Prenatal predictors of performance on the Brazelton Neonatal Behavioral Assessment Scale

The present study presents a prospective analysis of the interrelationships among prenatal medical, nutritional (dietary and biochemical) and behavioral determinants of Brazelton performance. Previous researchers (Scanlon 1984, Lester and Brazelton 1984) have raised questions regarding the relative roles of medical factors, nutrition, ponderal index and other behavioral factors in neonatal performance on the BNBAS. Four hundred sixty-seven predominantly Black nulliparous women and their neonates in Washington, D.C. who were enrolled in the study by the 20th week of gestation were subjects. Results of univariate tests of significant (P < 0.01) association between independent variables and Brazelton clusters from scores measured on day 2 are presented. The 26 behavioral items were summarized into 6 clusters as done in similar studies by linearizing measures made on a curvilinear scale and taking the mean. The 6 behavioral clusters are habituation, motor, orientation, range of states, regulation of states, and autonomic. Results of 16 reflex tests are used to define a seventh reflex cluster. Independent variables included demographic, lifestyle, nutritional, medical, ponderal index, and psychosocial measures. Several psychosocial variables, including stress, anxiety and partner interaction were associated with the behavioral clusters. Nutritional variables were associated with BNBAS habituation, motor, orientation, reflex score and autonomic responses. An analysis of co-variance was performed to determine the joint effect of the above variables on the variation in the Brazelton performance on the seven cluster scores. Five of the seven models (orientation, motor, range of states, autonomic, and reflex scores) were significant predictors of the outcome variables.