Neurobehavioral Development Measure Understanding neurobehavioral development is essential for assessing and supporting the growth of infants, particularly those who are premature or have experienced early medical complications. This section will explore the concepts of neurobehavioral development, nutritive sucking, and their link to sleep patterns, providing a multidisciplinary framework for understanding these phenomena and their implications for clinical practice.
Neurobehavioral Development and Nutritive Sucking
Definition and Process of Neurobehavioral Development:
Neurobehavioral development refers to the maturation of the central nervous system (CNS), a genetically determined process that relies on both biological and environmental factors. The CNS develops through an “experience-expectant” process, where normal, typical experiences trigger structural and functional changes required for the next stages of development (Greenough, Black, & Wallace, 1987).
This process is characterized by plasticity, meaning it can adapt to both the current developmental stage’s needs and the anticipated needs of future stages (Oppenheim, 1981). However, when an infant is placed in an atypical environment, such as a neonatal intensive care unit (NICU), this adaptive process may be disrupted, potentially causing long-term effects on neurobehavioral development.
Infants generally develop normally when neural plasticity compensates for any atypical adaptations or neurological insults. However, if neural plasticity is insufficient or compensatory processes result in maladaptive changes, infants may exhibit abnormal neurobehavioral development.
Exploring the Concept & Framework
The Synactive Model of Neonatal Behavioral Organization, proposed by Als (1991), provides a framework for assessing neurobehavioral development. This dynamic model suggests that an infant’s behavioral organization reflects the integrity of their CNS and its potential for normal development. The infant’s behaviors can be understood as manifestations of subsystems of functioning, which include:
- Autonomic System: Controls basic physiological functions necessary for survival, such as respiration and heart rate.
- Motor System: Involves muscle tone, movement, and posture.
- State Organization: Refers to the clarity of behavioral states and the patterns of transitioning between states.
- Attentional or Interactive System: Observable only when the infant is alert; it indicates the ability to respond to visual and auditory stimuli.
- Regulatory System: Reflects the infant’s efforts to achieve and maintain a balance among these subsystems.
Multidisciplinary Framework
Another framework for understanding neurobehavioral development is the perspective of developmental science, a multidisciplinary field integrating research from psychology, biology, nursing, and other disciplines (Cairns, Elder, & Costello, 1996; Miles & Holditch-Davis, 2003). This perspective views infants as active participants in a continuously ongoing, reciprocal process of interaction with their environment. Infants and their environments form a complex system, where elements, such as the mother and child, interact to create less variability than individual elements.
Plasticity in Development:
This framework assumes that plasticity is inherent in infants, their families, and their environment. Infants are seen as active participants who shape their environment as much as they are shaped by it. Interactions, rather than causation, are the primary focus, recognizing that the developmental outcomes of infants are the result of complex, bidirectional interactions that cannot be fully identified or attributed to a single cause.
Neonatal Behavior
Newborn behavior, including sucking, sleeping, and waking, represents the infant’s primary expression of brain functioning and a critical route for communication with caregivers. Understanding these behaviors and their central mechanisms is essential for nursing interventions aimed at improving neurodevelopmental status.
Nutritive Sucking:
Nutritive sucking begins in utero and develops in an organized pattern in the early weeks after birth. It involves the integration of multiple sensory and central motor nervous system functions (Wolff, 1968) and is considered a key indicator of CNS organization. Nutritive sucking can be precisely quantified and is sensitive to various neurological disturbances, making it a valuable tool for assessing neurobehavioral development.
Research by Medoff-Cooper and colleagues (1991, 2000, 2001, 2002) has shown that changes in nutritive sucking behaviors correlate strongly with gestational age and maturation. For example, more mature preterm infants (30-32 weeks gestational age) and full-term infants exhibit more competent feeding behaviors than extremely early-born preterm infants (gestational age ≤ 29 weeks).
Nutritive Sucking and Impact on Developmental Stages
The potential link between nutritive sucking and future developmental problems has been documented extensively in the literature. For instance, infants with significant intraventricular hemorrhage were found to be delayed in achieving a mature nutritive suck reflex (Burns et al., 1987). At 40 weeks, only 75% of these infants demonstrated mature sucking patterns. Furthermore, studies have shown that sucking organization is a better predictor of developmental outcomes at 6 and 12 months of age than neonatal morbidity (Medoff-Cooper, 1996, 2002).
Sleeping and Waking Patterns and Their Neurological Implications
Sleep as an Indicator of Neurodevelopmental Status:
Sleep and wakefulness patterns are essential indicators of neurodevelopmental status. Sleep states can be divided into active sleep (similar to REM sleep in adults) and quiet sleep (similar to non-REM sleep). These states are associated with different electrophysiological patterns and have widespread physiological effects on cardiovascular, respiratory, neurological, endocrine, and gastrointestinal systems.
Studies have indicated that sleep patterns, particularly the proportion of active versus quiet sleep, are directly linked to brain development. Active sleep, which is more common in infants than in adults, is thought to be necessary for brain development, contributing to synaptogenesis, neurotransmitter pool evolution, and myelination (Roffwarg, Mazio, & Dement, 1966).
Clinical EEG Evidence:
Electroencephalography (EEG) and behavioral scoring systems have been used to study sleep and waking states in infants. Several standardized systems are used by nurse researchers to score behavioral observations of sleep-wake states, including the systems developed by Brazelton, Thoman, Als, and Anderson (Holditch-Davis, Blackburn, & Vandenberg, 2003). These systems provide valuable insights into the infant’s neurodevelopmental status and guide individualized nursing care.
Sleep and Waking as Developmental Parameters
Sleep-Wake Patterns and Developmental Outcomes:
Measures of sleep-wake states during the preterm period, such as the amount of crying, quality of state organization, sleep cycle length, and amount of night sleep, have been shown to predict developmental outcomes during the first year. Moreover, changes in specific sleep behaviors during the first year are related to developmental and health outcomes in the second year. The stability of behavioral sleep-wake patterns in the late fetal period and early infancy can also predict later development (Holditch-Davis et al., 2003).
EEG measures of sleep in preterm infants have been linked to developmental outcomes up to 8 years of age, further underscoring the importance of sleep as a developmental parameter. Additionally, the acoustic characteristics of infant cries have been used to predict developmental outcomes in preterm infants and those exposed to prenatal drug exposure (Holditch-Davis et al., 2003b).
Conclusion
In conclusion, both nutritive sucking and sleeping patterns are critical indicators of neurodevelopmental status in infants. Nutritive sucking is a noninvasive, easily measured behavior that provides valuable insights into CNS organization and maturation. Sleeping and waking patterns offer an excellent index of neurodevelopmental status in both preterm and full-term infants and can be assessed using behavioral observation or EEG. Understanding these behaviors is essential for developing effective nursing interventions to support optimal neurodevelopmental outcomes.