The intervention

The NBO consists of 18 neurobehavioural observations focusing on the infant’s behavioural repertoire within the attentional-interactional, autonomic, motor and organisation of states domains [5]. This includes observations of responsivity to visual and auditory stimulation, capacity for habituation or sleep protection, amount of crying and ease of consoling, stress responses, reflexes, muscle tone and motor activity. Based on the observations, care giving strategies such as handling, sleep protection, comforting and regulation of social interaction are discussed [41]. The NBO takes 15 to 40 min to administer and can be used from birth until the infant is 3 months old. The observations are not performed as a checklist, but tailored to the needs of the individual family and the awake and sleep states of the infant [5]. Parents are encouraged to participate actively in the observation of their infant and to share their experiences, and the clinician meets them with a non-didactic and non-judgemental attitude. The overall aim is to provide tailored information and supervision related to parenting strategies based on the individual infant’s signals.

In this study, the NBO-group received three NBOs as an additional component to care as usual: 1. At the maternity ward with a midwife within 2 days post-delivery, 2. At the routine home visit with a public health nurse at 7–10 days post-delivery, and 3. NBO consultation at the well-baby clinic at 4 weeks post-delivery (additional to usual care visits). The comparison group received care as usual at the maternity ward, a home visit with a public health nurse at 7–10 days post-delivery, and had their first meeting at the well-baby clinic at 6 weeks post-delivery. Care as usual also included guidance on topics such as feeding, early social interaction, sleeping patterns, motor development, safe environment, crying, handling and caring for the baby, and the parents’ life situation and mental health [47]. In addition, the baby’s weight gain was evaluated. The NBO was integrated as part of the public health nurses’ regular practice. However, a distinction is that in the NBO the guidance is given as part of the observation of the baby and tailored to the unique baby’s state and behavioural communication cues, whereas care as usual may include more general guidance delivered as part of a conversation with the parents. The NBO was administered by certified midwives and public health nurses. They were instructed to keep logs after each NBO session to register the date of the NBO, who were present and which observation elements were performed.