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State Systems Development in High-risk Newborns in the Neonatal Intensive Care Unit: Identification and Management of Sleep, Alertness, and Crying

VandenBerg, Kathleen A. PhD

The Journal of Perinatal & Neonatal Nursing: April-June 2007 - Volume 21 - Issue 2 - p 130–139
doi: 10.1097/01.JPN.0000270630.96864.9a
Feature Article

The state system is a fundamental component of newborn neurodevelopmental function and demonstrates the newborn's underlying neurologic and behavioral competence. The role of the state system in newborn developmental assessment reflects the newborn's ability to respond to the environment. This overview examines the importance of the state system as a significant developmental process, identifies specific variations in sleep and wakefulness, and describes behavioral patterns of state in full-term as well as high-risk newborns. Specific intervention techniques are outlined for caregivers and parents, which address consolability, adjusting the environment, handling, and interactions. This information contributes to the nurse's ability to identify and assess neurobehavioral integrity and provides appropriate behavioral individualized developmental interventions during neonatal care.

West Coast NIDCAP & APIB Training Center and Mills College, Department of Education, Oakland, Calif.

Corresponding author: Kathleen A. VandenBerg, PhD, Special Start California Training Center, Department of Education, Mills College, 5000 MacArthur Blvd, Oakland, CA 94613 (e-mail:

Submitted for publication: November 21, 2006

Accepted for publication: January 24, 2007

© 2007 Lippincott Williams & Wilkins, Inc.