Risks and realities: dyadic interaction between 6-month-old infants and their mothers in opioid maintenance treatment

A number of studies point to methadone exposure in utero as a possible risk factor in the developing mother–infant relationship in the first year of life. This study is part of a larger, national follow-up of 38 infants prenatally exposed to methadone or buprenorphine and 36 comparison, low-risk infants. The aim of the present paper is to assess the quality of mother–infant relationship when the infants are 6 months old. Videotaped mother–infant interactions were rated in a global scale (NICHD). Maternal and infant contributions collapsed into the variables “infant style” and “maternal style” showed that the only factor making significant contribution to the outcome measure “dyadic mutuality” was maternal style. The importance of group membership (exposed versus non-exposed), was reduced when controlling for maternal drug use prior to opioid maintenance treatment (OMT), maternal depression and parenting stress as well as infants’ developmental status and sensory-integrative functions. This suggests that prediction of dyadic mutuality should be based on individual characteristics rather than group characteristics. These results support previous research findings that methadone and buprenorphine use per se does not have direct influence on the quality of early mother–infant relationship, but tailored follow-up procedures targeting drug-free pregnancies and parenting support are beneficial for women in OMT and their children.     

Prenatal tobacco exposure: developmental outcomes in the neonatal period

Smoking during pregnancy is a persistent public health problem that has been linked to later adverse outcomes. The neonatal period--the first month of life--carries substantial developmental change in regulatory skills and is the period when tobacco metabolites are cleared physiologically. Studies to date mostly have used cross-sectional designs that limit characterizing potential impacts of prenatal tobacco exposure on the development of key self-regulatory processes and cannot disentangle short-term withdrawal effects from residual exposure-related impacts. In this study, pregnant participants (N = 304) were recruited prospectively during pregnancy, and smoking was measured at multiple time points, with both self-report and biochemical measures. Neonatal attention, irritable reactivity, and stress dysregulation were examined longitudinally at three time points during the first month of life, and physical growth indices were measured at birth. Tobacco-exposed infants showed significantly poorer attention skills after birth, and the magnitude of the difference between exposed and nonexposed groups attenuated across the neonatal period. In contrast, exposure-related differences in irritable reactivity largely were not evident across the 1st month of life, differing marginally at 4 weeks of age only. Third-trimester smoking was associated with pervasive, deleterious, dose–response impacts on physical growth measured at birth, whereas nearly all smoking indicators throughout pregnancy predicted level and growth rates of early attention. The observed neonatal pattern is consistent with the neurobiology of tobacco on the developing nervous system and fits with developmental vulnerabilities observed later in life.     

Phonetic discrimination ability of a native vowel contrast in preterm infants

Preterm birth is considered a risk factor for cognitive and linguistic development; however, research focusing on the comparison between preterm and full term infants' early abilities in speech perception is still scarce. In this study, the ability to perceive and discriminate a native vowel contrast by a sample of preterm infants at 4 and 8 months of age (corrected for gestation) has been analyzed using the familiarization-preference procedure and complex stimuli (CV.CV, multispeakers). Results reveal differences at 4 months of age between pre-term and control groups; only the latter successfully categorize and react to the vowel change. By 8 months of age, preterm infants are able to solve the task. A positive correlation was observed between duration of attention (visual fixation measures) and a number of neonatal risk factors. Results show the effects of preterm birth on the processing of complex stimuli and suggest the need to further explore the connection between early speech perception capacities and language development in this at-risk population.     

Olfactory preferences resulting from mere exposure in human neonates

Twenty-four (12 males, 12 females) healthy, full-term neonates were exposed to an artificial odorant within the first day after birth for approximately 24 hrs to determine if mere exposure would lead to a subsequent preference for that odor. In choice tests following the treatment period, female infants displayed preferential orientation to the exposure odor. Males, in contrast, displayed no evidence of preference for the exposure odor; rather, they demonstrated a right turning bias regardless of odor location. These data suggest that familiarization with an odor shortly after birth is sufficient for female infants to develop preferential responsiveness to that odor.     

Neonatal physiological regulation is associated with perinatal factors: A study of neonates born to healthy African American women living in poverty

Maternal mental health and prenatal stress are linked with neurobehavioral differences in the offspring. The majority of studies documenting this effect have been conducted using either predominantly European American infants or minority infants exposed to teratogens in utero. In this study, we focus on healthy African American women from low‐income environments to investigate the earliest individual differences in biobehavioral regulation, including resting heart rate and variability (HRV). In 87 neonates, HRV was significantly lower in those born to mothers reporting past major depressive disorder (p = .01). The number of maternal life stressors also was associated with lower neonatal HRV (p = .03). Obstetrical complications were not associated with significant differences, but breast‐ versus bottle‐feeding in the first few days of life was related to higher HRV (p = .04). Early variation in physiological regulation may be linked to subsequent individual differences in response to stress. Thus, identifying the earliest point in development when such differences can be reliably measured may result in opportunities for prevention of later deficits in regulating response to stress.     

Immobility reaction at birth in newborn infant

Objective

To describe an immobility reaction (IR) that was not previously reported at or immediately after birth in human newborns.

Method

We analyzed 31 videos of normal term vaginal deliveries recorded from Time 0 of birth defined as the as the moment that lies between the birth of the thorax and the pelvis of the infant. We searched for perinatal factors associated with newborn's IR.

Results

IR at birth was observed in 8 of the 31 newborns. The main features of their behavior were immobilization, frozen face, shallow breathing and bradycardia. One of the 8 newborns had sudden collapse 2 h after birth. We found significant relationships between maternal prenatal stress (PS) and IR (p = .037), and a close to significant one between infants’ lividness at Time 0 and IR (p = .053). The first breath of the 31 newborns occurred before and was not associated with the first cry (p < .001).

Discussion

The main features of IR at birth are similar to those of the universal most severe response to severe stress or danger. The relationship with PS suggests that children who had IR at birth might be at risk for similar disorders as those associated with PS. Sudden neonatal collapse of one of the IR newborns needs further research to determine if they are at risk for sudden infant death syndrome.

Conclusion

This first report of an IR reaction at birth in human infants could open up new paths for improving early neonatal care. Further research is needed for maternal PS, stress hormones, umbilical cord blood pH measurements in IR newborns. The challenge of education and support for parents of IR newborns is outlined.     

The role of the mother's voice in developing mother's face preference: Evidence for intermodal perception at birth

Four experiments are described which investigated the role of the mother's voice in facilitating recognition of the mother's face at birth. Experiment 1 replicated our previous findings (Br. J. Dev. Psychol. 1989; 7: 3–15; The origins of human face perception by very young infants. Ph.D. Thesis, University of Glasgow, Scotland, UK, 1990) indicating a preference for the mother's face when a control for the mother's voice and odours was used only during the testing. A second experiment adopted the same procedures, but controlled for the mother's voice from birth through testing. The neonates were at no time exposed to their mother's voice. Under these conditions, no preference was found. Further, neonates showed only few head turns towards both the mother and the stranger during the testing. Experiment 3 looked at the number of head turns under conditions where the newborn infants were exposed to both the mother's voice and face from birth to 5 to 15 min prior to testing. Again, a strong preference for the mother's face was demonstrated. Such preference, however, vanished in Experiment 4, when neonates had no previous exposure to the mother's voice–face combination. The conclusion drawn is that a prior experience with both the mother's voice and face is necessary for the development of face recognition, and that intermodal perception is evident at birth. The neonates' ability to recognize the face of the mother is most likely to be rooted in prenatal learning of the mother's voice. Copyright © 2004 John Wiley & Sons, Ltd.     

Attachment behavior and its antecedents in offspring born to methadone-maintained women

Videotaped 35 full-term, African American infants exposed in utero to methadone and 46 comparison infants at 12 months participating in a separation-reunion procedure to assess aspects of the infant's attachment relationship to the mother. Mothers in the two groups were comparable on education, age (18-35 years), socioeconomic status, parity, IQ and marital status. Offspring born to methadone-maintained women did not differ from comparison infants in indexes of proximity-seeking at reunion but did display higher scores on indexes of disorganized and avoidant behavior and lower scores on indexes of contact-maintaining behavior. Mothers' perceptions during pregnancy of their future infants' degree of bothersomeness were also related to higher scores on contact-maintaining behavior and lower scores on avoidant behavior. Finally, antecedents of attachment behavior within the opioid group alone were considered. The implications of using dimensional attachment ratings for uncovering more subtle attachment antecedents are discussed.     

From imitation to conversation: the first dialogues with human neonates

The functional maturity of the newborn infant's brain, the resemblances between neonatal imitation and imitation in adults and the possibly lateralized neonatal imitation suggest that the mirror neuron system may contribute to neonatal imitation. Newborn infants not only imitate but also initiate previously imitated gestures, and are able to participate in overlapping imitation–initiation communicative cycles. Additionally, these social responses in neonates are faster than previously thought, and may enable them to have long‐lasting intimate interactions much before language develops. Infants are equipped with a powerful, innate, reciprocal communicative ability already at birth. The earliest communication originates from imitation and this communicative ability presumably later evolves to language. Copyright © 2006 John Wiley & Sons, Ltd.     

Rapid eye movement (REM) in premature neonates and developmental outcome at 6 months

Different aspects of early sleep organization have been associated with subsequent development in premature infants. The aim of the present study was to assess the relations between rapid eye movement (REM) activity in premature neonates and infants' developmental outcomes at 6 months. Participants were 81 premature infants (47 males). Sleep-wake states and REM were observed across 4 consecutive evening hours (7-11 PM) in 10-s frames when infants were between 32 and 36 weeks post-menstrual age. Developmental outcome was assessed at 6 months with the mental development index (MDI) of the Bayley II. Infants with low-REM activity spent more time in less growth-promoting states, including crying and unfocused alert states in the neonatal period and had lower MDI scores at 6 months corrected age compared to infants with high-REM. Differences between the high- and low-REM groups were independent of neonatal medical risk. Low-REM activity may serve as an indicator of developmental risk among premature neonates.     

Maternal and paternal infant representations: A comparison between parents of term and preterm infants

Objective

Research on parental attachment representations after preterm birth is limited and inconclusive. The present study is the first in which maternal and paternal attachment representations after term, moderately and very preterm birth are compared. In addition, special attention was directed toward disrupted attachment representations.

Method

Mothers and fathers of term infants (≥37 weeks of gestational age, n = 71), moderately preterm infants (≥32–37 weeks of gestational age, n = 62) and very preterm infants (<32 weeks of gestational age, n = 56) participated in the present study. Attachment representations (balanced, disengaged, distorted) about their infants were evaluated with the Working Model of the Child Interview (WMCI). To asses disrupted representations the coding of the WMCI was extended with the disrupted scale (WMCI-D).

Results

The three main classifications of attachment representations were not affected by preterm birth. In addition, there were no gender differences in the rate of balanced representations. In case of non-balanced representations however, maternal representations were more often distorted, whereas fathers showed more often disengaged representations. Results further revealed that maternal disrupted attachment representations were marked by role/boundary confusion or disorientation, whereas paternal disrupted attachment representations were characterized by withdrawal.

Conclusion

Given the gender differences it is essential to tailor interventions according to the attachment representations of the parent, in order to be able to alter their non-balanced and/or disrupted attachment representations.     

PRENATAL COCAINE EXPOSURE AND NEONATAL CONDITION

Infants who are prenatally exposed to cocaine have an increased risk of suffering neonatal medical complications. We hypothesized that this effect is mediated by the relation between cocaine use and prenatal medical risk of the mother, birth weight, and intrapartum risk, that would lead to increased neonatal complications. This study used structural equation modeling to assess the direct and indirect effects of prenatal cocaine exposure on neonatal medical risk in a sample of 337 neonates. Prenatal cocaine exposure had a significant indirect, but not direct effect on neonatal medical risk. Several paths contributed to this indirect effect. The strongest was via cocaine's impact on birth weight, and birth weight's effect on neonatal medical risk. The paths through prenatal risk and intrapartum risk also contributed to the total indirect effect. These results suggest that the observed relation between prenatal cocaine exposure and neonatal medical complications is mediated by prenatal and intrapartum risk factors.     

Interaction between mother and pre-term infant at 34 weeks post-conceptional age

The impact of premature birth and perinatal medical status on early mother–infant interaction was assessed in 75 dyads with pre-term infants divided into three groups. Infants' gestational age at birth and need for neonatal intensive care intervention differentiated the groups: group 1, 23–31 weeks with intensive care; group 2, 32–35 weeks with intensive care; group 3, 32–35 weeks with no intensive care. The methodological approach was based on observations of the dyads performed when the infant reached a post. conceptional age of 34 weeks (4 weeks before estimated due date of delivery). The observations were conducted in the neonatal nursery during cleaning, face-to-face and feeding interactions. Significant group differences were found in infant distress, maternal sensitivity to the infant and dyadic behaviours of positive interaction. Group 1 dyads showed higher scores or more desirable performance than dyads of group 3. Group 2 dyads usually achieved intermediate scores and performed better than dyads of group 3, especially during the feeding situation. We suggest that, in addition to a possible emergence of maternal compensatory mechanisms in the higher-risk groups, the amount of dyadic experience after birth affects the quality of mother–infant interaction at this early stage.     

Schwangerschaft und Sucht

At 65.7 billion € per year, addiction is the fifth most cost-intensive psychiatric disorder in Europe. More than 60,000 pregnant women in the EU are chronic illicit substance abusers, of which about half consume opioids. One third of these women are of childbearing age, with increasing tendency. More than 60% also suffer from at least one comorbid psychiatric disorder. State-of-the-art treatment for opioid dependence in pregnancy is maintenance therapy with the synthetic opioids methadone or buprenorphine in a multiprofessional setting with comprehensive medical care for women and neonates. A standardized approach of assessment and treatment comparable to the approach in pregnant women is recommended for neonates and for the related neonatal abstinence syndrome (NAS), which occurs in about 60% after intrauterine opioid exposure. An early investment in a multiprofessional treatment model increases not only quality of life of women and children but also lowers societal costs.     

Coping with dialects from birth: Role of variability on infants’ early language development. Insights from Norwegian dialects

Previous research suggests that exposure to accent variability can affect toddlers’ familiar word recognition and word comprehension. The current preregistered study addressed the gap in knowledge on early language development in infants exposed to two dialects from birth and assessed the role of dialect similarity in infants’ word recognition and comprehension. A 12-month-old Norwegian-learning infants, exposed to native Norwegian parents speaking the same or two Norwegian dialects, took part in two eye-tracking tasks, assessing familiar word form recognition and word comprehension. Their parents’ speech was assessed for similarity by native Norwegian speakers. First, in contrast to previous research, our results revealed no listening preference for words over nonwords in both monodialectal and bidialectal infants, suggesting potential language-specific differences in the onset of word recognition. Second, the results showed evidence for word comprehension in monodialectal infants, but not in bidialectal infants, suggesting that exposure to dialectal variability impacts early word acquisition. Third, perceptual similarity between parental dialects tendentially facilitated bidialectal infants’ word recognition and comprehension. Forth, the results revealed a strong correlation between the raters and parents’ assessment of similarity between dialects, indicating that parental estimations can be reliably used to assess infants’ speech variability at home. Finally, our results revealed a strong relationship between word recognition and comprehension in monodialectal infants and the absence of such a relationship in bidialectal infants, suggesting that either these two skills do not necessarily align in infants exposed to more variable input, or that the alignment might occur at a later stage.     

Interindividual differences in neonatal sociality and emotionality predict juvenile social status in rhesus monkeys

In humans, socioeconomic status (SES) has profound outcomes on socio‐emotional development and health. However, while much is known about the consequences of SES, little research has examined the predictors of SES due to the longitudinal nature of such studies. We sought to explore whether interindividual differences in neonatal sociality, temperament, and early social experiences predicted juvenile social status in rhesus monkeys (Macaca mulatta), as a proxy for SES in humans. We performed neonatal imitation tests in infants’ first week of life and emotional reactivity assessments at 2 and 4 weeks of age. We examined whether these traits, as well as the rearing environment in the first 8 months of life (with the mother or with same‐aged peers only) and maternal social status predicted juvenile (2–3 years old) social status following the formation of peer social groups at 8 months. We found that infants who exhibited higher rates of neonatal imitation and newborn emotional reactivity achieved higher social status as juveniles, as did infants who were reared with their mothers, compared to infants reared with peers. Maternal social status was only associated with juvenile status for infant dyads reared in the same maternal group, indicating that relative social relationships were transferred through social experience. These results suggest that neonatal imitation and emotional reactivity may reflect ingrained predispositions toward sociality that predict later outcomes, and that nonnormative social experiences can alter socio‐developmental trajectories. Our results indicate that neonatal characteristics and early social experiences predict later social outcomes in adolescence, including gradients of social stratification.     

Prenatal cocaine exposure and infants' preference for novelty and distractibility

The authors used the Fagan Test of Infant Intelligence (J. F. Fagan, L. T. Singer, J. E. Montie, & P. A. Shepherd, 1986) to examine preferences for novelty and to evaluate several indicators of attention (off- and on-task indexes and durations) in 6- and 9-month-old infants who had been prenatally exposed to cigarette smoke only or to cocaine plus other substances. The infants were matched for socioeconomic status. The authors found no group differences in preference for novelty, but the off-task distractibility index and duration were affected by exposure history and showed effects of dosage at the 9-month test time. Infants exposed to cocaine had a higher off-task index and a shorter average off-task look duration than did infants in the other groups. The authors interpreted this pattern of behavior as an indicator of distractibility or stimulation seeking. There were no group differences in measures involving on-task looks or duration at either test time. Correlations between the off-task look index and duration and teratogen use produced moderate correlations at 9 months of age. The authors calculated partial correlations between teratogen exposure and the off-task index at each trimester. Cocaine use during the 1st and 2nd trimesters was significantly correlated with the off-task index at 9 months of age, even when the authors controlled for neonatal measures (e.g., gestational age, birth weight) and during the 1st trimester when they controlled for alcohol and cigarette exposure.     

Interventions in early infancy

Infants of high-risk pregnancies and deliveries may need early intervention to facilitate attachment both to and from their caregivers. Three early interventions are described: (1) giving high-risk pregnant women video feedback during prenatal ultrasound, which reduced maternal anxiety, obstetric complications, and fetal activity and improved neonatal outcome (increased weight gain, better performance on the Brazelton, and decreased irritability); (2) providing preterm neonates nonnutritive sucking opportunities to reduce stress during heelsticks and gavage feedings; and (3) providing preterm neonates and preterm cocaine-exposed neonates massage therapy, which facilitated weight gain and better performance on the Brazelton scale. Following improved neonatal behavior, infants would be expected to have better interactions with their caregivers.     

Attenuated brain responses to speech sounds in moderate preterm infants at term age

Recent findings have revealed that very preterm neonates already show the typical brain responses to place of articulation changes in stop consonants, but data on their sensitivity to other types of phonetic changes remain scarce. Here, we examined the impact of 7–8 weeks of extra‐uterine life on the automatic processing of syllables in 20 healthy moderate preterm infants (mean gestational age at birth 33 weeks) matched in maturational age with 20 full‐term neonates, thus differing in their previous auditory experience. This design allows elucidating the contribution of extra‐uterine auditory experience in the immature brain on the encoding of linguistically relevant speech features. Specifically, we collected brain responses to natural CV syllables differing in three dimensions using a multi‐feature mismatch paradigm, with the syllable/ba/ as the standard and three deviants: a pitch change, a vowel change to/bo/ and a consonant voice‐onset time (VOT) change to/pa/. No significant between‐group differences were found for pitch and consonant VOT deviants. However, moderate preterm infants showed attenuated responses to vowel deviants compared to full terms. These results suggest that moderate preterm infants' limited experience with low‐pass filtered speech prenatally can hinder vowel change detection and that exposure to natural speech after birth does not seem to contribute to improve this capacity. These data are in line with recent evidence suggesting a sequential development of a hierarchical functional architecture of speech processing that is highly sensitive to early auditory experience.     

Electrophysiological responses to auditory novelty in temperamentally different 9‐month‐old infants

Behavioral reactivity to novel stimuli in the first half‐year of life has been identified as a key aspect of early temperament and a significant precursor of approach and withdrawal tendencies to novelty in later infancy and early childhood. The current study examines the neural signatures of reactivity to novel auditory stimuli in 9‐month‐old infants in relation to prior temperamental reactivity. On the basis of the assessment of behavioral reactivity scores at 4 months of age, infants were classified into groups of high negatively reactive and high positively reactive infants. Along with an unselected control group, these groups of temperamentally different infants were given a three‐stimulus auditory oddball task at 9 months of age which employed frequent standard and infrequent deviant tones as well as a set of complex novel sounds. In comparison to high positively reactive and control infants, high negatively reactive infants displayed increased amplitude of a positive slow wave in the ERP response to deviant tones compared to standard tones. In contrast, high positively reactive infants showed a larger novelty P3 to the complex novel sounds. Results are discussed in terms of optimal levels of novelty for temperamentally different infants.