Joke Kok

Circadian rhythms in early human development

The body temperature, heart rate and rest-activity cycles of 12 low-risk preterm infants (29-35 weeks) were continuously recorded in the neonatal intensive care unit over a period of 1-2 weeks. Throughout the recordings the light was on continuously, the feeding was done intra-gastrically every 2 h and the incubator temperature was constant. Under such conditions a significant circadian rhythm was found in the body temperature and heart rate of more than 50% of the infants. These findings indicate the possible existence of an endogenous circadian rhythm in early human infancy. Since lights are continuously on in the neonatal intensive care unit, this might impair the time of emergence of day-night entrainment of the biological clock in preterm infants.

The Infant Behavioral Assessment and Intervention Program for Very Low Birth Weight Infants at 6 Months Corrected Age

OBJECTIVEnTo determine whether the Infant Behavioral Assessment and Intervention Program (IBAIP), designed to support and enhance infants self-regulatory competence, improved developmental and neurobehavioral outcomes in very low birth weight (VLBW) infants.nnnSTUDY DESIGNnWe randomized 86 infants to 1 intervention before discharge and to 6 to 8 home interventions until 6 months corrected age, and 90 control infants received standard care. Developmental and behavioral outcomes were evaluated at 6 months corrected age with the Bayley Scales of Infant Development-II (BSID-II). Neurobehavioral functioning was evaluated with the Infant Behavioral Assessment (IBA) at baseline and at 6 months corrected age.nnnRESULTSnDespite randomization, some differences in neonatal characteristics were found between the intervention and control infants. After adjustment, intervention effects of 7.2 points (+/- standard error 3.1) on the Mental Developmental Index and 6.4 +/- 2.4 points on the Psychomotor Developmental Index favored the intervention infants. The Behavioral Rating Scale of the BSID-II (P = .000) and the IBA (more approach [P = .003] and less stress [P = .001] over time) also favored the intervention infants.nnnCONCLUSIONSnThe IBAIP improved the mental, motor, and behavioral outcomes of VLBW infants at 6 months corrected age.

A neurobehavioral intervention and assessment program in very low birth weight infants : Outcome at 24 months

OBJECTIVEnTo determine whether the Infant Behavioral Assessment and Intervention Program (IBAIP) improves development and behavior in very low birth weight (VLBW) infants at 24-month corrected age.nnnSTUDY DESIGNnIn a multicenter, randomized, controlled trial 86 infants received postdischarge intervention until 6-month corrected age. The intervention consisted of supporting infants self-regulation and development, and facilitating sensitive parent-infant interactions; 90 control infants received regular care. At 6 months, positive intervention effects were found. At 24 months, development and behavior were evaluated with the Bayley Scales of Infant Development-II (BSID-II) and the Child Behavior Check List (CBCL).nnnRESULTSnEighty-three intervention and 78 control infants were available for follow-up. After adjustment for differences in perinatal characteristics, an intervention effect of 6.4 points (+/- standard error, 2.4) on the Psychomotor Developmental Index favored the intervention infants. Groups did not differ on the Mental Developmental Index, the Behavioral Rating Scale of the BSID-II, or on the CBCL. Subgroup analyses revealed improved motor as well as improved mental outcomes in intervention infants with bronchopulmonary dysplasia and with combined biological and social risk factors.nnnCONCLUSIONSnThe IBAIP shows sustained motor improvement in VLBW infants until 2-year corrected age.

The effect of the Infant Behavioral Assessment and Intervention Program on mother-infant interaction after very preterm birth

BACKGROUNDnPrematurity and perinatal insults lead to increased developmental vulnerability. The home-based Infant Behavioral Assessment and Intervention Program (IBAIP) was designed to improve development of preterm infants. In a multicenter randomized controlled trial the effect of IBAIP on mother-infant interaction was studied as a secondary outcome.nnnMETHODnMother-infant interaction was assessed during the Still-face procedure at 6 months corrected age. One hundred and twelve mother-infant dyads (57 intervention, 55 control) were studied.nnnRESULTSnFindings partially supported our hypothesis that the intervention would increase maternal sensitivity in interaction with their preterm infants. No effects were found on infant self-regulatory behavior or positive interaction behavior.nnnCONCLUSIONnu2002 The family-centered and strength-based approach of IBAIP appears to be a promising intervention method to promote sensitive mother-infant interaction at home after discharge from hospital. However, no positive effects were found on infant interaction behavior.

Circadian rhythms in preterm infants: a preliminary study

A method has been developed for long-term continuous recordings of several physiological variables in humans, including body movements, core temperature, heart rate and respiratory rate. This method enabled us to study circadian rhythms of body temperature and rest-activity in preterm infants. In 5 out of 9 infants (recorded at 28-34 weeks conceptional age) circadian rhythms were found in body temperature. We conclude that circadian rhythmicity is present during the early neonatal period in certain physiological variables (body temperature) but not in others (rest-activity).

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

OBJECTIVEnFor 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 infants regulatory competence and development. The intervention consisted of 6-8 home visits during the first 8 months after birth.nnnMETHODnSeventy-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.nnnRESULTSn30% 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.nnnCONCLUSIONnEarly 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.

Infant behavioral assessment and intervention program in very low birth weight infants improves independency in mobility at preschool age

OBJECTIVEnTo evaluate the effects of the Infant Behavioral Assessment and Intervention Program(©) (IBAIP) in very low birth weight infants on sensory processing and daily activities at preschool age.nnnSTUDY DESIGNnFollow-up of children included in a randomized controlled trial. Eighty-six infants were enrolled in post-discharge IBAIP until 6 months corrected age, and 90 infants received standard care. At 3.5 years of age, the Sensory Profile-Dutch version (SP-NL) and Pediatric Evaluation of Disability Inventory-Dutch version (PEDI-NL) were administered. For comparison, parents of 41 term-born children also completed the SP-NL.nnnRESULTSnSeventy-six children (88%) in the IBAIP group and 75 children (83%) children in the control group were examined at 44 months corrected age. After adjustment for pre-randomization differences in perinatal characteristics, the IBAIP group outperformed the control group significantly on SP-NL domains of oral sensory processing and sensory processing related to endurance/tone and PEDI-NL domains of mobility. The control group only scored significantly lower than the term group on the SP-NL domain endurance/tone. The very low birth weight groups performed significantly below the PEDI-NLs norm.nnnCONCLUSIONnIn line with the positive developmental effects of the IBAIP until 24 months corrected age, independency in mobility in daily activities was improved at 3.5 years.

The infant behavioral assessment and intervention program in very low birth weight infants; outcome on executive functioning, behaviour and cognition at preschool age.

BACKGROUNDnThe Infant Behavioral Assessment and Intervention Program (IBAIP©) improved motor function at 24 months, and mental and behavioural development in high risk subgroups of very low birth weight (VLBW) infants.nnnAIMnTo determine IBAIPs effects on executive functioning, behaviour and cognition at preschool age.nnnSTUDY DESIGNnFollow-up of a randomised controlled trial (RCT).nnnSUBJECTSnAt 44 months corrected age, all 176 VLBW infants were invited for follow-up. Forty-one term born children were assessed for comparison.nnnOUTCOME MEASURESnVisual Attention Task (VAT), Gift delay, Peabody Picture Vocabulary Test III-NL (PPVT), Visual motor integration tests and Miller assessment for preschoolers. Parents completed Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P) and Child Behavior Checklist (CBCL).nnnRESULTSnAt preschool age, 76 (88%) children of the intervention group and 75 (83%) children of the control group participated. There were no significant differences between the intervention and the control group. However, positive interaction effects between intervention and infants with bronchopulmonary dysplasia, infants born at gestational age<28 weeks, and infants of low educated mothers were found on CBCL, CBCL and BRIEF-P, and PPVT respectively. Most interaction effects exceeded 1 standard deviation in favour of the intervention children. The 151 VLBW children performed significantly worse than the term born children on the VAT, BRIEF-P and CBCL.nnnCONCLUSIONnIBAIP effects in VLBW children did not sustain until preschool age on executive functioning, behaviour and cognition. However, the most vulnerable children had a clinical relevant profit from IBAIP. VLBW children performed worse than the term born children. This study is a follow-up at preschool age of the multi-centre RCT of IBAIP versus usual care in VLBW infants. The RCT was performed in Amsterdam, The Netherlands (IBAIP).

Mental, psychomotor, neurologic, and behavioral outcomes of 2-year-old children born after preimplantation genetic screening: follow-up of a randomized controlled trial

OBJECTIVEnTo evaluate the effect of preimplantation genetic screening (PGS) on neurodevelopmental outcomes in children.nnnDESIGNnProspective, assessor-blinded, follow-up study of children born to women randomly assigned to in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) with or without PGS.nnnSETTINGnUniversity Medical Center, Groningen, and Academic Medical Center, Amsterdam, the Netherlands.nnnPATIENT(S)nFifty-four PGS children and 77 controls.nnnINTERVENTION(S)nPGS.nnnMAIN OUTCOME MEASURE(S)nMental, psychomotor, neurologic, and behavioral outcomes in 2-year-old children as measured with the Bayley Scales of Infant Development, the Hempel neurologic examination, and the Child Behavior Check List.nnnRESULT(S)nThe mental, psychomotor, and behavioral outcomes at 2 years in children born after IVF with and without PGS were similar overall. The PGS children showed lower neurologic optimality scores than the control children. Scores on all tests were within the normal range.nnnCONCLUSION(S)nConception with PGS does not seem to be associated with impaired mental, psychomotor, or behavioral outcomes by age 2. However, the lower neurologic optimality scores found in the PGS children may signal less favorable long-term neurologic outcomes in PGS children. Our findings stress the need for safety evaluations with new assisted reproductive techniques before large-scale implementation.

Maternal psychological distress in the first two years after very preterm birth and early intervention

Preterm delivery may have a strong impact on mothers. In a multicentre randomised controlled trial, including very preterm infants (<32 weeks and/or <1500 g), the effect of the Infant Behavioral Assessment and Intervention Program (IBAIP) on maternal psychological distress at 6, 12 and 24 (corrected) months after preterm birth was assessed. The programme is designed to assist parents to support and enhance their infants’ regulatory competence and development. Eighty‐six infants and their parents were randomly assigned to the intervention group and 90 to the control group. Maternal psychological distress was assessed with the General Health Questionnaire. In general, the mothers reported high levels of psychological distress, especially during the first six months after discharge from hospital when 56% had clinical scores. No differences were found in maternal psychological distress between the intervention and control group. Early intervention to decrease maternal distress in mothers of preterm infants is warranted.