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BRIEF RESEARCH REPORT
published: 13 January 2021
doi: 10.3389/fped.2020.506384
Frontiers in Pediatrics | www.frontiersin.org 1January 2021 | Volume 8 | Article 506384
Edited by:
Gerry Leisman,
University of Haifa, Israel
Reviewed by:
Pankaj Bhardwaj,
All India Institute of Medical Sciences
Jodhpur, India
Lilach Soreq,
University College London,
United Kingdom
*Correspondence:
Rose-Angélique Belot
rose-angelique.belot@univ-fcomte.fr
Specialty section:
This article was submitted to
Children and Health,
a section of the journal
Frontiers in Pediatrics
Received: 21 October 2019
Accepted: 12 November 2020
Published: 13 January 2021
Citation:
Belot R-A, Bouteloup M, Mariage A,
Candilis-huisman D, Mottet N and
Mellier D (2021) Relevance of
Neonatal Behavior Assessment Scale
for Infants With Somatic Disorders:
Comparison on One Matched Group
of Control. Front. Pediatr. 8:506384.
doi: 10.3389/fped.2020.506384
Relevance of Neonatal Behavior
Assessment Scale for Infants With
Somatic Disorders: Comparison on
One Matched Group of Control
Rose-Angélique Belot 1
*, Margaux Bouteloup 1, André Mariage 1, Drina Candilis-huisman 2,
Nicolas Mottet 3and Denis Mellier 1
1Laboratory of Psychology EA3188, UFR SLHS, University of Bourgogne/Franche-Comte, Besançon, France, 2Research
Center “Psychanalyse et Médecine” EA 3522, Paris Diderot University, Paris, France, 3Department of Obstetrics and
Gynecology, Besançon Regional University Hospital, Besançon, France
Objective: To compare the Neonatal Behavior Assessment Scale results in two groups
of infants with or without somatic disorder (N=26).
Method: The Neonatal Behavior Assessment Scale was administered to two groups
(clinical and control) of 13 infants each, aged from 5 to 18 weeks, matched 2 by 2
according to sex, age, rank among siblings, and parental socio-professional category.
The first group includes infants with somatic disorder (clinical) and is matched with a
second group of “healthy infants” (control).
Results: Results indicate that the mean score of the control group is significantly higher
than that of the clinical group. Most of the items are affected by the presence of a somatic
disorder. Indeed, five out of the six categories present a statistically significant difference
in favor of the control group, more specifically for the items “state regulation,” “motor
system,” and “orientation/interaction.”
Conclusion: This exploratory research enables a precise description of infants’ difficulty
in regulating excitations and the impact of somatic disorders on their development.
This innovative knowledge will assist pediatricians and health professionals in the
understanding of infants’ characteristics to develop an adapted-care.
Keywords: infants 5–18 weeks, somatic disorders, emotion, regulation, care, NBAS
INTRODUCTION
Early somatic disorders in the baby are complex because many parameters must be taken into
account. Eating and sleeping are central functions that are particularly important during the first
year (1) because they require autonomous internal regulation to be established (hunger, satiety, and
circadian rhythm). Twenty-five percent of infants developing normally present eating disorders
(2,3) with no link to any growth disorder. In addition, a literature review evidenced the reported
presence of colic in 5–40% of infants (4) and painful gastroesophageal reflux in 5–30% of infants in
the first weeks of life. Colic predominates among somatic disorders in infants, accounting for more
than a third (5).
Sleeping disorders are difficult to characterize and are regularly underestimated because there
is no circadian rhythm during the first months of an infant’s life. Indeed, before 2–3 months of
Belot et al. RElevance of NAS for Infants With Somatic Disorders
age, infants tend to follow an ultradian pattern in which four
stages alternate: quiet wakefulness, agitated wakefulness, quiet
sleep, and agitated sleep (6).
The prevalence of sleeping disorders is known to be 30% (7) in
under 2-year-olds, with 75% recognized as behavioral disorders
(8). Furthermore, idiopathic colic in infants is a characteristic
somatic sign contributing to other bodily manifestations in
the first year of life (9). Five percent of infants present
breath-holding spells, a proportion that is equivalent in girls
and boys.
Infants resort very early on to rudimentary self-regulation
strategies, such as the neurophysiological mechanisms
of sucking and other movements. These mechanisms
become more complex with age (10,11). Because the
infant’s nervous system is immature, it cannot on its own
manage a high level of excitation. The mother’s role as
a protective shield to her child’s excitation is primordial
(12,13) until the formation of the infant’s psychic envelopes
(14,15).
Many studies have shown that difficulties in emotional
regulation are linked to eating disorders (16,17).
In infants with psychosomatic disorders, emotional regulation
is weak and inadequate in the early months. The infant is
overwhelmed by internal and external excitations.
His entourage is powerless to help him calm down (18–20).
Observation and the application of the Neonatal
Behavioral Assessment Scale (NBAS) (21–23) provide a
privileged and relevant tool to thoroughly assess an infant’s
development and abilities and emotional regulation: signs
of stress, motor and tonic abilities, excitability, irritability,
appeasement and self-appeasement, alertness, orientation,
and relational skills. The NBAS evidences an infant’s
contribution and his abilities to model his interactions:
sensory characteristics (sight, sense of smell, and hearing), motor
characteristics (muscular tension and diverted attention), and
kinesthetic characteristics.
The NBAS is used in many research areas. This scale is an
excellent tool to appreciate the infant’s development and behavior
and the risk factors associated such as prematurity (24–26), the
influence of life in utero in certain cultural contexts (27), a wide
variety of cultural contexts (28–31), and the effects of post-natal
depression on infant (32,33). Other studies using the NBAS
methodology focus on the neonatal behavior of infants at familial
risk for attention deficit hyperactivity disorder (34). The NBAS
scores also permit to predict the infant’s development: these
scores accounted for 21–47% of the variance in developmental
outcome at 36 months of age (35).
Only two studies reported using the NBAS for infants with
colic (36,37). Covington demonstrated that the scores of infants
with colic were lower for orientation items. Keefe shows that two
components of the NBAS were related to the development of colic
or infant irritability at 1 month of age.
Another study shows that results at the NBAS are related to
cerebral blood flow velocity asymmetry for premature infants
(38). There is, therefore, an interest to explore by using
NBAS the competencies and aptitudes of infants presenting
somatic disorders.
METHODS
This research originates from a thesis: all ethical principles have
been taken into account, and all written informed consents
have been obtained. At the moment of the study, under French
legation, ethics committee approval was not requested in the case
of this non-interventional study.
Sample
The study focused on comparing two groups (clinical and
control) of 13 infants each, aged ∼5–18 weeks and their families,
matched 2 by 2 according to sex, age, rank among siblings, and
parental socio-professional category (see Tables 1,2). The infants
in the clinical group were seen in the hospital, and the infants in
the control group were seen in nurseries.
All institutional approvals were obtained before the start of
the study.
The inclusion criteria were as follows:
•full-term infants and good health aged up to 18 weeks
•somatic manifestations without organic etiology
•with no natal difficulty (no reoxygenation). All measures taken
were normal.
•parents were living together and had wanted to have a child
The two groups (13 in each group) differed with respect to the
absence or presence of a somatic manifestation.
The first group, referred to as the clinical group (eight boys
and five girls), had somatic manifestations in the following
areas: sleeping, eating, digestion, and breathing (including losses
of consciousness with no organic etiology and breath-holding
spells). The other 13 infants formed the control group and did
not present any somatic manifestations.
The youngest infant in our study was aged 5 weeks, and the
oldest was 18 weeks.
The clinical group was composed of:
•2 children who presented gastroesophageal reflux as their main
symptom−4 other children had gastroesophageal reflux, but in
association with sleeping disorders, colic or fainting.
•4 children with an association of colic and sleeping disorders,
•2 children who had been hospitalized after a third episode
of bronchiolitis,
•1 child who had been hospitalized for refusing to be fed,
•3 children who had been hospitalized for investigation of spells
of sobs,
•1 child had diurnal sleeping problems with no other associated
somatic manifestation.
Crying and states of agitation do not constitute a specific category
because they are linked to other manifestations such as colic
episodes and/or sleeping disorders. In our population, several
disorders could occur for the same child—for instance, apparent
life-threatening event and gastroesophageal reflux. Sleeping and
digestion (colic) disorders were often combined and/or occurred
alongside other somatic manifestations.
Infant’s somatic disorders are, by nature, varied and are
quickly reversible (12,39), mostly spontaneously or after medical
and psychological care. This was the case with all the infants we
Frontiers in Pediatrics | www.frontiersin.org 2January 2021 | Volume 8 | Article 506384
Belot et al. RElevance of NAS for Infants With Somatic Disorders
met. Indeed, all the infants enjoyed a regular follow-up with a
pediatrician. After the assessment using the NBAS, some families
benefited from counseling.
At the age of 6 months, in our clinical population, all
the infants presented a favorable evolution, conforming to the
definition of punctual symptomatology.
In this context, we can consider the clinical group as
homogeneous, even if there are some original diversities in
somatic manifestations.
Procedure
The pediatricians constituted the clinical group. They were
informed of the inclusion criteria and offered families to
participate in the research. The researcher contacted the mother
to present in more detail the study and obtain an agreement and
written consent. No refusal has been recorded.
The control group has been constituted by a day-nursery
manager, respecting the matching criteria. The same approach for
presentation and agreement was followed up. All the infants were
with their mothers during the NBAS assessment.
The test was administrated by a researcher psychologist,
certified to Brazelton Scale, and in the combined presence of a
pediatrician for the clinical group. All the assessments took place
during the somatic manifestations.
The main characteristic of the NBAS is that it records
the best performance and assesses infants’ ability to organize
their responses in well-defined states of consciousness. The
presentation of the items is, therefore, not linear but depends
on the infant’s state of consciousness. The behavior items
are classified according to six variables to simplify data
analysis: habituation, orientation–interaction, motor system,
state regulation, and autonomic nervous system (ANS).
Brazelton (21,22) and Lester (40) have recommended
recoding several scale items to appreciate optimal scores
homogeneously. Indeed, without recoding, the optimal scores
can be 1, 5, or 9. With the recoding, number 9 corresponds to the
best possible result and number 1 the lower infant’s performance.
In our study, it was thus necessary to recode according to
Brazelton and Lester’s principle.
Statistical Analyses
Each cluster was presented with a mean and standard deviation.
Comparisons (clinical group vs. control group) were performed
using the Student t-test with SPSS version 19.0.
RESULTS
The means of both groups are calculated and compared for the six
items of the NBAS: habituation, orientation/interaction, motor
system, state organization, state regulation, and ANS (Table 3).
The only criterion that distinguished the two groups was
the presence of the clinical group of a somatic manifestation:
disorders relating to sleep, digestion, eating, or breathing.
First of all, the means obtained for the 26 items by the
clinical group (M=5.04, SD =1.72) were significantly lower
(p<0.01) than those obtained by the control group (M=7.34,
SD =0.47). The infants’ competencies and performances were,
TABLE 1 | Characteristics of the control and clinical groups.
Clinical group Control group
• with somatic disorders
•n=13
• Age: 5–18 weeks
• constituted by pediatricians
in hospital
• without somatic disorders
•n=13
• matched and according to sex, age,
rank among siblings, and parental
socio-professional categories
• constituted by manager in day-nursery
Comparison of two groups. (Institutional approvals and individual consents obtained).
therefore, generally greater in the control group than in the
clinical group. There is one important point: to ensure that the
infants in the clinical group could obtain their best possible score,
the investigator had to pay considerable attention and provide
support, whereas with the control group, the participation was
less demanding.
Furthermore, in five out of six categories in the NBAS
(habituation, orientation/interaction, motor system, state
organization, and state regulation), the control group obtained
significantly higher scores than those in the clinical group.
Only the category ANS did not show any statistically
significant difference.
The most significant differences were for the following
categories: state regulation (p<0.001), orientation–interaction
(p<0.01), and motor system (p<0.01).
DISCUSSION
Habituation includes items such as response to light, to a rattle,
and to a small bell and reflects infants’ aptitude for getting used to
external stimulation. The difference in scores between the control
group (M=8.23, SD =1.62) and the clinical group (M=6.60,
SD =2.20) was considerable and significant [t(26) =2.06, p
<0.05]. During the different administrations of the NBAS, we
indeed observed that infants had difficulty in regulating all the
endogenous and exogenous excitations that they were subjected
to. For infants with somatic disorders, their sensitivity to stimuli
seemed to us to be much greater than for the infants in the control
group. Their habituation abilities were more difficult to mobilize.
We think that this suggests a chain reaction, whereby a context of
hyperactivity discourages the emergence of internal regulations
and habituation skills.
Orientation–interaction includes orientation items with single
or multiple visual, auditory stimuli of the inanimate type (red
ball and rattle) and animate (the researcher’s face and voice).
The performances of the control group infants here (M=8.26,
SD =0.94) were significantly better than those of the clinical
group (M=6.10, SD =2.25) [t(26) =3.34, p<0. 01]. Infants
with somatic disorders provided weaker responses when faced
with interactive and orientation stimulations.
Indeed, the various competencies explored with the
NBAS—speed of habituation to stimulus, orientation and
interaction with the investigator, and variety and range of the
infant’s motor skills—showed poor responses. Is this failure
to respond encouraged by burgeoning somatic disorders, or
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Belot et al. RElevance of NAS for Infants With Somatic Disorders
TABLE 2 | Population: children matched for sex, age, socio-professional category, and rank among siblings.
Family and
allocated group
Sex First
name/anonymity
Age
M month
D Days
Nature of somatic
expression
Family make-up
and siblings
Prof. father Age father,
years
Prof. mother Age mother,
years
Mr. and Mrs A.
clinical
Boy Alexis 3M 22D 3rd episode
bronchiolitis
2nd child of couple
and mother (1G, 5
years)
Cat. 5 39 Cat. 4 30
Mr. and Mrs N.
control
B Ulysse 3M 22D No somatic
expression
2nd child of mother,
1 B,18 years 1st child
of couple
Cat. 5 33 Cat. 4 37
Mr. and Mrs B.
clinical
B Tristan 1M 28D GERD—Crying,
agitation, sleep
disorders
1st child of mother
and couple (Father
has 3 adolescent G )
Cat. 3 46 Cat. 3 31
Mr. and Mrs O.
control
B Désiré 2M 3D No somatic
expression
1st child of couple Cat. 3 39 Cat. 3 36
Mr. and Mrs C.
clinical
Girl Inès 1M 19D Spells of sobs 1st child of couple Cat. 6 28 Cat. 6 29
Mr. and Mrs P.
control
G Mélodie 1M 11D No somatic
expression
1st child of couple Cat. 6 35 Cat. 6 27
Mr. and Mrs D.
clinical
G Blanche 2M 7D Food refusal 3rd child of couple
(2 G, 4 and 7 years)
Cat. 5 33 Cat. 8 32
Mr. and Mrs Q.
control
G Diane 2M 7D No somatic
expression
3rd child of couple Cat. 5 39 Cat. 8 27
Mr. and Mrs E.
clinical
B Pierre 3M 8D 3rd episode
bronchiolitis
3rd child of couple
(2 G, 3 and 5 years)
Cat. 4 36 Cat. 4 29
Mr. and Mrs R.
control
B Remy 3M No somatic
expression
3me enfant du couple
(1 G, 3 years and 1 B,
7 years)
Cat. 4 34 Cat. 4 33
Mr. and Mrs F.
clinical
B Virgile 1M 13D Colic. Sleep
disorders. Agitation
1st child of couple Cat. 6 24 Cat. 6 28
Mr. and Mrs S.
control
B Elie 1M 13D No somatic
expression
1st child of couple Cat. 6 23 Cat. 6 24
Mr. and Mrs G.
clinical
G Alma 2M Spells of
sobs—crying
1st child of
couple–2nd child of
mother, 1 B, 19 years
Cat. 4 33 Cat. 3 37
Mr. and Mrs T.
control
G Anna 2M No somatic
expression
2nd child of couple (1
B 3 years)
Cat. 3 38 Cat. 4 34
Mr. and Mrs H.
clinical
B Gratien 3M 25D Spells of sobs and
slight oesophagitis
1st child of
couple–2nd child of
mother (1 B 3 years)
2nd child of father
(1 G 4 years)
Cat. 5 30 Cat. 4 24
Mr. and Mrs U.
control
B Félicien 3M 11D No somatic
expression
2nd child of couple
(1 G 4 years)
Cat. 4 34 Cat. 4 36
Mr. and Mrs I.
clinical
G Eva 4M 15D GERD 1st child of couple Cat. 3 30 Cat. 3 30
Mr. and Mrs V.
control
G Emma 4M 12D No somatic
expression
1st child of couple Cat. 3 31 Cat. 3 31
Mr. and Mrs J.
clinical
B Noël 3M 2D Colic—GERD—
daytime sleep
disturbances
1st child of couple
and mother (Father
has 2 B, 15 and
17 years)
Cat. 6 38 Cat. 6 35
Mr. and Mrs W.
control
B Nathan 3M 2D No somatic
expression
1st child of couple Cat. 6 27 Cat. 6 26
Mr. and Mrs K.
clinical
G Océane 1M 21D Colic, screaming,
daytime sleep
disorders
1st child of couple
and mother. Father
has 2 B 16 and 17
years
Cat. 4 42 Cat. 4 37
Mr. and Mrs X.
control
G Oriane 1M 22D No somatic
expression
1st child of couple
and mother. Father
has 2G
Cat. 4 30 Cat. 4 26
(Continued)
Frontiers in Pediatrics | www.frontiersin.org 4January 2021 | Volume 8 | Article 506384
Belot et al. RElevance of NAS for Infants With Somatic Disorders
TABLE 2 | Continued
Family and
allocated group
Sex First
name/anonymity
Age
M month
D Days
Nature of somatic
expression
Family make-up
and siblings
Prof. father Age father,
years
Prof. mother Age mother,
years
Mr. and Mrs L.
clinical
B Aymé 1M 8D Daytime sleeping
disorders
1st child of couple Cat. 4 30 Cat. 4 26
Mr. and Mrs Y.
control
B Justin 1M 15D No somatic
expression
1st child of couple Cat. 4 31 Cat. 4 32
Mr. and Mrs M.
clinical
B Madras 2M 15D Colic—GERD—
Sleep
disorders—
Screaming
2nd child of mother
(1 G, 15 years) 1st
child of couple
and father
Cat. 5 30 Cat. 5 36
Mr. and Mrs Z.
control
B Constant 2M 12D No somatic
expression
2nd child of mother
(1 B, 18 months)
Cat. 3 41 Cat. 3 36
GERD, gastroesophageal reflux disease.
TABLE 3 | Means for the Brazelton neonatal behavioral assessment scale and
comparison of the two groups.
Group
Clinical Control
M (SD) M (SD) t p
Habituation 6.60 (2.20) 8.23 (1.62) 2.06 0.05
Orientation/interaction 6.10 (2.25) 8.26 (0.94) 3.34 0.01
Motor system 4.50 (1.63) 6.46 (0.98) 3.87 0.01
State organization 2.39 (1.62) 3.80 (1.77) 2.21 0.05
State regulation 3.83 (2.36) 7.15 (1.15) 4.76 0.001
Autonomic nervous system 7.18 (1.34) 7.87 (0.29) 1.90 NS
Global mean 5.04 (1.72) 7.34 (0.47) 4.86 0.01
do somatic manifestations hamper the development of these
aptitudes? The question has not been addressed. It is difficult to
identify the origin of the disorders, but chain reactions take effect
very quickly and could amplify the initial cause, if there is one.
Our clinical observations, however, provide some insights. For
instance, the children from the clinical group generally seemed
less available or receptive to provide optimal reactions to the
stimuli, as they were not able to stay in a quiet state of wakefulness
for very long (state 4).
This means that all the other functions in the various
domains are hampered. For example, their performances on
orientation and interaction items are dependent on their ability
to present stability in the various states and to control their
level of excitation. Motor system includes the following items:
general tone, motor maturity, the Moro reflex test, and the level of
spontaneous and induced activity. The mean score for the control
group (M=6.46, SD =0.98) was higher than for the clinical
group (M=4.50, SD =1.63). This difference was also significant
[t(26) =3.87, p<0.01] in favor of the control group. Our
observations overall showed that there was either spontaneous
hyperactivity in infants with somatic disorders or the complete
opposite, a lack of muscle tone and excessive slackening. For
instance, in the Moro reflex test, infants with somatic disorders
did not have enough muscle tone to support their heads, and
their spontaneous activity was poor. Other infants with somatic
disorders exhibited hypertonic performances and considerable
muscular tension. The alternation of periods of tension and
slackening was generally not as frequently observed in the clinical
group, where tonicity was present but more flexible.
State organization includes peaks of excitation, states of
increased agitation, and liability of states of wakefulness. The
mean scores were also significantly different here in favor of
the control group (M=3.80, SD =1.77) against (M=
2.39, SD =1.62) for the clinical group. This difference is also
significant [t(26) =2.21, p<0.05].
The infants’ responses to these items, in our view, provide a
good prognosis for detecting their abilities in all the other areas
studied on the NBAS. Indeed, an infant’s ability to face either
internal stimuli (coming from their body) or external stimuli
(noise, light, and heat) constitutes major elements whereby all
the infant’s other aptitudes and competencies can emerge and
be expressed. This involves the issue of infants’ own abilities
to control their excitation, the quality of the environment, and
the help received in managing their excitation, both internal
and external.
State regulation includes items such as cuddliness,
consolability, self-appeasement, hand-to-mouth activity,
and highlights infants’ ability to “let themselves go” in the
arms of an adult and relax in a comforting position (cuddliness
item), to use their own self-consolation abilities (hand-to-mouth
and self-appeasement items) and their ability to be consoled
(consolability item). This is the area where infants from the
clinical group obtained the lowest scores (M=3.83, SD =2.36)
compared with the control group (M=7.15, SD =1.15). This
difference was the most significant of the five categories studied
[t(26) =4.76, p<0.001].
The excessive excitation and motor agitation observed in
the clinical group hindered the infants’ ability to relax and
hampered contact and hand-to-mouth coordination. Similarly,
an infant’s ability to be consoled is necessarily hindered
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Belot et al. RElevance of NAS for Infants With Somatic Disorders
when he is subjected to excess excitation that cannot be
controlled by the infant himself nor by his environment.
We noticed that the infants’ self-appeasement abilities could
not develop when they did not succeed in settling down to
a sufficiently long state of quietude. Alongside, insufficient
excitation (particularly from the environment) generated the
same kind of difficulty. Infants cannot on their own regulate
states of excitation that result from their main functions. Their
physical and psychological immaturity requires appropriate care.
In some cases, these infants present an excess of excitation
that is not triggered by the environment but is residual,
leading to the same consequences as described when excess
excitation dominates.
The ANS includes tremors, starts, and rapid changes in skin
color. The scores for the two groups were different (mean =7.87
for the control group and mean =7.18 for the clinical group),
but the difference was not significant. This study did not
consider premature infants. However, tremors and starts were
more frequent in infants with somatic disorders. The stability
of the ANS (as illustrated on the NBAS by the presence or
absence of tremors and starts or by changes in skin color) is
less affected than other domains by the presence of somatic
manifestations. Indeed, infants over 1-month-old can maintain
regulations inside their nervous system quite well. However,
the most sensitive item in this group of items, which shows
the greatest interpopulation variation, is skin color. Infants
presenting a somatic manifestation are less likely to show the
ability to regulate their body temperature.
Als (24), who carried out repeat assessments on 10-day-old
infants, evidenced a hierarchy in the control of physiological
functions and the different dimensions of behavior. According
to these authors, regulation of the ANS in infants could precede
motor organization, which could be followed by the potential
to regulate their states. Orientation–interaction abilities could
come last.
From this observation, a hierarchy within the nervous system
internal regulations could be defined: blood supply could be
the most sensitive regulation and, therefore, the last step in the
formation of the ANS regulations.
CONCLUSION
This exploratory research on 26 infants is relevant because it
shows a link between the infant somatic manifestation and
NBAS skills. The inclusion of a control group in this research
helped shed light, via an interpopulation comparison, on the
circumstances favoring satisfactory psychosomatic development
in infants.
The use of the NBAS in this context, even if the sample
is small, enables us to grasp the range of competences and
the specific defense modes that are characteristic of the main
functions: the development of sensory qualities (sight, smell,
and hearing), motor qualities (muscular tension and diverted
attention), and coenesthetic abilities.
This study has thus provided precise information on the
differences between infants with somatic disorders and those
without and in what areas these differences occur. In addition,
it has enabled the identification of the strengths and weaknesses
in each group, thanks to the NBAS indicators. The NBAS is
a rich and fruitful investigation tool to understand what is
usually known as temperament data or infants’ personal initial
characteristics: their modes of organization, their development
dynamics, and their range of responses to disruptions and also
to environmental, affective, and/or relational stimulations. The
in-depth understanding of these characteristics will be helpful for
pediatricians and health professionals to propose care adapted to
each baby.
LIMITS AND PERSPECTIVE OF OUR
STUDY
•The promising results of this exploratory research confirm the
need for in-depth research with a larger sample.
•The next NBAS assessments will be videotaped for double-
blind quotes, always with certified professionals.
•A question remains: is emotional regulation impacted by
somatic manifestations, or are difficulties in emotional
regulation caused early symptomatology? This study cannot
say clearly either way. A longitudinal study with a larger
sample is required to throw more light on the issue.
DATA AVAILABILITY STATEMENT
The datasets generated for this study are available on request to
the corresponding author.
ETHICS STATEMENT
Ethical approval was not provided for this study on human
participants because at the moment of the study, under French
legatory, registered number and Clinical Trial registration was
not requested in case of non-interventional study. This research
originates from a thesis: all approvals are obtained and all ethical
principles have been taken into account. Written informed
consent to participate in this study was provided by the
participants’ legal guardian/next of kin.
AUTHOR CONTRIBUTIONS
R-AB devised the project, the main conceptual ideas, and
proof outline. AM realized the statistical analyses. DC and
NM reviewed the manuscript and provided their thoughtful
comments and suggestions. R-AB, MB, and DM wrote the
manuscript. All authors contributed to the article and approved
the submitted version.
ACKNOWLEDGMENTS
We are grateful to Professor Noir, Head of Pediatrics
Department, CHU Besançon, to Doctor Saade B., Pediatrician,
and to Mrs. Bugnon, Nursery Manager in Besançon. We also
thank the parents and infants for agreeing to be part of this study.
Frontiers in Pediatrics | www.frontiersin.org 6January 2021 | Volume 8 | Article 506384
Belot et al. RElevance of NAS for Infants With Somatic Disorders
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Frontiers in Pediatrics | www.frontiersin.org 7January 2021 | Volume 8 | Article 506384
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Conflict of Interest: The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be construed as a
potential conflict of interest.
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