At 6 hrs after birth, a neonate is seen crying loudly with eyes closed and moving all four limbs well. There is no chest retraction. What is will be the Neonatal Behavioral assessment Scale in this case? (LQ)
Brazelton neonatal behavior assessment scale:
1. State 1: Sleep with regular breathing, eyes closed, no spontaneous activity except startles or jerky movements at quite regular intervals; external stimuli produce startles with some delay; suppression of startles is rapid; state changes are less likely than from other states; no eye movements.
2. State 2: Sleep with eyes closed; rapid eye movements can often be observed under closed lids; low activity level, with random movements and startles or startle equivalents; movements are likely to be smoother and more monitored than in state 1; responds to internal and external stimuli with startle equivalents, often with a resulting change of state; respiration is irregular; sucking movements occur on and off; eye opening may occur briefly at intervals.
3. State 3: Drowsy or semidozing; eyes may be open but dull and heavy-lidded, or closed, eyelids fluttering; activity level minimal, may be reactive to sensory stimuli, but response often delayed; movements are usually smooth, although there may be startles; infant has a dazed appearance and is minimally reactive even when eyes are open. This state is considered to be “transitional” and is sometimes difficult to score. Some infants may also show fuss/cry vocalizations in this state. When this happens, state 3 may be difficult to distinguish from state 5 (below). What distinguishes state 3 from state 5 when both are accompanied by fuss/cry vocalizations is the minimal movement in state 3 and considerable movement in state 5.
4. State 4: Alert, eyes open with bright look and appropriate changes in facial expression as stimulation is varied; focuses attention on source of stimulation or a visual or auditory stimulus; motor activity is minimal; there can be a glazed look that is easily changed into a brighter look with appropriate stimulation.
5. State 5: Eyes likely to be open; considerable motor activity, with thrusting movements of the extremities, and even a few spontaneous startles; reactive to external stimulation with increase in startles or motor activity, but discrete reactions are difficult to distinguish because of general activity level. Brief fussy vocalizations can occur in this state. Some infants may transition directly from lower states (1, 2, or 3) directly to state 5. These are often the cases described above in which fuss/cry vocalizations occur and states 5 and 3 are difficult to distinguish unless the differences in motor activity are taken into account.
6. State 6: Crying; characterized by intense, loud, rhythmic, and sustained cry vocalizations that are difficult to break through with stimulation; motor activity is high. It is important to distinguish between crying as a state from the fuss/cry vocalizations that can occur in state 5 and even state 3. Some infants show repeated episodes of fuss/cry vocalizations in state 5 but may not reach state 6. This may also be a maturational issue, because some preterm infants may not have the energy reserves to sustain state 6. In general, state 6 can be distinguished from state 5 by the intensity and sustained quality of the crying (at least 15 seconds) and unavailability of the infant in state 6. Repeated brief episodes of fuss/cry in state 5 do not mean that the infant has moved into state 6. Examiners need to give the infant the opportunity to show state 6. Premature administration of consol-ability and cuddling maneuvers may prevent the infant from reaching state 6 and provide an inaccurate assessment of the infant.