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Hospital Clínic de Barcelona

by Costas-Moragas, PhD
Clinical & Health Psychology Department
Facultat de Psicologia
Universitat Autònoma de Barcelona
& NBAS Trainer

Nowadays much of our work at the Hospital Clínic de Barcelona is centered on the neurobehavioral assessment of the premature infant. We have two main goals: to detect possible risk factors during the first months of life, as well as assess the influence of the environment (mother-infant interactions) on infant development.

Longitudinal Studies on Neurobehavioral Development in Premature Infants

Recent evidence has shown that the fetal cortex has its peak development between weeks 28 and 40 gestation, being the frontal cortex the last to develop. With this in mind, we can deduce that prematurity will largely affect functions in these areas, specialized in attention, learning and executive functions. In this period, the prefrontal cortex is also in full development, this area is in charge of complex mental processing: attention and self-regulation. Premature birth will have long lasting, serious, and multiple sequelae.

We conducted a nine-year follow-up study of premature infants at the Hospital Clínic de Barcelona. Using magnetic resonance imaging, results showed patterns of affected brain matter –gray and white-, as well as lower scores in cognitive functioning, assessed with the WISC-IV, in a group of 9-year-old children that were moderate premature infants (Soria et al., 2009). These disorders may present the first symptoms as early as the neonatal period. (The full report may be found in: Soria-Pastor, S., Padilla, N., Zubiaurre-Elorza, L., Ibarretxe-Bilbao, N., Botet, F., Costas-Moragas, C., Falcón, C., Bargalló, N., Mercader, J.M. & Junqué, C. (2009). Decreased Regional Brain Volume and Cognitive Impairment in Preterm Children at Low Risk. Pediatrics, 6 (124), 1161-1170.)

We have also received a grant from the Spanish Government to fund three research projects:

  • Neurobehavioral Study of the Preterm Newborn in the NICU. The objective is to analyze the correlation between the premature infant’s physiological responses following a stressful situation (heart and respiratory rates, apnea and hemoglobin saturation) and the infant’s behavior assessed with the NIDCAP observation record, while they are still in the NICU.

    Although the NIDCAP (Als, 2001) was developed as an idiographic clinical assessment tool, it has been successfully quantified and used nomothetically in research (Costas, Botet, Arranz, López & Fornieles, 2008; Holsti, Grunau, Oberlander & Whitfield, 2004; Pressler & Hepworth, 2002).

  • Longitudinal Study of the Premature Infant. Two groups of premature infants (extreme and moderate) will be assessed with the NIDCAP while still in the NICU. At 40 weeks gestational age they will be evaluated with the NBAS, and at 9 months corrected age the Bayley Developmental Scales III will be used to assess overall development.

  • Relationship Between Maternal Self-Efficacy, Maternal Attitudes and Infant Behavior. In a previous study with full term infants, assessed with the NBAS, we found that maternal perceptions are influenced by the infant’s behavior as early as the neonatal period; these perceptions in turn influence the baby’s behavior. Overall results show that newborn neurological stability is a key factor in the development of mother/infant interaction and feelings of maternal self-efficacy. (Mancera-Jiménez, 2010).

    We considered that in the case of the premature infant, maternal self-efficacy as well as the mothers’ emotional state might be of great relevance to the infant’s development. To further our research, we are working on a new study that has three phases: 1) Assess maternal self-efficacy using the Mother and Baby Scales (Wolke & St James Roberts, 1987). Postpartum depression, anxiety and social support will be also evaluated because they can have a major impact on the mother-infant relationship. 2) Assess premature infant behavior using the NBAS and its effect on maternal perceptions and maternal sensitivity. 3) Examine and compare mother-infant interaction patterns in preterm and full term dyads.


Costas, C., Botet, F., Arranz, A., López, M. & Fornieles, A. (2008). NIDCAP Neurobehavioral Observations in Premature Newborns: Detection of Stress and Well-Being Signals. Supplement to the Infant Mental Health Journal, Vol. 29 N 3A. Abstract n. 346, p.40

Holsti, L., Grunau, R. E., Oberlander, T. F. & Whitfield, M. F. (2004). Specific Newborn Individualized Developmental Care and Assessment Program Movements Are Associated With Acute Pain in Preterm Infants in the Neonatal Intensive Care Unit. Pediatrics, 1 (114), 65-72.

Mancera-Jiménez, M.A. (2010). Mothers’ perception of self-efficacy and its association with newborn infant behavior. (Unpubished MA dissertation), Universitat Autònoma de Barcelona, Barcelona, Spain.

Pressler, J. L. y Hepworth, J. T. (2002). A Quantitative Use of the NIDCAP Tool. Clinical Nursing Research, 1, 89-102.

Soria-Pastor, S., Padilla, N., Zubiaurre-Elorza, L., Ibarretxe-Bilbao, N., Botet, F., Costas-Moragas, C., Falcón, C., Bargalló, N., Mercader, J.M. & Junqué, C. (2009). Decreased Regional Brain Volume and Cognitive Impairment in Preterm Children at Low Risk. Pediatrics, 6 (124), 1161-1170.

Wolke, D. & St James-Roberts, I. (1987). Multi-method measurement of the early parent-infant system with easy and difficult newborns. In H. Rauh & H. C. Steinhausen (Eds.) Psychobiology and Early Development (pp. 49-70). Amsterdam: Elsevier.