Barcelona - The Brazelton Institute

Barcelona (Catalonia). Spain
We are an inter-disciplinary team working in the ambit of perinatal psychology. We have
been using the Neonatal Behavioral Assessment Scale, NBAS as an instrument for the
evaluation of behavior in newborn infants since the outset of the 1980’s.
Since 1995 we have been recognized by the Brazelton Institute, Harvard Medical School,
Boston (USA) as a center for the provision of training courses for specialists with the
The psychologists and pediatricians making up the team belong to the following
Universitat Autònoma de Barcelona. Psychology department.
Universitat de Barcelona. Pediatrics department.
Apart from the organizing and participating in a great number of activities such as
conferences, special sessions, short courses and seminars, the most formal teaching
activity was consolidated in December 1995, in which date we were recognized by the
Brazelton Institute as a center for the provision of training courses for specialists with the
The Neonatal Behavioral Assessment Scale Trainings are organized as follows:
 INTRODUCTION. Two-day skill-building workshoop to explain and demonstrate the
newborn characteristics as well as introducing the NBAS. In this phase the trainees
learn to administer the NBAS with a doll representing a newborn.
 PRACTICAL ACTIVITIES. Two-day skill-building workshoop to learn exam techniques
“in vivo”, and practice administering and scoring the NBAS.
 SELF STUDY PHASE. During an optional period, the trainees must administer the
Scale to about 20 newborns at his hospital. During this phase we usually offer a
half-day session to clear any doubts the trainees may have.
 CERTIFICATION SESSION. One day personal session in which a trainee administer
the Scale for the trainer and then they score the exam separately. The trainer and
trainee must reach a 90 percent level of agreement on the exam scores.
The theoretical activities take place at the Universitat Autònoma (Department of
Psychology) and practicals at the Hospital Clinic (Universitat de Barcelona). The practical
sessions are undertaken with reduced groups (3-4 trainees).
Behavior of newborn infants at risk
The aim of this study is the analysis of the relationships between different risk factors
and neonatal behavior evaluated with the NBAS. The following works are of particular
 Studies on the effects of birth-weight, both of low birth-weight (Costas and
Domènech, 1987; Costas, Botet and Ortolà, 1989) as well as overweight
(Castells and Domènech, 1987; Costas, Castells and Domènech, 1988)
 The effect of lead (de Cáceres, Botet, Costas and Rosales, 1995)
 Normal levels of bilirubin and its relation with neonatal behavior (de Cáceres,
Costas, Botet and Rosales, 1992)
 Study of neonatal behavior in acute foetal distress (Jirón, Costas, Botet and de
Cáceres, 1998)
 Assessment of the behavior of infants recently born to diabetic mothers
(Botet, de Cáceres, Rosales and Costas, 1996)
 The study of premature infant (works currently being undertaken):
 Assessment of premature newborn infant behavior at 40 weeks’
post-conceptional age, in terms of the NBAS (Costas, Lleonart, Botet and
de Cáceres, 2000) and the study of their subsequent development at 8
months (corrected age), with the Bayley Scales of Infant Development, as
well as the assessment of their temperament with the Revised Infant
Temperament Questionnaire (Carey Scales).
 Detection of the risk factors on the premature infant at 12-18 month
(corrected age).
 The efficacy of the tactile/kinesthetic stimulation on the premature
Interaction between the newborn infant and the mother
The study of interaction behavior between the newborn infant and the mother is the
general direction in which research is being developed by Missio and collaborators, using
observational methodology and, in certain cases, the NBAS (Missio, 1993; Missio, Botet,
Costas and Deulofeu, 1995; Missio, Domènech, Deulofeu, Botet et al, 1994; Missio,
Romero, Costas, Botet et al, 1992 and Romero, Missio, Domènech, Cararach et al, 1993).
The effects of epidural analgesia on newborn infant behavior
Research aims at the analysis of newborn infant behavior with respect to the different
epidural analgesic guidelines: ropivacaine, fentanyl and the combination of both
analgesics. This is based on work carried out by the team in which a negative correlation
was observed between the level of fentanyl in the umbilical cord and neonatal behavior
(Botet, Plaza, de Cáceres, Taurà and Coll, 1999; Plaza, 2000). We are also studying the
effects of caesarian birth with epidural analgesia (Botet, Lleonart, Costas and Figueras,
Other works
Translation into Spanish, in response to the authors’ request, of the Brazelton
Scale manual (Brazelton and Nugent, 1995): Brazelton, T.B. y Nugent, J.K.
(1997). Escala para la evaluación del comportamiento neonatal. Barcelona:
We are working on the standardization of the NBAS in our ambit (Barcelona,
Catalonia, Spain). We have received funding from the Spanish Ministry of Health
Botet, F., de Cáceres, M.L., Rosales, S. & Costas, C. (1996). Behavioral assessment of
newborns from diabetic mothers. Behavioural Neurology, 9, 1-4.
Botet, F., Lleonart, I., Costas, C. & Figueras, J. (1999). Estudio del comportamiento del
neonato a término nacido mediante cesárea con analgesia epidural, según la Escala de
Brazelton. Revista Latinoamericana de Neonatología. Comunicaciones al XVII
Congreso Español de Medicina Perinatal, Supl. 2, p. 51.
Botet, F., Plaza, A.M., de Cáceres, M.L., Taurà, P. & Coll, O. (1999). Valoración de la
conducta neonatal en la analgesia epidural controlada por la paciente, según la Escala
de Brazelton. Revista Latinoamericana de Neonatología. Comunicaciones al XVII
Congreso Español de Medicina Perinatal, Supl. 2, p. 51.
Brazelton T.B. & Nugent K. (1995). Neonatal Behavioral Assessment Scale. 3 rd Edition.
Clinics in Developmental Medicine. Nº 137. London: MacKeith Press.
Brazelton T.B. & Nugent K. (1997). Escala para la evaluación del comportamiento
neonatal. Barcelona: Paidós.
Cáceres de M.L., Botet F., Costas, C. & Rosales, S. (1995). Umbilical cord lead levels and
neonatal behaviour. Behavioral Neurology, 8, 39-41.
Cáceres de M.L., Costas, C., Botet F & Rosales, S. (1992). Niveles fisiológicos de
bilirrubina y conducta en el período neonatal en recién nacidos normales. Anales
Españoles de Pediatría, 37: 466-468.
Castells, M. & Domènech, E. (1987). Estudio de la conducta del recién nacido de peso
elevado para la EG: análisis con la Escala de Brazelton. Acta Pediátrica Española., 45,
Costas, C. (2000). Capacidades del neonato. In: J. Callabed et al. El primer año de vida
del niño, pp. 35-43. Barcelona: Editorial CIMS 97..
Costas, C., Botet, F. & Ortolà, M.E. (1989). Comportamiento del neonato de bajo peso
nacido a término, según la Escala de Brazelton. Anales Españoles de Pediatría, 34,
Costas, C., Castells, M. & Domènech E. (1988). Comparación entre la conducta de recién
nacidos de peso elevado y bajo. Acta Pediátrica Española, 46, 501-506.
Costas, C. & Domènech, E. (1987). Análisis de la Escala para la Evaluación del
Comportamiento Neonatal de T.B. Brazelton: valoración de la conducta del recién
nacido de bajo peso. Evaluación Psicológica / Psychological Assessment, 3, 383-407.
Costas, C., Lleonart, I., Botet, F. and de Cáceres, M.L. (2000). Behavior of the Newborn
Premature Infant according to the Brazelton Scale. Infant Mental Health Journal.
Abstracts at 7th Congress. World Association for Infant Mental Health. July 26-30, 2000
Montréal, p. 344
Jirón, P., Costas, C., Botet, F. & de Cáceres, M.L. (1998) Estudio del comportamiento
neonatal en el sufrimiento fetal agudo. Anales Españoles de Pediatría 48, 163-166.
Missio, M. (1993) Le nouveau né et sa mère en maternité. Compétences du bébé,
compétences des parents, compétences des professionnels. Les cahiers de l’Afrée. Nº
5. Association de Formation et de recherche sur l’Enfant et son Environnement.
Montpellier. Juillet.
Missio, M., Botet, F., Costas, & C., Deulofeu, P. (1995). Articulation des compétences
dans le système mère-nouveau-né Neuropsyquiatrie de l‘Enfance et de l’Adolescence.
43: 34-42
Missio, M., Domènech, E., Deulofeu, P., Botet, F., Cararach, V. & Costas, C. (1994)
Influencia de la edad materna y del sexo del bebé en las primeras reglas de la
alternancia. Acta Pediatrica Española 52: 550-554.
Missio, M., Romero, L., Costas, C., Botet, F., Deulofeu, P. & Domènech, E. (1992). Étude
de l'ajustement des compétences de la mère et de son nouveau-né en situation
d'allaitement au sein. Neuropsychiatrie de l'Enfance et de l'Adolescence, 40, 109-116.
Plaza, A. (2000). Analgesia epidural controlada por la paciente en Obstetricia.
Repercusión en la evolución del parto y en el neonato. Doctoral thesis. Facultat de
Medicina. Universitat de Barcelona.
Romero, L., Missio, M., Domènech, E., Cararach, V., Botet, F. & Costas, C. (1993).
Preparación al parto y percepción materna del futuro neonato. Acta Pediatrica
Española 51: 260-264