Neurobehavioral assessment in the neonatal period--the impact of Ferenc Katona.

BACKGROUND AND PURPOSE: Identifying and treating CNS-injured infants has always been Ferenc Katona's main goal. Early on, he showed the importance of "elementary motor patterns" to development, and their application in treatment of early brain injury. We report on a neonatal neurobehavioral assessment derived from Katona that has concurrent and predictive validity in the NICU population. It evaluates early behavioral capabilities and dysfunctions in areas often disrupted by CNS injury, such as attention, motor organization, and autoregulation; provides a valuable approach for assessing recovery from CNS injury; and predicts later mental and motor performance.

METHODS

A population-based NICU sample (n=3226) studied from 1989-2004 had CNS injury ranging from none to severe. Our neurobehavioral assessment is a categorical clinical evaluation suitable for small, sick, high-risk neonates that is composed of visual, auditory, head control, tone, state, and elicited active motor behaviors designed to challenge the infant. Infants are tested at hospital discharge and one month post term. A series of tasks are administered enabling a trained examiner to make judgments of abnormality on over 20 categories of behavior.

RESULTS

Maximum likelihood ordered logistic regression and multiple regression specified the relation of abnormality in neurobehavioral performance to concurrent estimates of CNS injury and to later cognitive and motor outcome. All behavioral categories were significantly associated with CNS abnormality at one or both ages (p's<0.03-0.0001). Multiple regression showed a significant linear relationship (p<0.0001) of CNS injury to number of neurobehavioral abnormalities, which decreased with decreasing injury and across age.

CONCLUSIONS

Katona's strong contributions form the basis of neurobehavioral assessment that can detect early abnormalities and help design early interventions. He is unique in his understanding of the neural mechanisms underlying early CNS injury and its behavioral consequences. His concepts allowed us to devise a valid newborn neurobehavioral assessment to evaluate early behavioral capabilities frequently disrupted by CNS injury.