplay between maternal state and fetal development.
Abstract:
Newborn neurobehavior is a critical indicator of early childhood development. Therefore, we examined perinatal predictors of neurobehavioral patterns among healthy, medically low-risk infants. Participants include 385 mothers and infants. Self-reported emotion dysregulation and respiratory sinus arrhythmia (RSA) data were collected during the third trimester. Infant neurobehavior was measured approximately 24-h after birth (M = 3.61, SD = 8.39, range = 1-61 days) using the NICU Network Neurobehavioral Scale (NNNS). Latent profile analysis identified three NNNS profiles. Infants in the high-arousal, high-stress profile (P3) demonstrated more dysregulated neurobehavior than infants in the high-attention, moderate-regulation profile (P1) or the low-arousal, high-lethargy profile (P2). There were no differences between profiles on infant sex, head circumference, or APGAR scores. Differences in birth gestational age were minimal. Expectant mothers with lower emotion dysregulation were more likely to have infants in P3 than P2. Mothers with more flexible autonomic responses-RSA decreases to a stress task and better recovery-were more likely to have infants in P1 and P2 than P3. We successfully replicated low-risk NNNS profiles, suggesting that the NNNS is a reliable assessment tool for healthy, term infants. Our findings also underscore unexpected and varied associations between maternal emotional wellbeing and fetal development.
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