Reliability and validity of the NBO system to identify newborn neurobehaviors

McManus, B., Magnusson, D., Nugent, J. K.

Introduction: The NBO assists clinicians in identifying and interpreting newborn neurobehaviors with the goal of enhancing parent-infant relationships. Rooted in neurobehavioral theory, 18 observed and elicited maneuvers address autonomic, motor, state organization and responsivity with each item scored on a 3-point scale. This study explores the psychometric properties of the NBO.

Method: The study sample was drawn from a clinical database of 210 caregiver-newborn dyads who participated in a NBO intervention as part of their typical clinical course. Complete NBO records and parent questionnaires were available for 186 newborns. Reliability was calculated for items within 3 of the 4 AMOR systems. The correlation between total NBO scores and gestational age was calculated to determine validity. Associations between parent reported knowledge about their baby's behavior gained from the NBO and parent-reported 1) ability to interact with their baby, 2) parenting confidence, and 3) maternal characteristics were examined.

Results: Among 7 motor domain items, reliability was .79. Among 5 state organization domain items, reliability was .81. Among the 5 Responsivity items, reliability was .82. Greater gestational age was positively associated with NBO scores (beta =0.28, p=.0001). Greater knowledge about their infant's behavior post-NBO was positively associated with parent-reported ability to interact with their infant (beta = 0.21, p=0.003), confidence with parenting (beta = 0.22, p=.002), and was higher among non-English speaking (beta = 0.31, p=<.001) and primiparous mothers (beta = 0.20, p=.006). Less educated mothers reported greater ability to address their infant's crying after the NBO (beta = -0.19, p=.008).

Conclusions: The NBO appears to reliably and validly identify newborn behaviors within a theoretically sound neurobehavioral framework. The NBO has the potential to be an important tool for newborn clinical decision-making and outcomes research, yet more research is needed.