from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.table import WD_TABLE_ALIGNMENT
from docx.oxml.ns import qn
from docx.oxml import OxmlElement

doc = Document()

style = doc.styles["Normal"]
style.font.name = "Arial"
style.font.size = Pt(12)

def set_cell_shading(cell, color_hex):
    tcPr = cell._tc.get_or_add_tcPr()
    shd = OxmlElement('w:shd')
    shd.set(qn('w:val'), 'clear')
    shd.set(qn('w:color'), 'auto')
    shd.set(qn('w:fill'), color_hex)
    tcPr.append(shd)

# Title
title = doc.add_heading("Organization of the Neonate", level=0)
title.alignment = WD_ALIGN_PARAGRAPH.CENTER
sub = doc.add_paragraph("An Assignment on Neonatal Behavioral and Physiologic Organization")
sub.alignment = WD_ALIGN_PARAGRAPH.CENTER
sub.runs[0].italic = True

doc.add_paragraph()

# Introduction
doc.add_heading("1. Introduction", level=1)
doc.add_paragraph(
    "The transition from intrauterine to extrauterine life requires the newborn to integrate and "
    "regulate multiple physiologic and behavioral subsystems simultaneously. \"Organization\" in "
    "neonatal science refers to the newborn's capacity to coordinate autonomic, motor, state, "
    "attentional, and self-regulatory functions in a stable, adaptive way in response to caregiving "
    "and the environment. This concept underlies neonatal behavioral assessment tools (e.g., the "
    "Brazelton Neonatal Behavioral Assessment Scale and the Newborn Behavioral Observations system) "
    "and guides individualized, developmentally supportive nursing care, particularly for preterm "
    "and high-risk infants in the NICU."
)

doc.add_heading("2. Definition", level=1)
doc.add_paragraph(
    "Neonatal (neuro)behavioral organization has been defined as the ability of the neonate to use "
    "goal-directed states of consciousness, in reciprocal interaction with the caregiving environment, "
    "to facilitate the emergence of differentiated, hierarchical, and coordinated neurobehavioral "
    "systems. Maturation of this organization is reflected in the infant's increasing resilience and "
    "growing capacity to process complex stimuli without physiologic or behavioral disruption."
)

# Als Synactive Theory
doc.add_heading("3. The Synactive Theory of Development (Als)", level=1)
doc.add_paragraph(
    "Heidelise Als' Synactive Theory of Development, which underpins the NIDCAP (Newborn "
    "Individualized Developmental Care and Assessment Program) framework, describes neonatal "
    "organization as the interaction of five subsystems that mature in a layered, hierarchical "
    "sequence. Stability in an earlier subsystem supports organization of the next."
)

subsystems = [
    ("Autonomic system", "Stability of heart rate, respiration, color, temperature regulation, and "
     "visceral (digestive) function. This is the most basic subsystem and must stabilize before "
     "higher systems can organize."),
    ("Motor system", "Muscle tone, posture, and the smoothness/quality of movements, including flexor "
     "and extensor balance."),
    ("State organization system", "The range, clarity, and stability of sleep-wake states and the "
     "smoothness of transitions between them."),
    ("Attention/interaction system", "The infant's ability to orient to and engage with visual, "
     "auditory, and social stimuli (faces, voices, objects)."),
    ("Self-regulatory system", "The infant's capacity to use self-comforting strategies (hand-to-mouth, "
     "sucking, grasping, postural adjustments) to maintain balance across all other subsystems."),
]

for name, desc in subsystems:
    p = doc.add_paragraph(style="List Bullet")
    run = p.add_run(f"{name}: ")
    run.bold = True
    p.add_run(desc)

doc.add_paragraph(
    "A well-organized newborn shows smooth transitions between states and stable vital signs during "
    "handling, and can self-console. A disorganized or stressed infant may show autonomic instability "
    "(color change, apnea, tremors), motor disorganization (flaccidity, hyperextension), or state "
    "lability (gaze aversion, irritability) when overstimulated. These are recognized clinically as "
    "\"stress cues\" versus \"stable/approach cues.\""
)

# AMOR
doc.add_heading("4. The AMOR Framework", level=1)
doc.add_paragraph(
    "The Brazelton Institute's Newborn Behavioral Observations (NBO) system summarizes the "
    "hierarchically organized developmental tasks facing the newborn using the acronym AMOR:"
)
amor = [
    ("A - Autonomic/physiologic stability", "Stabilization of breathing, temperature regulation, and "
     "reduction of tremors and startles."),
    ("M - Motor regulation", "Development of muscle tone, controlled activity level, and feeding "
     "coordination."),
    ("O - Organization of State", "Ability to cope with stress and develop predictable, regulated "
     "sleep-wake patterns."),
    ("R - Responsiveness", "Social engagement and responsiveness to caregivers."),
]
for name, desc in amor:
    p = doc.add_paragraph(style="List Bullet")
    run = p.add_run(f"{name}: ")
    run.bold = True
    p.add_run(desc)

# States of consciousness
doc.add_heading("5. States of Consciousness (State Organization)", level=1)
doc.add_paragraph(
    "A key, directly observable component of neonatal organization is the infant's behavioral state. "
    "Brazelton described six states, and a well-organized neonate can move fluidly between them:"
)

table = doc.add_table(rows=1, cols=2)
table.style = "Light Grid Accent 1"
table.alignment = WD_TABLE_ALIGNMENT.CENTER
hdr = table.rows[0].cells
hdr[0].text = "State"
hdr[1].text = "Characteristics"
for cell in hdr:
    for p in cell.paragraphs:
        for r in p.runs:
            r.bold = True
    set_cell_shading(cell, "D9E2F3")

states = [
    ("1 - Deep sleep", "Quiet, regular breathing; no eye movement; minimal response to external stimuli."),
    ("2 - Light sleep", "Rapid eye movements under closed lids; some body movement; startles to noise."),
    ("3 - Drowsy", "Transitional state; eyes open and close; may doze; semi-alert."),
    ("4 - Quiet alert", "Eyes wide open and bright; focused attention; body relatively still. Optimal state for feeding cues and social interaction."),
    ("5 - Active alert", "Increased motor activity; more sensitive/reactive to stimuli; fussiness may build."),
    ("6 - Crying", "Intense, disorganized motor activity; difficult to console without caregiver intervention."),
]
for s, d in states:
    row = table.add_row().cells
    row[0].text = s
    row[1].text = d

doc.add_paragraph()
doc.add_paragraph(
    "Predictable cycling through these states, and the infant's ability to self-soothe (e.g., "
    "bringing hand to mouth) rather than requiring prolonged external intervention, is a marker of "
    "good state organization."
)

# Clinical relevance
doc.add_heading("6. Clinical and Nursing Relevance", level=1)
points = [
    "Timing care: Feeding, bathing, and physical examinations are best performed during the quiet-alert state, when the infant is most receptive to interaction.",
    "Recognizing stress cues: Color changes, apnea, tremors, flaccid posture, gaze aversion, and irritability signal system disorganization and the need to reduce stimulation.",
    "Supporting self-regulation: Swaddling, containment holds, non-nutritive sucking, and skin-to-skin (kangaroo) care help the infant maintain autonomic and state stability.",
    "Developmental care in the NICU: NIDCAP and similar individualized developmental care programs use ongoing behavioral observation to minimize physiologic and neurobehavioral stress in preterm or ill infants, clustering care and reducing noise/light exposure.",
    "Parent education and bonding: Understanding infant states helps parents recognize readiness for feeding or play versus the need for a calming environment, supporting attachment and co-regulation.",
]
for pt in points:
    doc.add_paragraph(pt, style="List Bullet")

# Recent evidence
doc.add_heading("7. Supporting Evidence", level=1)
doc.add_paragraph(
    "Concept analyses across nursing and developmental psychology consistently describe neonatal "
    "neurobehavioral organization as a holistic, multidimensional phenomenon involving reciprocal "
    "interaction between the infant and caregiving environment (Concept clarification of neonatal "
    "neurobehavioural organization). A 2025 systematic review in Neuroscience and Biobehavioral "
    "Reviews found that gentle touch (e.g., skin-to-skin contact, containment holding) reliably "
    "facilitates newborn self-regulation across multiple arousal measures, reinforcing the clinical "
    "practice of touch-based interventions to support organization (PMID: 40912346)."
)

# Conclusion
doc.add_heading("8. Conclusion", level=1)
doc.add_paragraph(
    "Organization of the neonate describes how the newborn integrates autonomic, motor, state, "
    "attentional, and self-regulatory functioning to adapt successfully to extrauterine life. "
    "Frameworks such as Als' Synactive Theory and the AMOR model, together with direct observation "
    "of behavioral states, give caregivers practical tools to assess an infant's readiness for "
    "interaction, detect early signs of stress, and provide individualized, developmentally "
    "supportive care that promotes long-term neurobehavioral outcomes."
)

# References
doc.add_heading("References", level=1)
refs = [
    "Als, H. (1982). Toward a synactive theory of development: Promise for the assessment and support of infant individuality. Infant Mental Health Journal, 3(4), 229-243.",
    "Brazelton, T.B., & Nugent, J.K. (2011). Neonatal Behavioral Assessment Scale (4th ed.). Wiley-Blackwell.",
    "Brazelton Institute. Newborn Behavioral Observations (NBO) system. Boston Children's Hospital.",
    "Concept clarification of neonatal neurobehavioural organization. PMC2573022.",
    "Valori, I., Merkel, J.L., Furlan, G., et al. (2025). Touch facilitates newborns' self-regulation: Systematic review of multidimensional arousal outcomes. Neuroscience and Biobehavioral Reviews. PMID: 40912346.",
]
for r in refs:
    doc.add_paragraph(r, style="List Bullet")

out_path = "/tmp/workspace/neonate-organization/output/Organization_of_the_Neonate_Assignment.docx"
doc.save(out_path)
print("Saved:", out_path)