NATURAL COURSE OF BEHAVIORAL ORGANIZATION IN PREMATURE-INFANTS

This experiment describes a method of scoring naturalistic behavioral observations made on 84 premature infants who received nursing care in the traditional medical model. The Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) was used for making the observations, and the systems component of the Assessment of Preterm Infant Behavior (APIB) was used for scoring. We found that (a) behavior was best where the infant was at rest and undisturbed prior to care (i.e., baseline); (b) behavioral disorganization increased with care; (c) behavioral recovery after care was limited; and (d) baseline behavioral disorganization increased with age. Gestational age, level of pulmonary support, and bronchopulmonary dysplasia had effects on certain aspects of behavior. These systematic observations suggest that nursing care necessary for medical management is quite demanding for premature infants and that repeating such experiences over time may inadvertently produce behavioral disorganization. If these findings can be replicated in other intensive care nurseries, then there will be additional support to recommend the nursing approach to care be expanded to incorporate attention to the infant's response to, and tolerance of, care.