Developmental change in the neuropsychological functioning of very low birth weight infants

Research on very low birth weight (VLBW) infants has not carefully evaluated developmental patterns of neurological and neuropsychological functioning across time. This study reports on a broad range of developmental outcomes for VLBW infants of low (LR, n = 116) and high (HR, n = 84) medical risk compared to full term infants (FT, n = 120) across 6, 12, and 24 months of age. While low risk infants showed initial delays in most areas, faster rates of change in motor and neurological development resulted in catch-up by 2 years of age as compared to the FT infants. The lack of acceleration in development of mental skills demonstrates a persistent lag in this area. In contrast, HR infants showed initial delays in all areas as compared to both LR and FT infants with slower rates of change in mental and expressive language skills. Although faster rates of change were evident for HR infants in motor, neurological, and receptive language skills, scores in these areas remain lower than those for the LR and FT infants. The absence of accelerated rates of development for certain VLBW infants has implications for prognosis and patient access to early intervention services.     

Early interactive behaviours in preterm infants and their mothers: Influences of maternal depressive symptomatology and neonatal birth weight

The study evaluated the quality of preterm infant–mother interactions, considering severity of birth weight (ELBW and VLBW) and maternal depression, compared to full term babies. 69 preterm infants (29 ELBW and 40 VLBW) and 80 full-term (FT) infants and their mothers were recruited. At 3 months of corrected age, the quality of mother–infant interaction was evaluated through Global Rating Scales; moreover, infant level of development and maternal depression were assessed through Griffith Development Mental Scales and Edinburgh Postnatal Depression Scale. Results showed adequate sensitivity in preterm infants’ mothers and higher involvement with their infants, compared to full term mothers, but ELBW ones exhibited an intrusive interactive pattern and a higher prevalence of depressive symptoms. The study underlined the relevance of paying special attention to both ELBW infants and their mothers, in order to support the parenting role and the co-construction of early interactions.     

Dyadic co-regulation,affective intensity and infant's development at 12 months: A comparison among extremely preterm and full-term dyads

Extremely low gestational age children (ELGA, born below 28 weeks of GA) represent the most at-risk preterm group in terms of survival, developmental sequelae and rates of impairment and cognitive delays. However, the impact of an extremely preterm birth on mother–infant co-regulation and affective intensity which may affect early infant's development has not been investigated. Based on a relational dynamic system approach, our study aimed to investigate the quality of co-regulation and affective intensity during spontaneous play interaction in 20 mother–infant ELGA dyads compared to 20 full-term (FT) dyads at 12 months (corrected age for ELGA infants). Relationships between the quality of dyadic co-regulation and the infant's level of cognitive, motor and language development were also investigated. The quality of dyadic co-regulation was assessed using the Revised Relational Coding System (R-RCS) by Fogel et al. (2003), the mothers’ and infants’ affective intensity was coded using a coding system by Lunkenheimer, Olson, Hollenstein, Sameroff, and Winter (2011). Infants’ development was assessed using the Bayley Scales (BSID-III, 2006). With respect to FT dyads, ELGA dyads were characterised by less frequent symmetric and more frequent unilateral co-regulation patterns and by less positive and more neutral affective intensity of both infants and mothers. Cognitive, motor and language scores were lower in ELGA infants than in FT infants. Symmetrical co-regulation was related to motor scores in ELGA infants, and to cognitive scores in FT infants. Our findings contribute to the literature by demonstrating the difficulties of ELGA mother–infant dyads at 12 months in sharing the symmetric co-regulation and positive affective intensity and how symmetric co-regulation is strictly related to motor development in ELGA infants. Based on these findings, intervention programmes to foster joint attention, active involvement and positive affective intensity in ELGA dyads and infants’ development in the first year of life should be designed.     

Emotional interaction in a group of preterm infants at 3 and 6 months of corrected age

Twenty preterm infants (birthweight<1500 g) and 20 healthy fullterm infants were compared with respect to emotional interaction with their mothers in a face‐to‐face situation at 3 months of age and in a feeding situation at 6 months of age (ages corrected for preterm birth). The assessed outcome was analysed with respect to infant variables (group, gender, gestational age, birthweight and neonatal risk factors) and maternal variables (age, education and parity). The outcomes at 3 and 6 months of age were also compared with findings of Griffiths’ testing at 10 months of age. At 3 months of age, the findings reveal no significant difference between the two groups with respect to emotional interaction. Maternal variables are more important for this interaction than are infant variables. The mother's level of formal education has a significant impact in both groups. In the group of fullterm infants, significantly lower scores for interaction are obtained by first‐time mothers in comparison with multi‐parae mothers. At 6 months of age, the difference between fullterm and preterm infants is significant. The preterm infants and their mothers now relate to one another more poorly than is the case for the fullterm dyads. These findings suggest that the difficulties encountered by the preterm infant emerge with time. Emotional interaction at this age and the results of Griffiths’ testing 4 months later are significantly correlated. Copyright © 1999 John Wiley & Sons, Ltd.     

Is Segmental Trunk Control Related to Gross Motor Performance in Healthy Preterm and Full-Term Infants?

Abstract

The authors’ aim was to verify the correlation between segmental trunk control and gross motor performance in healthy preterm (PT) and full-term (FT) infants aged 6 and 7?months and to verify if there are differences between groups. All infants were assessed at 6 and 7?months by means of Segmental Assessment of Trunk Control (SATCo) to identify the exact level of segmental trunk control and Alberta Infant Motor Scale (AIMS) to measure gross motor performance. A significant correlation between segmental trunk control and gross motor performance was found in healthy PT infants at 7?months and FT infants at 6?months. PT infants showed a delay on segmental trunk control at 6 and 7?months and in supported standing posture at 6?months compared with FT infants. Segmental trunk control and gross motor performance showed an important relationship in healthy PT and FT infants, mainly in sitting posture.     

The efficacy of massage on short and long term outcomes in preterm infants

Purpose

Premature infants lack the tactile stimulation they would have otherwise experienced in the womb. Infant massage is a developmentally supportive intervention that has been documented for several decades to have a positive effect on both full term and preterm infants. The purpose of this study was to assess the short and long term benefits of massage on stable preterm infants.

Methods

A quasi experimental design was used, 66 infants were recruited from two university hospitals with tertiary level NICUs; 32 infants received the massage therapy by their mothers. Data collection by a researcher blind to the infants’ group assignments included weight at discharge, pain responses on the PIPP scale at discharge, length of stay in hospital, neuro-developmental outcome (Bayley scores) and breastfeeding duration at 12 months corrected age.

Results

Infants who were massaged had significantly lower scores on the PIPP after a heel-stick compared to before the massage and had lower PIPP scores at discharge compared to the control group. Massaged infants had higher cognitive scores at 12 months corrected age. Weight gain, length of stay, breastfeeding duration and motor scores did not differ between groups.

Conclusion

Stable preterm infants benefit from massage therapy given by their mothers and may be a culturally acceptable form of intervention to improve the outcomes of preterm infants.     

Intervention for infants with brain injury: results of a randomized controlled study

A randomized clinical trail (RCT) employed a 12-month individualized cognitive/sensorimotor stimulation program to look at the efficacy of the intervention on 62 infants with suspected brain injury. The control group infants received the State-funded follow-up program provided by the Los Angeles (LA) Regional Centers while the intervention group received intensive stimulation using the Curriculum and Monitoring System (CAMS) taught by public health nurses (PHNs). The developmental assessments and outcome measures were performed at 6, 12 and 18 months corrected age and included the Bayley motor and mental development, the Home, mother-infant interaction (Nursing Child Assessment Feeding Scale (NCAFS) and Nursing Child Assessment Teaching Scale (NCATS)), parental stress and social support. At 18 months, 43 infants remained in the study. The results indicate that the intervention had minimal positive effects on the Bayley mental and motor development scores of infants in the intervention group. Likewise, the intervention did not contribute to less stress or better mother-infant interaction at 12 or 18 months although there were significant differences in the NCAFS scores favoring the intervention group at 6 months. There was a significant trend, however, for the control group to have a significant decrease over time on the Bayley mental scores. Although the sample was not large and attrition was at 31%, this study provides further support to the minimal effects of stimulation and home intervention for infants with brain injury and who may have more significant factors contributing to their developmental outcome.     

Cumulative psychosocial and medical risk as predictors of early infant development and parenting stress in an African-American preterm sample

The present study examined predictive linkages between cumulative psychosocial and medical risk, assessed neonatally, and infant development and parenting stress at 4 months of infant corrected age. Predominantly low-income, African-American mothers and their preterm infants served as participants. Cumulative psychosocial risk predicted early mental, but not motor development, while cumulative medical risk predicted both mental and motor development. Cumulative psychosocial risk, but not medical risk, predicted parenting stress. Few studies of preterm infants have reported links between cumulative psychosocial risk and infant development at such an early age, nor has earlier work found associations between cumulative psychosocial risk and mothers' perceptions of parenting. Results support the premise that early intervention should target both the medical and psychosocial needs of low-income families with preterm infants, and that addressing psychosocial stressors shortly after birth may improve developmental outcomes in infancy.     

Kicking coordination captures differences between full-term and premature infants with white matter disorder

This study explores the relation of white matter disorder (WMD) to intralimb coordination patterns in premature infants with very low birth weight (VLBW). We specifically measured the temporal-spatial characteristics of intralimb coordination patterns of the legs. Three groups of infants were compared at one month corrected age (CA): 10 premature infants born VLBW and WMD (PTWMD), 10 premature infants born VLBW without WMD (PT) and 10 full term infants (FT). Using kinematic variables, we discriminate among VLBW infants with WMD from the two comparison groups. Infants born with WMD maintain patterns of tight coupling among leg joints (all flexion or all extension) while PT and FT term infants have begun to decouple leg joints by this age (combinations of flexion with extension). The coupling pattern is captured through joint correlations, discrete relative phase, and phase plane portraits. The PTWMD infants also demonstrate aberrant patterns of coordination evident through both temporal and spatial characteristics of the kicks. This is the first evidence that movement disorder associated with brain lesions can be identified and quantified with kinematic variables as early as one month of age.     

Joint attention abilities in Brazilian preterm and full-term infants

Joint attention abilities of preterm and full-term Brazilian infants were assessed at 12- and 18-months, age corrected for prematurity. Results showed that preterm infants displayed significantly lower levels of correct responses to others’ bids for joint attention at both time-points, compared to full-term infants. Both groups improved their responding to joint attention from 12 to 18 months of age. Contrastingly, prematurity did not impact infants’ initiating joint attention behaviors, which remained stable over time for both groups. Findings were discussed in terms of the specific mental processes involved in distinct behavioural dimensions of joint attention.     

Predicting preschool motor and cognitive performance in appropriate-for-gestational-age children born at ≤ 32 weeks gestation

Although many follow-up studies have been performed on preterm infants, little attention has been devoted to prediction of motor skills in the preschool or school years. We studied the relationship of performance on the Bayley Scales of Infant Development at a mean corrected age of 21 months to performance on the McCarthy Scales of Children's Abilities at a mean corrected age of 44.7 months for 43 appropriate-for-gestational-age (AGA) children born at ≤ 32 weeks gestation. Motor scores were stable over time with a significant correlation between the Bayley Psychomotor Developmental Index (PDI) and the McCarthy Motor subscale (r = 0.60; p = 0.0001). Scores of cognitive abilities also showed a significant correlation between the Bayley Mental Developmental Index (MDI) and the McCarthy General Cognitive Index (r = 0.42; p = 0.009). Small-for-gestational-age (SGA), very low-birthweight (≤ 1500 grams) children scored lower on the McCarthy General Cognitive Index (p = 0.01) and on the Motor subscale (p = 0.047) than the AGA children. We concluded that motor performance of AGA children born at ≤ 32 weeks gestation is stable from toddlerhood to preschool age. We suggest that SGA children be excluded from studies of motor performance of prematurely born children.     

Attachment representations in mothers of preterm infants

The aim of the study was to assess attachment representations in mothers of preterm infants using the Working Model of Child Interview (WMCI) at the 12 months of the infant's corrected age. In addition, the relation between WMCI representation categories and the Edinburgh Postnatal Depression Scale score at 6 months of the infant's corrected age was studied. There were 38 mothers of preterm infants (<1500 g or <32 gestational weeks) and 45 mothers of full-term infants. The results showed no differences between the study groups in the distribution of the three main representation categories (balanced, disengaged and distorted). However, there were qualitative differences in representations between the groups. Furthermore, maternal depression symptoms were associated with distorted representation category. We suggest that despite the qualitative differences in the mothers’ representations, mothers of preterm infants are as likely to form balanced attachments with their infants as mothers of full-term infants.     

Cognitive and motor development in children with vertically transmitted HIV infection

This study was designed to examine mental and motor development in infants with vertically transmitted human immunodeficiency virus (HIV) infection. Early neurodevelopment was examined in 25 young children with HIV infection acquired through vertical transmission. Compared with 25 children born to HIV-positive mothers but not infected with the virus, and after controlling for developmental risk factors, the HIV-infected group showed impairments in mental and motor development. Mental and motor development were assessed using the Bayley Scales of Infant Development. On the mental scale (MDI), the HIV-infected infants obtained significantly lower scores than the uninfected infants. On the performace scale (PDI), the HIV-infected infants obtained significantly lower standard scores than the uninfected infants. CT scan results were available for 20 of the HIV-infected children. CT abnormalities were associated with developmental delays, particularly for motor development. The results point to the importance of early abnormalities in myelination and of subcortical lesions of cognitive and motor development.     

Visual attention skills of premature infants with and without intraventricular hemorrhage

The relation between two medical complications associated with prematurity (intraventricular hemorrhage (IVH) and respiratory distress syndrome (RDS)) and visual attention skills of very low birth-weight (VLBW) infants were examined. Fourteen preterm VLBW infants with IVH and RDS, 9 preterms with RDS and no IVH, and 10 full-term infants matched on SES, sex, and race were assessed at 7 months of age (after correction for prematurity) for their ability to show a decremental response to a familiar visual stimulus and an increment in response to a novel visual stimulus. Measures of attention getting (turning toward a stimulus) and attention holding (sustained fixation on the stimulus after turning) were taken. On the attention-getting measures, IVH-RDS preterms had longer latencies than both the RDS-no-IVH preterm group and the full-term group. There were no group differences on attention-holding measures. The three groups did not differ in habituation to the familiar visual stimulus or discrimination of the novel stimulus. This study indicates that the early visual attention skills of preterm infants are differentially affected by specific types of prenatal complications.     

Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age

BackgroundTo determine the effect of developmental care on neurodevelopmental outcome in formerly preterm infants at a corrected age of 2 years.MethodsA prospective phase-lag study was performed at an Austrian neonatal intensive care unit (NICU). From January 2003 to December 2005 (study period of conventional care) and January 2007 to December 2009 (study period of developmental care), we enrolled all infants born in Tyrol at less than 32 weeks of gestation. During this period a total of 261 of 359 preterm infants (participation rate 72.7%) completed the follow-up visit at 2 years of age; there were 124 children in the conventional and 137 in the developmental care group. The association between developmental care and delayed motor or mental development (Bayley Scales of Infant Development II; psychomotor or mental developmental index <85) was analyzed by means of logistic regression analysis at a corrected age of 24 months.ResultsChildren in the developmental care group showed less psychomotor delay than did those in the control group (developmental care group: 16.1%, conventional care group 27.4%; adjusted odds ratio 0.37 [95% confidence interval: 0.19–0.74], P = 0.005). Not smoking in pregnancy and higher gestational age were also significant predictors for a better psychomotor outcome at 2 years of age. Regarding cognitive outcome, no significant difference was observed between these two groups.ConclusionOur data implicate that developmental care may result in an improved 2-year psychomotor outcome in formerly preterm infants.     

Infant Mental Health Intervention for Preterm Infants in Japan: Promotions of Maternal Mental Health,Mother–Infant Interactions,and Social Support by Providing Continuous Home Visits until the Corrected Infant Age of 12 Months

The aim of this study was to investigate the effectiveness of the Japanese Infant Mental Health Program (JIMHP) for preterm mother–infant dyads until the infants reached 12 months of corrected age. Mothers in the JIMHP group (n = 26) received one hospital visit in addition to standard care in the Growing Care Unit (GCU) and five home visits based on the principles of infant mental health (IMH) after discharge from the hospital, until the infant reached 12 months of corrected age. In contrast, mothers in the control program group (n = 40) received standard care in the GCU and three conventional home visits during the same period. The dyads were then compared across groups, revealing that the JIMHP dyads showed less maternal depressive symptoms, better maternal interaction, increased social support by medical workers and healthcare professionals, a high persistence rate for attending the program, and a more positive perception toward the program (p < .05). However, there were no significant differences in the impact of parenting stress or in child development. These results are discussed in terms of their significance and the practical/clinical availability of IMH principles and the JIMHP as a new support model for preterm infants in Japan.     

Neurodevelopmental outcomes of Ugandan infants with HIV infection: an application of growth curve analysis.

Neurodevelopmental outcomes of human immunodeficiency virus Type 1 (HIV-1)-infected infants of non-drug-using mothers were assessed in a controlled, prospective study from birth to 24 months with 3 groups: 61 infants of HIV-infected mothers, 234 uninfected infants of HIV-infected mothers (seroreverters), and 115 uninfected infants of uninfected mothers. Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated lower mental and motor development on the Bayley Scales and greater deceleration in their rate of motor development. HIV-infected infants with abnormal neurologic exams had lower motor and mental test scores and lower rates of motor Bayley Scales scores than their HIV-infected counterparts with normal neurologic exams. Contrary to prediction, no group differences in mean performance or growth rates were found on visual information processing on the Fagan Test of Infant Intelligence.     

Maternal attachment representations after very preterm birth and the effect of early intervention

Objective

For very preterm infants the mother-infant relationship may be compromised. Maternal attachment representations 18 (corrected) months after very preterm birth and the effect of the post-discharge Infant Behavioral Assessment and Intervention Program (IBAIP) were studied. The IBAIP is designed to assist parents to support and enhance their infant's regulatory competence and development. The intervention consisted of 6-8 home visits during the first 8 months after birth.

Method

Seventy-eight mothers of very preterm infants (<32 weeks and/or <1500 g) were interviewed, who participated in a randomized controlled trial: 41 from the intervention group and 37 from the control group. Maternal attachment representations were assessed with the Working Model of the Child Interview (WMCI). The interviews resulted in a classification of the attachment representations into balanced or non-balanced.

Results

30% of the mothers had non-balanced attachment representations. Qualitative content analysis of the answers showed that negative feelings when first seeing their baby and negative or ambivalent feelings in the first weeks at home with their baby are related to non-balanced attachment representations. The WMCI revealed no differences between the intervention and control group.

Conclusion

Early support for mothers of very preterm born infants to develop a healthy mother-infant relationship is recommended especially for mothers who report negative first experiences.     

Practices and representations of child care and motor development among West Africans in Paris

Massage techniques and postural manipulation used by West African women immigrants in Paris were studied, with the aim of demonstrating that culturally regulated caretaking practices have an influence on infant motor development. Twenty-five infants were observed between the ages of 3 and 12 months and 9 and 15 months. Frequency of massage and its accompanying set of physical exercises were found to be related to age at onset of independent walking. The findings show that infants receiving daily massage walk significantly earlier than infants who do not receive massage, thus confirming other reports that vestibular and postural stimulation have a positive effect on motor development. These results are discussed in relation to the observed frequencey of contact and of physical games with the caregiver for a smaller sample of three infants, and to parental expectations about the age of acquisition of certain cognitive and motor abilities. African immigrant mothers expect their infants to sit and to walk earlier than French mothers. The conclusion emphasizes the contribution of social anthropology, which shows that in all cultures, physical development and body changes elicit symbolic practices and a search for explanation.     

Joint attention in term and preterm infants at 12 months corrected age: the significance of gender and intervention based on a randomized controlled trial

This study tested the effects of optimized neonatal mother–infant transactions on joint attention performance at 12 months. Surviving infants <2000 g from a geographically defined area were randomly assigned to a preterm intervention (n = 71) or preterm control group (n = 69). Comparisons were made between preterm groups, secondary with a term group (n = 75). Joint attention was measured using the Early Social Communication Scales. Preterm intervention infants scored significantly higher than preterm control infants on elements Initiating Joint Attention (p < 0.05), Initiating Object Requests (p < 0.05), and Responding to Social Interaction (p < 0.0005). Intervention was not associated with performance on elements Responding to Joint Attention, or on Responding to Requests. ELBW infants scored significantly lower than VLBW and LBW infants on imperative functions. Girls outperformed boys on all communication elements. An intervention implemented during the neonatal period can be of advantage for certain aspects of joint attention performance in preterm infants.