Early behaviour, development and parenting in a very low birthweight infant group

Abstract Thirty-seven mothers, their very low birthweight infants and a matched group of term infants of normal birth-weight and their mothers were seen when the infants were 12 months old (corrected for prematurity). Data were collected about infant behaviour and development, mother-infant interaction in a free-play situation, and parenting behaviour indicating child-centred care. Findings for the mother-infant dyads in the two birthweight groups were compared to determine the extent to which the data supported possible outcomes of: differences in behaviour/development only, differences in behaviour/development compounded by disturbances of interaction or parenting, or interaction/parenting disturbances despite apparently normal behaviour and development. Results of this analysis indicated significantly poorer scores for the very low birthweight infants on measures of behaviour and development only. Recent reports that interactional problems, which commonly exist early on, resolve through a process of mother-infant adaptation are discussed in light of the findings of this study. The need to consider developmental problems and interactive failure jointly if early intervention is to be offered is also examined.     

The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants

Background  

Very low birthweight infants are at risk for deficits in cognitive and language development, as well as attention and behaviour problems. Maternal sensitive behaviour (i.e. awareness of infant cues and appropriate responsiveness to those cues) in interaction with her very low birthweight infant is associated with better outcomes in these domains; however, maternal anxiety interferes with the mother's ability to interact sensitively with her very low birthweight infant. There is a need for brief, cost-effective and timely interventions that address both maternal psychological distress and interactive behaviour. The Cues and Care trial is a randomized controlled trial of an intervention designed to reduce maternal anxiety and promote sensitive interaction in mothers of very low birthweight infants.     

Maternal depression is associated with mother-infant interaction in preterm infants.

AIM: The purpose of this study was to assess the prevalence and the background factors of maternal depressive symptoms and their relation to the quality of mother-infant interaction in a group of preterm infants and their mothers. METHODS: The signs of maternal depression were evaluated in 125 mothers of very preterm infants (birth weight < or = 1500 g or < 32 gestational weeks) at 6 months of infant's corrected age using Edinburgh Postnatal Depression Scale (EPDS). The association between maternal depressive symptoms and the quality of mother-infant interaction as assessed by the parent child early relational assessment method (PCERA) method was studied at 6 and 12 months of corrected age in 32 preterm infants who were their mothers' firstborn infants and singletons. RESULTS: The prevalence of depression assessed by EPDS in mothers of very preterm infants was 12.6%. Most interestingly, the number of postnatal signs of depression associated negatively with the quality of the maternal interaction behaviour with their preterm infants. CONCLUSIONS: This study suggests that maternal depression may be a risk factor in the development of the mother-infant relationship between preterm infants and their mothers. Therefore, it would be important to identify signs of depression in mothers of preterm infants to offer early support.     

The effects of maternal social phobia on mother-infant interactions and infant social responsiveness

BACKGROUND: Social phobia aggregates in families. The genetic contribution to intergenerational transmission is modest, and parenting is considered important. Research on the effects of social phobia on parenting has been subject to problems of small sample size, heterogeneity of samples and lack of specificity of observational frameworks. We addressed these problems in the current study. METHODS: We assessed mothers with social phobia (N = 84) and control mothers (N = 89) at 10 weeks in face-to-face interactions with their infants, and during a social challenge, namely, engaging with a stranger. We also assessed mothers with generalised anxiety disorder (GAD) (N = 50). We examined the contribution to infant social responsiveness of early infant characteristics (neonatal irritability), as well as maternal behaviour. RESULTS: Mothers with social phobia were no less sensitive to their infants during face-to-face interactions than control mothers, but when interacting with the stranger they appeared more anxious, engaged less with the stranger themselves, and were less encouraging of the infant's interaction with the stranger; infants of index mothers also showed reduced social responsiveness to the stranger. These differences did not apply to mothers with GAD and their infants. Regression analyses showed that the reduction in social responsiveness in infants of mothers with social phobia was predicted by neonatal irritability and the degree to which the mother encouraged the infant to interact with the stranger. CONCLUSIONS: Mothers with social phobia show specific parenting difficulties, and their infants show early signs of reduced social responsiveness that are related to both individual infant differences and a lack of maternal encouragement to engage in social interactions.     

Heart rate variations in five-month-old children during interactions in a controlled environment

This paper reports the first data of a study on heart rate variations of 13 5-mo-old infants seated in special chairs. Their electrocardiograms and behaviour were continuously recorded during sessions that were set up with their mother and a mother-child dyad that they met for the first time when the first session was organized. The protocol comprised two interaction phases between the infants and their mothers and two with one another. The same pairs of mother-child dyads were studied a second time 1 wk later. During the first session, the infants' heart rate variability increased significantly from the mother-infant interaction phases to the infant-infant interaction phases. During the second session, the variability was higher during the mother-infant phases than in the corresponding phases of the first session. This could be linked to changes in the mothers' behaviour and the infants' idea and excitement of meeting the child from the first session again. However, the variability was significantly lower during the infant-infant phases than during the mother-infant phases and the corresponding infant-infant phases of the first session. This corresponds to the development of affiliative behaviours in the infants. Conclusion : When two 5-mo-old infants were seated by their mothers in special chairs, significant differences were observed in their heart rate variability when they became familiar with each other, whether they were interacting with their mothers or with one another.     

Early maternal anxiety predicts cognitive and behavioural outcomes of VLBW children at 24 months corrected age

Aim: The present study examined the effects of maternal anxiety during infant hospitalization in the Neonatal Intensive Care Unit (NICU) on the child’s cognitive and behavioural development at 24 months corrected age. Parental anxiety following the birth of a very low birthweight (VLBW, <1500 g) infant may impede their capacity to be sensitive to the infant’s cues and adversely affect infant developmental outcomes. Methods: A sample of 88 mothers and their VLBW infants were recruited in the NICU; 57 were followed at 24 months corrected age. During the infant’s hospitalization, mothers completed a self‐report measure of trait anxiety. When the infants were 24 months corrected age, mother–child interaction was videotaped during free play at home. These videotaped observations were coded using Emotional Availability Scales. Child cognitive and behavioural outcomes were evaluated using the Bayley Scales of Infant Development (II) and the Child Behavior Checklist for Ages 1.5–5. Results: Maternal anxiety in the NICU was found to be a significant and independent predictor of child cognitive development and internalizing behaviour problems, controlling for maternal education and neonatal morbidity. Conclusion: These results suggest that early intervention programmes targeting anxious mothers of VLBW infants are indicated, to promote optimal developmental outcomes.     

Comparison of parenting stress between Malaysian mothers of four-year-old very low birthweight and normal birthweight children

A study was carried out to compare parenting stress between 116 mothers of very low birthweight (VLBW) children and 96 mothers of normal birthweight (NBW) children at 4 y of age, using the Parenting Stress Index (PSI). Multiple regression analysis was used to determine factors associated with child-domain stress (CDS) and parent-domain stress (PDS). There was a significantly higher proportion (39.7%) of mothers of VLBW children with high CDS scores >90th percentile than mothers of NBW children (20.8%). No significant differences were observed for PDS scores. Lower intelligence quotient (IQ) scores and adverse child behaviour, as evidenced by higher Child Behavior Checklist (CBCL) scores, were significantly associated with higher CDS scores (p < 0.001). Factors associated with higher PDS scores were higher CBCL scores (p < 0.001), mothers who were the primary caregivers (p < 0.001), male sex (p = 0.018) and lower level of maternal education (p = 0.048). These factors remained statistically significant even when physically and cognitively impaired children were excluded from the analysis. Conclusion: Specific child characteristics and the social environment appear to have a greater impact on parenting stress than the biological risk of VLBW birth per se.     

The Nature of the Mother's Tie to Her Infant: Maternal Bonding under Conditions of Proximity, Separation, and Potential Loss

Attachment has generally been examined from the infant's perspective. We focused on mothers' post-partum thoughts and behaviors. Guided by an ethological approach, maternal bonding was examined under conditions of proximity, separation, and potential loss. Ninety-one mothers were interviewed: mothers of full-term infants who maintained continuous proximity to the infant, mothers of healthy premature infants who were separated from the infant, and mothers of very low birthweight infants who experienced potential loss and prolonged separation. Mothers of term infants reported medium-to-high levels of preoccupations with thoughts of infant safety and well-being. Preoccupations increased with separation (Group 2) and significantly decreased with impending loss (Group 3). Attachment behaviors and representations were the highest among mothers of term infants and declined linearly with the duration of mother-infant separation. Maternal trait anxiety and depression were related respectively to higher levels of preoccupations and reduced attachment behaviors and representations, independent of the infant medical condition and mother-child separation. Discussion focused on the comparability of maternal and infant attachment in relation to the neurobiological system underlying bond formation.     

Plasma angiotensin II concentrations in the early neonatal period

BACKGROUND: There have been only a few reports on the renin-angiotensin system in low birthweight infants; in particular, plasma angiotensin II concentrations have not been studied. AIM: To investigate plasma angiotensin II concentrations in early neonatal infants including low birthweight infants. METHODS: Forty six patients were studied, of whom 14 weighed not less than 2500 g (normal birth weight), 16 weighed less than 2500 g but not less than 1500 g (moderately low birth weight), and 16 weighed less than 1500 g (very low birth weight). Blood samples were collected twice, on day 0 and day 7. Angiotensin II concentration was assayed using an enzyme immunoassay kit with a microplate. RESULTS: Geometric means of angiotensin II concentrations on day 7 were 19 pg/ml in the normal birthweight group, 28 pg/ml in the moderately low birthweight group, and 76 pg/ml in the very low birthweight group. The concentrations on day 7 in the very low birthweight group were significantly higher than those in the normal birthweight and moderately low birthweight groups (p = 0.005, p = 0.031). There were significant correlations between angiotensin II concentration on day 7 and gestational age (r(s) = -0.4, p = 0.007) and birth weight (r(s) = -0.36, p = 0.016). CONCLUSIONS: Specific physiological conditions associated with a very low birth weight are thought to be responsible for the increased concentration of angiotensin II on day 7. It is necessary to measure angiotensin II concentration for a longer period after birth and study the factors that could influence it.     

Stability of longitudinal motor development in very low birthweight infants from 5 months to 5.5 years

Aim: The motor performance of 165 very low birthweight (VLBW) infants was assessed prospectively at 5, 10, 18 mo and 5.5 y. The aim of the study was to evaluate longitudinal stability of motor development and its association with birthweight (BW), gestational age at birth, intraventricular haemorrhage (IVH), periventricular leucomalacia (PVL) and retinopathy of prematurity (ROP). Furthermore, at 5.5 y the motor behaviour of the VLBW population was compared with that of 124 children born at term. Methods: The results of each examination were ranked into four levels and the stability of motor development was evaluated on the basis of this ranking. At 5.5 y, VLBW children and controls were compared according to percentiles in the Movement ABC. Results: Fifty-three percent of the VLBW infants displayed a stable motor development. Only PVL and BW contributed significantly to the variability in their motor performance. Forty-seven percent of the infants exhibited an unstable motor development with no association to risk factors. In the entire group only IVH and severe ROP were related to poor motor performance. The majority of the VLBW children performed within the normal range at 5.5 y but their performances were inferior to those of control children. Conclusion: VLBW infants with poor early motor performance and/or severe IVH/PVL and ROP should be recruited into individualized follow-up programmes, whereas regular ongoing monitoring by follow-up may be sufficient for those with normal early motor performance and normal ultrasound findings.     

Developmental outcomes and environmental correlates of very low birthweight, cocaine-exposed infants.

Fetal cocaine exposure may have differentially adverse effects on developmental outcomes of very low birthweight (VLBW) infants. As part of a longitudinal study, 31 cocaine-positive very low birthweight infants, and age, race and socioeconomic status matched VLBW controls enrolled at birth were followed. Neonatal maternal-child interactions, concurrent maternal psychological characteristics and environmental factors conceptualized as important for child outcome were assessed as well as standard developmental outcomes at 3 years.In the neonatal period, cocaine-exposed VLBW infants who remained in maternal custody tended to be rated as less responsive and their mothers as less nurturing, less emotionally available and with a tendency to use more maladaptive coping mechanisms than nonexposed VLBW infants. At follow-up, cocaine-exposed VLBW children were delayed in cognitive, motor and language development compared to controls. Almost half (45%) of the exposed children scored in the range of mental retardation compared to 16% of the comparison VLBW children.The persistent cognitive, motor and language delays of the cocaine-exposed VLBW children, combined with the poorer behavioral interactions of cocaine-using women with their infants in the neonatal period, indicate a need for increased developmental surveillance of cocaine-exposed VLBW infants with a focus on maternal drug treatment and parenting interventions.     

Maternal tactile behaviour correlated with mother and newborn infant characteristics

Filmed observations of spontaneous interactions between mothers and their newborn infants (N = 50) were used to quantify the occurrences, duration and frequency of maternal tactile behaviours (stroking, kissing, touching the clothes, etc.). The analysis of the data shows that these maternal behaviours vary from one mother to another according to the activities of the newborn infant (sleeping, arousal but not feeding, feeding) and to different biological (sex of the infant, birthweight) and social (socio-economic status of the mother) variables. These results would suggest discussion topics concerning the differences between the mother-infant interaction systems.     

Maternal blood pressure in pregnancy and newborn irritability

The neonatal period is being recognized as an important period for the development of patterns of interaction between mother and infant, and infant state has been shown to have a significant impact on mother-infant interactions. A major dimension of infant state, with implications for this interaction and for the development of later behaviour disorders, is the infant's irritability. Research with Navajo, Malay, Chinese and Tamil mothers and infants showed that normal variation in maternal blood pressure during pregnancy was related to newborn irritability as assessed with the Brazelton Scale. This relationship is discussed in terms of possible underlying mechanisms.     

Does maternal prenatal attachment predict postnatal mother-infant interaction?

The current study examined whether maternal prenatal attachment is associated with the mother-infant relationship. One hundred pregnant women and their infants at 12 weeks participated in the study. The sample was part of the Umea Child and Family Development project and was randomly recruited by midwives or health visitors. The expectant women completed a self-administered questionnaire, the PAI (the Prenatal Attachment Inventory) measuring prenatal attachment towards their unborn baby. At about 12 weeks postpartum, mothers and their infants were observed and videotaped during an en face interaction. The results revealed that maternal prenatal attachment towards the unborn baby is a good predictor of the early mother-infant relationship. Mothers who were high on the PAI-factor fantasy, for example, in general showed more involvement while interacting with their babies. Mothers rated highly on PAI-factors such as interaction and affection stimulated their infants by using more proximal stimulation, while those rated highly on differentiation of self with the unborn baby used more distal stimulation. Maternal responsive behaviour was only predicted by infant attentive behaviour. This study demonstrated that maternal prenatal attachment during the third trimester of pregnancy is associated with the postnatal maternal involvement, and can serve as an important diagnostic aid in identifying those women for whom the mother-child interaction is likely to be sub-optimal.     

MINERALIZATION DEFECTS IN DECIDUOUS TEETH OF LOW BIRTHWEIGHT INFANTS

ABSTRACT. A group of 91 children with birthweights below 2000 g and 48 healthy full-term children, reference group, were examined for mineralization disturbances of the enamel of deciduous teeth. Perinatal data were collected retrospectively from obstetric and neonatal records. Within the low birthweight group, children with enamel hypoplasia had on the 5% level a significantly lower intake of breast milk during the first week of life than children without disturbances. The only perinatal complication associated with development of mineralization defects was IRDS. Infants with IRDS, however, had a significantly lower intake of breast milk during the first week of life than low birthweight without IRDS. A low frequency of enamel defects was found in the growth-retarded sub-group of the low birthweight infants. These infants had a significantly higher intake of breast milk during the first week compared to the AGA-group. A seasonal variation was found, with the highest prevalence of mineralization disturbances in infants born during winter months. It is concluded that the occurrence of mineralization defects of the deciduous teeth in LBW infants seems to be dependent upon the amount of breast milk given during the early neonatal period and also possibly in which season of the year they are born.     

Interaction between mothers and infants born at risk during the first six months of corrected age

Abstract The effects of preterm birth and the perinatal infant health condition on mother-infant interactions were analysed in 278 mother-infant pairs, divided into four groups according to infants' gestational age at birth: group 1. 23–31 weeks; group 2,32–36 weeks; group 3, 37–42 weeks; and group 4, a control group of healthy full-term infants. The methodological approach was based on observation of the pairs at 2,4 and 6 months of infants" corrected age (± 1 week) during undressing of the infant and face-to-face interaction. It was found that mother-infant pairs with preterm infants (groups 1 and 2) did not differ in interactional variables from those of the control group. On the other hand, the birth of a full-term infant in need of neonatal intensive care (group 3) affected maternal and infant interactive behaviour. Additionally, infants from group 3 did not show stability in their interactive behaviour between any ages of measurement. This result suggests that interactive behaviour of full-term infants in need of neonatal intensive care are rather unpredictable during their first 6 months of life, which might have contributed to the less optimal interactive pattern observed for their mothers compared with mothers of the control group.     

Oxygenation, Heart Rate and Temperature in Very Low Birthweight Infants during Skin-to-Skin Contact with Their Mothers

ABSTRACT. Fourteen very low birthweight infants were studied positioned either prone horizontal or skin-to-skin at 60 degree tilt between the mother's breasts. Heart rate, skin temperature and oxygenation by transcutaneous Po₂ and pulse oximetry were measured. Nine of the infants had normal lungs when studied. These infants showed no change in tcPo₂, or oxygen saturation but heart rate increased significantly by a mean of 6.5 beats per min during skin-to-skin contact. Five infants with chronic lung disease, including two on nasal catheter oxygen, showed a significant 1.0 kPa rise in tcPo₂ during skin-to-skin contact. Back skin temperature was well maintained during skin-to-skin contact with the room temperature at 26 to 29°C. None of the infants had a significant apnoea or bradycardia during the study. Stable very low birthweight infants can enjoy such close contact with their mothers and the tilted position may improve pulmonary function in some cases.     

Immunogenicity of hepatitis B vaccine in term and preterm infants

Some studies have suggested that decreased seroconversion rates might be found in premature infants with low birthweight (< 2000 g) following administration of hepatitis B vaccine at birth. The aim of the present investigation was to evaluate possible differences in seropositive rates between full-term and preterm infants after primary vaccination, in particular when gestational age or birthweight is very low. Two-thousand and nine neonates born to HBs Ag-negative mothers were vaccinated with 10 μg of recombinant hepatitis B virus (HBV) vaccine, from May 1991 to October 1994. Children with infections, congenital malformations or serious illnesses were excluded. HBV vaccine was administered intramuscularly, on the fourth day of life and again at 1 and 6 months of age. A 1-ml blood sample was drawn from each infant 1 month after the third vaccine dose for determination of the level of anti-HBs antibody. The response to HBV vaccination was evaluated in 241 preterm (gestational age < 38 weeks) infants and 1727 term neonates. No statistical difference was observed in the distribution of anti-HBs antibody level, either between preterm infants (< 38 weeks) and newborns of normal gestational age, or between low birthweight (< 2500 g) and normal weight infants. The results suggest that preterm and low birthweight infants (< 2500 g) respond to HBV vaccine in the same measure as normal-term infants.     

Skin to skin contact for very low birthweight infants and their mothers.

Separation between mothers and very low birthweight infants is often prolonged with subsequent psychological distress, behaviour problems, and lactation failure. Babies as small as 700 g, who no longer require oxygen, can be safely and enjoyably held naked, except for a nappy, between the mother''s breasts for up to four hours a day. We have carried out a randomised trial among babies less than 1500 g. Seventy one infants were randomised. In 35, the mother was helped to hold her baby in skin to skin contact and encouraged to do so whenever she visited the baby. In 36, the mother was encouraged to handle her baby but without skin to skin contact. Mothers using skin to skin contact lactated for four weeks longer on average than the control group. At 6 months of age the infants who had skin to skin contact cried significantly less than the control group. Skin to skin contact can safely and enjoyably be offered to very low birthweight infants especially in developing countries where the mother''s lactation is vital.     

Retinol concentration in maternal and cord serum: its relation to birth weight in healthy mother-infant pairs

BACKGROUND: Vitamin A is an essential micronutrient for the development and growth of the fetus. The objective of this study was to identify a possible association between low serum retinol and birth weight in healthy mother-infant pairs in Southern Israel. A secondary objective was to examine ethnic differences in maternal and cord serum retinol. METHODS: Serum retinol was measured at delivery from pairs of healthy mothers and healthy mature newborns. RESULTS: Of the 313 mother-infant pairs studied, 56% were Jews and 44% Bedouins. The proportion of infants with birth weight of 2500-2999 g was greater among mothers with lower serum retinol (<0.7 micromol/l) compared to mothers with normal serum retinol (> or =0.7 micromol/l) (p<0.001). Cord retinol <0.7 micromol/l was more frequent in infants with birth weight 2500-2990 g compared to infants with birth weight > or =3000 g (p=0.006). Using a split model and stepwise multiple regression analysis, infant's birth weight was significantly influenced by cord retinol concentration in infants born to mothers with low serum retinol; gestational age and cord retinol alone explained 27% of the variability of birth weight in this group. A higher proportion of Bedouin than Jewish infants had serum retinol <0.7 and <0.35 micromol/l (both p<0.001). CONCLUSION: Low cord and maternal serum retinol may reflect poor vitamin A status of the newborn and the mother, which in turn may affect fetal growth.