Réjean Tessier

Kangaroo Mother Care: 25 Years after

UNLABELLED The components of the Kangaroo Mother Care (KMC) intervention, their rational bases, and their current uses in low-, middle-, and high-income countries are described. KMC was started in 1978 in Bogotá (Colombia) in response to overcrowding and insufficient resources in neonatal intensive care units associated with high morbidity and mortality among low-birthweight infants. The intervention consists of continuous skin-to-skin contact between the mother and the infant, exclusive breastfeeding, and early home discharge in the kangaroo position. In studies of the physiological effects of KMC, the results for most variables were within clinically acceptable ranges or the same as those for premature infants under other forms of care. Body temperature and weight gain are significantly increased, and a meta-analysis showed that the kangaroo position increases the uptake and duration of breastfeeding. Investigations of the behavioral effects of KMC show rapid quiescence. The psychosocial effects of KMC include reduced stress, enhancement of mother-infant bonding, and positive effects on the family environment and the infants cognitive development. CONCLUSION Past and current research has clarified some of the rational bases of KMC and has provided evidence for its effectiveness and safety, although more research is needed to clearly define the effectiveness of the various components of the intervention in different settings and for different therapeutic goals.

CONTINGENCY DETECTION AND THE CONTINGENT ORGANIZATION OF BEHAVIOR IN INTERACTIONS : IMPLICATIONS FOR SOCIOEMOTIONAL DEVELOPMENT IN INFANCY

In this report, the authors review studies addressing the issue of contingencies in social and nonsocial contexts during infancy. The review is divided into 4 groups of studies that suggest that (a) young infants detect contingencies unrelated to their behavior; (b) infants detect contingencies involving their behavior; (c) the study of contingency is pertinent for addressing behavioral organization within parent-infant interaction; and (d) there is a link between behavioral contingency in early infancy and global measures of socioemotional development that are predictive of social functioning at later points during childhood. Throughout the report, the pertinence of infant emotional responses during contingency-related tasks is emphasized. Finally, the authors delineate certain enduring questions regarding contingency experience in infancy and suggest ways of organizing research to address some of them.

Mediators of behavioral problems in 7-year-old children born after 24 to 28 weeks of gestation

We tested the hypothesis that prematurity acts through its association with neuromotor and intellectual functioning to explain behavior problems at school age. Sixty-one extremely preterm (EP) very low birth weight (VLBW) children (< 29 wk and < 1500 g) born in 1987-1990 and 44 normal birth weight children (NBW) (> 37 wk and > 2500 g) were matched for age, sex, and socioeconomic status (SES). Mediator variables were evaluated at a hospital at 5 years and 9 months. Behaviors were evaluated at school at 7 years by peers, teachers, and parents. When compared with NBW children, EP/VLBW children had poorer IQ and neuromotor development. At school, EP/VLBW children were evaluated by peers as more sensitive/isolated, and by teachers and parents as more inattentive and hyperactive than NBW. When mediators were introduced, the previously significant relation between prematurity and behavior problems disappeared. Hyperactive and inattentive behaviors were explained by a specific working memory factor for the latter, and by a general intellectual delay for the former, whereas sensitive/isolated behaviors were best explained by neuromotor delays. Inattentive behaviors were also related to family adversity. At school age, extreme prematurity had thus an indirect effect on behaviors via specific and nonspecific intellectual and neuromotor delays.

Another look inside the gap: Ecological contributions to the transmission of attachment in a sample of adolescent mother-infant dyads

Ecological contributions to attachment transmission were studied in a sample of 64 adolescent mother-infant dyads. Maternal sensitivity was assessed when infants were 6 and 10 months old, and infant security was assessed at 15 and 18 months. Maternal attachment state of mind was measured with the Adult Attachment Interview (AAI) after the 1st assessment. Ecological variables considered were maternal education and depression, paternal support, and infant maternal grandmother support. Results indicated that when the contribution of ecological variables was statistically controlled for, sensitivity was a significant mediator and state of mind no longer contributed to infant security. Sensitivity also mediated an association between maternal education and infant attachment, suggesting that attachment transmission is embedded in a more global process of infant attachment development.

Kangaroo Mother Care: A method for protecting high-risk low-birth-weight and premature infants against developmental delay

Aim: The purpose of this study was to examine the relationship between intervention with Kangaroo Mother Care (KMC) and the subsequent mental development of the infants. In this prospective study, 431 low-birth-weight and premature infants (≤1801 g) were assigned randomly to KMC or Traditional Care. Of these, 336 (78%) received the Griffiths test at 12 months of corrected age. Results: After control for the infant’s health at birth, family socioeconomic status and mother labor and delivery characteristics, the KMC infants had a higher IQ than those given traditional care (TC). The difference was most highly significant for infants who were more premature (30–32 weeks of gestational age), had required intensive care, and had a diagnosis of doubtful or abnormal neurological development at 6 months. The main impact of KMC was on the development of personal relations and on planning functions related to brain developmental stage at birth. Discussion: The KMC intervention can be viewed as a developmentally supportive care, in which parents are guided in managing their biological parenting abilities and which provides “brain care” during a highly sensitive period of a preterm infant’s neurological development.

Victimization: a newly recognized outcome of prematurity

Victimization by peers affects 10 to 20% of school children under the age of 12 years. Physical, verbal, and psychological victimization (being pushed, hit, called names, teased, being the target of rumours, theft, extortion) is associated with short‐ and long‐term adjustment problems, such as peer rejection, social withdrawal, low self‐esteem, anxiety, loneliness, and depression, as well as academic problems and school drop‐out. Research on populations of school children (primary and secondary) has associated victimization with personal risk factors (the victims characteristics and behaviour) and interpersonal risk factors (social relationships between peers). Studies on the social adjustment of preterm children at school age show that, even in the absence of a major motor or cognitive disability, this population has several personal risk factors associated with victimization. The objective of this study was to compare the level of victimization experienced by a group of 96 seven‐year‐old children born extremely preterm (EP, <29 weeks of gestation; 49 females) against that experienced by a group of 63 term children (34 females) matched for age and sex, maternal level of education, and family socioeconomic status. The children born EP had a mean gestational age of 27.3 weeks (SD 1.2) and a mean birthweight of 1001.1g (SD 223) and normal birth weight children had a mean gestational age of 39.5 weeks (SD 1.5) and a mean birthweight of 3468.7g (SD 431). Physical and verbal victimization were assessed in a school setting by peers with individual sociometric interviews (Modified Peer Nomination Inventory). After controlling for physical growth (height and weight) at the age of 7 years, the data indicate two independent effects: males were more victimized than females, and children born preterm experienced more verbal victimization by their peers than their term classmates, even when participants with a visible motor, intellectual, or sensory disability were excluded. Several hypotheses are presented to account for the higher incidence of verbal victimization of preterm children.

Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study

Aims:  This study tested the hypothesis that Kangaroo Mother Care creates a climate in the family, which enhances infants’ performance on the developmental quotient scale.

Salivary IGA is a Weak Stress Marker

Several studies support the hypothesis that psychological stress may negatively affect immunocompetence. The present study sought to determine whether a relationship can be established between a measure of psychological state of stress and level of immunoglobulin of the A class (IgA) in saliva. To this end, 44 dentistry students were tested on four occasions; two occasions were stress inductive (examination situation), and two occasions were free of any academic stressor. At each session, the participants were asked to fill out the stress rating instrument, and unstimulated whole saliva samples were obtained. Salivary IgA was measured by a microplate Enzyme Linked Immunosorbent Assay (ELISA). A significant difference in the level of salivary IgA was observed only for the most polarized contrast, ie, between final exam and end of summer vacation (p less than .01). A weak negative correlation between the level of salivary IgA and the stress rating was observed (r = -0.25) only at the final exam. Our results suggest that assaying immunoglobulin A in saliva to measure stress may not be as useful in psychophysiological research as expected.

Cerebral motor function in very premature-at-birth adolescents: a brain stimulation exploration of kangaroo mother care effects.

Aim:  Given that prematurity has deleterious effects on brain networking development beyond childhood, the study explored whether an early intervention such as Kangaroo Mother Care (KMC) in very preterm preemies could have influenced brain motor function up to adolescence.

Extremely Premature and Very Low Birthweight Infants: A Double Hazard Population?

This article evaluates the contributions of birth status (defined by gestational age and birthweight) and family adversity at birth and at age 7 to explaining behavior problems at age 7. The behaviors of 96 extremely preterm and very low birth-weight children and 66 full-term children were assessed in a school setting by peers, teachers and parents. The results show that a significant relationship exists between birth status and isolation and social withdrawal problems as well as between birth status and social immaturity and inattention problems. Family adversity at birth has a significant contribution to aggressive behaviors reported by the three sources whereas, at age 7, this index is associated only with aggressive behaviors and social immaturity problems reported by parents. In conclusion, the results of the present study qualify the findings of studies that suggest that at school age, the effect of prematurity decreases and that behavior problems are explained chiefly by family environment characteristics. Our results indicate that the findings must take into account the cohort studied, the environmental measures used, the type of behaviors assessed as well as the type of informants.