Marie-Jeanne Wolf

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

BACKGROUND Prematurity 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. METHOD Mother-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. RESULTS Findings 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. CONCLUSION   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.

The Infant Behavioral Assessment and Intervention Program to support preterm infants after hospital discharge: a pilot study

In this pilot study we investigated the feasibility of The Infant Behavioral Assessment and Intervention Program (IBAIP) in a group of preterm infants. At the age of 6 months, the neurobehavioural organization and self-regulatory competence of an intervention group was compared with a control group who had received the standard follow-up care. The intervention group consisted of 13 males and seven females (mean gestational age [GA] 29.2 weeks, SD 1.3wks; mean birthweight 1232g, SD 320g). The control group consisted of 11 males and nine females (mean GA 29wks, SD 1.6wks; mean birthweight 1198g, SD 397g). Inclusion criteria were: a GA of 32 weeks and family residence in the district of Amsterdam. Exclusion criteria were: severe congenital abnormalities, intraventricular haemorrhage grade III or IV, periventricular leukomalacia grade III or IV, and infants whose mothers had a history of illicit drug use. The intervention infants received 6 to 8 IBAIP interventions at home, from discharge until 6 months of age. The Neonatal Behavioral Assessment Scale was administered at term; the Infant Behavioral Assessment (IBA) at term, 3, and 6 months of age; and the Bayley Scales of Infant Development-II at 3 and 6 months (corrected age). At 6 months, intervention infants showed less stress and more approach behaviours on the IBA compared with control infants. These promising results warrant further evaluation in a randomized controlled trial.

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 infants 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.

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.

Rethinking preventive post-discharge intervention programmes for very preterm infants and their parents.

Post‐discharge preventive intervention programmes with involvement of the parent may support the resilience and developmental outcomes of infants born very preterm. Randomized controlled trials of home‐based family‐centred intervention programmes in very preterm infants that aimed to improve cognitive outcome, at least at age two, were selected and updated on the basis of a recent systematic review to compare their content and effect over time to form the basis of a narrative review. Six programmes were included in this narrative review. Four of the six programmes led to improved child cognitive and/or motor development. Two programmes, which focused primarily on responsive parenting and development, demonstrated improved cognitive outcome up till 5 years after completion of the programme. The programmes that also focused on maternal anxiety remediation led to improved maternal mental well‐being, along with improved child behaviour, in one study – even at 3 years after completion of the programme. The magnitude of the effects was modest. Family‐centred preventive intervention programmes that aim at improvement of child development should be continued after discharge home to improve the preterm childs resilience. Programmes may be most effective when they support the evolvement of a responsive parent–infant relationship over time, as well as the parents well‐being.

Early intervention in preterm infants after discharge from hospital

ity of admissions were for a febrile illness (see Table 1). During the weekends, admitted patients were more likely to have unconsciousness or seizures and less likely to have a prolonged illness, malnutrition, or subcostal indrawing. There was no evidence for differences in the distributions of very early, early, and late prognostic scores between weekend and weekday admissions (Kruskall-Wallis tests: very early 2 1.08, P 0.30; early 2 0.51, P 0.47; late 2 2.53, P 0.11). When adjusted for prognostic score, age, bacteremia and Plasmodium falciparum parasitemia, admission during the weekend was associated with ORs for death of 2.05 (95% CI: 1.26–3.31) within 4 hours of admission, 1.54 (95% CI: 1.17–2.03) within 4 to 48 hours, and 1.09 (95% CI: 0.80–1.47) 48 hours after admission. There was a substantially higher risk of early inpatient death among weekend compared to weekday pediatric admissions. Because we adjusted for the presence or absence of the major clinical correlates of mortality, we cannot simply attribute the excess mortality on weekends to children being more severely ill on arrival on the ward. It could be argued that the prognostic scores were not sensitive enough to detect clinically important differences. Yet, the greatest mortality excess was in the first 4 hours, and the very early prognostic score had previously been shown to very accurately predict these deaths in this population.4 We recently reported that mortality among severely ill children with severe anemia is associated with delayed blood transfusion.5 Delays in identification and treatment of other common, severe complications such as hypoxemia, hypovolemia, metabolic acidosis, or hypoglycemia could be similarly associated with increased risk of early mortality. We think that these findings warrant a careful audit of the quality of care provided during the first few hours after admission. Since these data were collected, we have examined staffing levels and strengthened training in basic and advanced life support.

Reliability, sensitivity and responsiveness of the Infant Behavioral Assessment in very preterm infants.

Aim:  The aim of this study is to investigate the reliability, sensitivity and responsiveness of the Infant Behavioral Assessment (IBA) to evaluate neurobehavioural organization in very preterm infants.