Samantha C. Butler

A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects.

ABSTRACT. Medical, neurodevelopmental, and parenting effects of individualized developmental care were investigated in a three-center, randomized, controlled trial. A total of 92 preterm infants, weighing less than 1250 g and aged less than 28 weeks, participated. Outcome measures included medical, neurodevelopmental and family function. Quality of care was also assessed. Multivariate analysis of variance investigated group, site, and interaction effects; correlation analysis identified individual variable contributions to significant effects. The results consistently favored the experimental groups. The following contributed to the group effects: shorter duration of parenteral feeding, transition to full oral feeding, intensive care, and hospialization; lower incidence of necrotizing enterocolitis; reduced discharge ages and hospital charges; improved weight, length, and head circumferences; enhanced autonomic, motor, state, attention, and self-regulatory functioning; reduced need for facilitation; and lowered family stress and enhanced appreciation of the infant. Quality of care was measurably improved. Very low birth weight infants and their parents, across diverse settings, may benefit from individualized developmental care.

Maternal Depressive Symptoms Affect Infant Cognitive Development in Barbados

This longitudinal study is part of a series examining the relationships between maternal mood, feeding practices, and infant growth and development during the first 6 months of life in 226 well-nourished mother-infant dyads in Barbados. In this report, we assessed maternal moods (General Adjustment and Morale Scale and Zung Depression and Anxiety Scales), feeding practices (scales describing breast-feeding and other practices associated with infant feeding in this setting), and infant cognitive development (Griffiths Mental Development Scales). Multivariate analyses, with and without controlling for background variables, established significant relationships between maternal moods and infant cognitive development. Infants of mothers with mild moderate depression had lower Griffiths scores than infants of mothers without depression. Maternal depressive symptoms and lack of trust at 7 weeks predicted lower infant social and performance scores at 3 months. Maternal moods at 6 months were associated with lower scores in motor development at the same age. Although no independent relationships emerged between feeding practices and infant cognitive development, the combination of diminished infant feeding intensity and maternal depression predicted delays in infant social development. These findings demonstrate the need to carefully monitor maternal moods during the postpartum period, in order to maximize the benefits of breast-feeding and related health programs to infant cognitive development.

Infant Understanding of the Referential Nature of Looking

To determine whether infants follow the gaze of adults because they understand the referential nature of looking or because they use the adult turn as a predictive cue for the location of interesting events, the gaze-following behavior of 14- and 18-month-olds was examined in the joint visual attention paradigm under varying visual obstruction conditions: (a) when the experimenters line of sight was obstructed by opaque screens (screen condition), (b) when the experimenters view was not obstructed (no-screen condition), and (c) when the opaque screens contained a large transparent window (window condition). It was assumed that infants who simply use adult turns as predictive cues would turn equally in all 3 conditions but infants who comprehend the referential nature of looking would turn maximally when the experimenters vision was not blocked and minimally when her vision was blocked. Eighteen-month-olds responded in accord with the referential position (turning much more in the no-screen and window conditions than in the screen condition). However, 14-month-olds yielded a mixed response pattern (turning less in the screen than the no-screen condition but turning still less in the window condition). The results suggest that, unlike 18-month-olds, 14-month-olds do not understand the intentional nature of looking and are unclear about the requirements for successful looking.

Gaze following at 12 and 14 months: Do the eyes matter?

Two questions were addressed: (1) Is the gaze following of infants under 18 months sensitive to eye status? (2) Do they construe looking as referential behaviour? Corkum and Moore (1995) concluded that, prior to 18 months, gaze following is responsive to the head turn alone (H), because infants followed such turns as frequently as conjoint head and eye turns (H/E). Since their results may have been compromised by an absence of targets and a relatively lengthy response time, we retested a 12- and 14- month group with H/E, H and eyes closed (H/Ecl) cues in the presence of targets and with reduced response time. To examine comprehension of referentiality, two more H/E cues were shown—(1) saying ‘oh wow’ while turning and (2) actively scanning the targets—each intended to increase gaze following if infants regard looking as seeing something. Fourteen-month-olds, but not 12-month-olds, responded significantly more to the standard H/E cue than to the H and H/Ecl cues, indicating the importance of eyes for gaze following at this age. Neither age group, however, responded more to the two ‘enhanced’ H/E cues than to the standard. In a second experiment, a new 14-month group was tested without targets, and again, responding was significantly greater to H/E than to H and H/Ecl. It was concluded that by 14 months, the eyes are co-equal with the head in controlling gaze following, but whether such head/eye turns are understood as object-directed is problematic.

Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at Age 8 Years: Preliminary Data

The current study reports the effects of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) at 8 years of age for a randomized controlled trial of 38 very early born (≤29 weeks postmenstrual age), high-risk preterm infants. It was hypothesized that the experimental group at school age in comparison with the control group would perform significantly better neuropsychologically and neuroelectrophysiologically. Twenty-two (11 control, 11 experimental) children of the original 38 (18 control, 20 experimental) participants were studied at school age with a detailed neuropsychological battery and with EEG spectral coherence measures. Results indicated significantly better right hemisphere and frontal lobe function in the experimental group than the control group, both neuropsychologically and neurophysiologically. Neurobehavioral and physiological results in the newborn period successfully predicted the beneficial brain function effects at age 8 years. Results support the conclusion that the NIDCAP intervention has lasting effects into school age.

Is the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) effective for preterm infants with intrauterine growth restriction

Objective:This study investigates the effectiveness of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on neurobehavioral and electrophysiological functioning of preterm infants with severe intrauterine growth restriction (IUGR).Study Design:Thirty IUGR infants, 28 to 33 weeks gestational age, randomized to standard care (control/C=18), or NIDCAP (experimental/E=12), were assessed at 2 weeks corrected age (2wCA) and 9 months corrected age (9mCA) in regard to health, anthropometrics, and neurobehavior, and additionally at 2wCA in regard to electrophysiology (EEG).Result:The two groups were comparable in health and anthropometrics at 2wCA and 9mCA. The E-group at 2wCA showed significantly better autonomic, motor, and self-regulation functioning, improved motility, intensity and response thresholds, and reduced EEG connectivity among several adjacent brain regions. At 9mCA, the E-group showed significantly better mental performance.Conclusion:This is the first study to show NIDCAP effectiveness for IUGR preterm infants.

Individualized developmental care for a large sample of very preterm infants: health, neurobehaviour and neurophysiology

Aim:  To assess medical and neurodevelopmental effects of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) for a large sample of very early‐born infants.

Two-year-olds' search strategies and visual tracking in a hidden displacement task.

Children younger than 3 years have difficulty with search tasks that involve hidden displacement. Partial visual information was provided about a balls path as it moved toward a hiding place. Children (2.0 and 2.5 years old) saw a ball rolling down a ramp placed behind a transparent screen with 4 opaque doors. A wall, placed on the ramp and directly behind 1 of the doors, protruded above the screen and stopped the ball. Children were asked to find the ball. The transparency of the screen permitted visual tracking of the ball between the doors, but its final resting place was obscured. Both age groups were equally proficient at tracking the ball as it rolled behind the screen, but the 2.5-year-olds were more likely to reach to the correct door. Looking behavior was related to errors in the younger group in that tracking that stopped short or continued past the correct door was associated with incorrect choices.

Prolonged T *2 values in newborn versus adult brain: Implications for fMRI studies of newborns

The neonatal brain possesses higher water content, lower macromolecular concentration, and reduced synaptic density than is found in the brain of a 1‐year‐old child. Changes in MRI characteristics of brain such as relaxation times accompany rapid changes in brain during early postnatal development. It was hypothesized that T  *2 values found in newborns would be significantly higher than those found in 9‐month‐old children and adults as measured at 1.5 T. Spoiled gradient echo measurements of T  *2 within the brains of newborns, 9‐month‐olds, and adults confirmed this hypothesis. The results have implications with regard to functional MRI studies in newborns since, in general, BOLD signal optimization is achieved when echo times TE are set equal to the T  *2 values of the tissue of interest. Since significantly longer T  *2 values are found in newborns, it is suggested that the TE values employed for fMRI studies of newborns should be increased to maximize BOLD signal intensity changes and improve the overall reliability of fMRI results in newborns. Magn Reson Med 51:1287–1291, 2004.

School-age effects of the newborn individualized developmental care and assessment program for preterm infants with intrauterine growth restriction: preliminary findings

BackgroundThe experience in the newborn intensive care nursery results in premature infants’ neurobehavioral and neurophysiological dysfunction and poorer brain structure. Preterms with severe intrauterine growth restriction are doubly jeopardized given their compromised brains. The Newborn Individualized Developmental Care and Assessment Program improved outcome at early school-age for preterms with appropriate intrauterine growth. It also showed effectiveness to nine months for preterms with intrauterine growth restriction. The current study tested effectiveness into school-age for preterms with intrauterine growth restriction regarding executive function (EF), electrophysiology (EEG) and neurostructure (MRI).MethodsTwenty-three 9-year-old former growth-restricted preterms, randomized at birth to standard care (14 controls) or to the Newborn Individualized Developmental Care and Assessment Program (9 experimentals) were assessed with standardized measures of cognition, achievement, executive function, electroencephalography, and magnetic resonance imaging. The participating children were comparable to those lost to follow-up, and the controls to the experimentals, in terms of newborn background health and demographics. All outcome measures were corrected for mother’s intelligence. Analysis techniques included two-group analysis of variance and stepwise discriminate analysis for the outcome measures, Wilks’ lambda and jackknifed classification to ascertain two-group classification success per and across domains; canonical correlation analysis to explore relationships among neuropsychological, electrophysiological and neurostructural domains at school-age, and from the newborn period to school-age.ResultsControls and experimentals were comparable in age at testing, anthropometric and health parameters, and in cognitive and achievement scores. Experimentals scored better in executive function, spectral coherence, and cerebellar volumes. Furthermore, executive function, spectral coherence and brain structural measures discriminated controls from experimentals. Executive function correlated with coherence and brain structure measures, and with newborn-period neurobehavioral assessment.ConclusionThe intervention in the intensive care nursery improved executive function as well as spectral coherence between occipital and frontal as well as parietal regions. The experimentals’ cerebella were significantly larger than the controls’. These results, while preliminary, point to the possibility of long-term brain improvement even of intrauterine growth compromised preterms if individualized intervention begins with admission to the NICU and extends throughout transition home. Larger sample replications are required in order to confirm these results.Clinical trial registrationThe study is registered as a clinical trial. The trial registration number is NCT00914108.