The Brown Center For The

Study Of Children At Risk

Brown Center for the Study of Children at Risk
50 Holden Street
Providence RI 02908

Academic Administration:
(401) 453-7640

Clinical Services:
(401) 274-1122
x8936 or x8935

Contact Us


NICU Network Neurobehavioral Scale (NNNS)
The NICU Network Neurobehavioral Scale (NNNS) examines the neurobehavioral organization, neurological reflexes, motor development - active and passive tone, and signs of stress and withdrawal of the at-risk and drug-exposed infant. The NNNS was developed for the NIH as part of the multisite Maternal Lifestyles Study.

2The NNNS was designed to provide a comprehensive assessment of both neurological integrity and behavioral function. In addition, the NNNS documents the range of withdrawal and stress behavior likely to be observed in assessment and intervention with substance-exposed infants. Traditionally, scales that measure neonatal abstinence such as the Finnegan Neonatal Abstinence Score are treated separately from neurological and behavioral evaluation even though there is some overlap. In the NNNS, a stress/abstinence scale was incorporated into a neurobehavioral scale by recording signs of stress and withdrawal observed during the neurobehavioral examination. Thus, in addition to providing the behavioral items, the NNNS also provides a separate stress/abstinence scale and a systematic neurological evaluation.

The NNNS’ comprehensive assessment of neurobehavioral functioning is applicable to term, normal healthy infants, preterm infants, and infants at-risk due to factors such as prenatal substance exposure.  As such, it is a useful tool for both researchers and clinicians. The NNNS provides a useful format for neuro-developmental and neurobehavioral assessment in clinical settings such as hospital nurseries - including the neonatal intensive care unit (NICU) - neonatal follow-up programs and early intervention programs (EIP). Users are able to create a symptom oriented intervention plan for the infant. Additionally, the NNNS exam can be repeated on a regular basis, without affecting reliability and validity of the scoring.  Although the NNNS can be used for a single observation, repeated observations over time provide the user with the necessary data to inform his or her clinical practice or enhance a research protocol while accommodating the dynamic nature of the developing neonate. 


To download the Pediatrics supplement (click on link):

Pediatrics supplement articles

For NNNS training information, please contact:

Lynne Andreozzi Fontaine, Ph.D. at