TABLE 2.

Summary Scores of the NICU Network Neurobehavioral Scale (NNNS)

Attention	Indicates an infant’s ability to attend and respond to auditory and visual stimulation; high scores on this scale show good response and sustained alertness
Handling	Indicates the number and type of maneuvers necessary to keep the infant in the appropriate state to administer items; high scores indicate infants who need substantial input from the examiner in order to elicit attention and response to stimuli
Quality Movement	A measure of motor control including smoothness, maturity, modulation of movement of the arms and legs as well as startles and tremors; high scores indicate good quality of movement
Self Regulation	Indicates how the infant copes with the demands of the exam, with higher scores indicating better regulation
Non-Optimal Refl.	The number of non-optimal reflex responses
Stress/Abstinence	The number of stress/abstinence signs displayed by the infant across five organ systems
Arousal	Indicates the infant’s overall level of arousal and associated motor activity during the exam; high scores indicate high arousal, activity, and fussing and crying during the exam
Hypertonia	Indicates increased muscle tone in the arms, legs, and trunk; a high score describes an infant whose overall tone is consistently hypertonic
Hypotonia	Indicates decreased muscle tone in the arms, legs, and trunk; a high score on this scale describes an infant who was consistently hypotonic
Asymmetrical Refl.	A count of the number of times a reflex on one side of the body is stronger or weaker than on the other side
Excitability	A measure of high levels of motor, state and physiological reactivity; high scores indicate high levels of irritability even with attempts to soothe
Lethargy	A measure of low levels of motor, state and physiological reactivity; high scores indicate extreme under-arousal despite the necessary handling during the exam