Early Sensitivity Training for Parents of Preterm Infants: Impact on the Developing Brain

After birth, preterm infants face a stressful environment, which may negatively impact early brain development and subsequent neurobehavioral outcomes. This randomized controlled trial involving 45 women with infants <30-wk gestation, assessed the effectiveness of training parents in reducing stressful experiences. Intervention consisted of 10 sessions in the Neonatal Intensive Care Unit (NICU). Postintervention, at term-equivalent (40-wk postmenstrual age), magnetic resonance imaging (MRI) was performed to evaluate brain structure and development. Quantitative volumetric techniques were used to estimate overall and regional brain volumes for different tissue types including CSF, CGM, DNGM, UWM, and MWM. DTI was used to evaluate the integrity and maturation of white matter by ADC and FA. Maturation and connectivity of white matter, characterized by diffusion MR measures of ADC and FA, were significantly enhanced in the intervention group, who displayed greater restriction in ADC and increase in FA. There were no significant effects on either brain volumes or on short-term medical outcomes. Thus, sensitivity training for parents in the NICU is associated with improved cerebral white matter micro-structural development in preterm infants.

[1]  Simon K Warfield,et al.  Neonate hippocampal volumes: Prematurity, perinatal predictors, and 2‐year outcome , 2008, Annals of neurology.

[2]  Douglas G. Altman,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials , 2001, The Lancet.

[3]  J. Allsop,et al.  Relationship Between White Matter Apparent Diffusion Coefficients in Preterm Infants at Term-Equivalent Age and Developmental Outcome at 2 Years , 2007, Pediatrics.

[4]  H. Würbel,et al.  Maternal separation and maternal care act independently on the development of HPA responses in male rats , 2008, Behavioural Brain Research.

[5]  T. Achenbach,et al.  Nine-year outcome of the Vermont intervention program for low birth weight infants. , 1993, Pediatrics.

[6]  L. Doyle,et al.  Cognition, School Performance, and Behavior in Very Low Birth Weight and Normal Birth Weight Children at 8 Years of Age: A Longitudinal Study , 1993, Journal of developmental and behavioral pediatrics : JDBP.

[7]  Jeffrey J. Neil,et al.  Transport, monitoring, and successful brain MR imaging in unsedated neonates , 2008, Pediatric Radiology.

[8]  B. Vohr,et al.  Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. , 2000, Pediatrics.

[9]  B. Nurcombe,et al.  The Mother-Infant Transaction Program. The content and implications of an intervention for the mothers of low-birthweight infants. , 1990, Clinics in perinatology.

[10]  J. E. Tanner,et al.  Spin diffusion measurements : spin echoes in the presence of a time-dependent field gradient , 1965 .

[11]  H. Lagercrantz,et al.  A Randomized, Controlled Trial to Evaluate the Effects of the Newborn Individualized Developmental Care and Assessment Program in a Swedish Setting , 2000, Pediatrics.

[12]  Deanne K. Thompson,et al.  Preterm infant hippocampal volumes correlate with later working memory deficits. , 2008, Brain : a journal of neurology.

[13]  B. Nurcombe,et al.  Seven‐Year Outcome of the Vermont Intervention Program for Low‐Birthweight Infants , 1990 .

[14]  T. Inder,et al.  White matter injury in the premature infant: a comparison between serial cranial sonographic and MR findings at term. , 2003, AJNR. American journal of neuroradiology.

[15]  Christopher J. Cannistraci,et al.  Regional brain volume abnormalities and long-term cognitive outcome in preterm infants. , 2000, JAMA.

[16]  S. Matthews,et al.  Fetal programming of hypothalamo‐pituitary‐adrenal function: prenatal stress and glucocorticoids , 2006, The Journal of physiology.

[17]  D. Wilson‐Costello,et al.  Corpus Callosum Size and Very Preterm Birth: Relationship to Neuropsychological Outcome , 2006 .

[18]  Simon K. Warfield,et al.  Fast k-NN classification for multichannel image data , 1996, Pattern Recognit. Lett..

[19]  L. Lanfumey,et al.  Chronic Mild Stress during Gestation Worsens Neonatal Brain Lesions in Mice , 2007, The Journal of Neuroscience.

[20]  Ron Kikinis,et al.  Adaptive, template moderated, spatially varying statistical classification , 2000, Medical Image Anal..

[21]  Alan Lucas,et al.  Hippocampal Volume and Everyday Memory in Children of Very Low Birth Weight , 2000, Pediatric Research.

[22]  J. Volpe.  Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances , 2009, The Lancet Neurology.

[23]  T. Inder,et al.  Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. , 2006, The New England journal of medicine.

[24]  L. Bergman,et al.  Developmental science and the holistic approach. , 2000 .

[25]  Saroj Saigal,et al.  An overview of mortality and sequelae of preterm birth from infancy to adulthood , 2008, The Lancet.

[26]  S. Watson,et al.  Maternal deprivation regulates serotonin 1A and 2A receptors in the infant rat , 2000, Brain Research.

[27]  井上 彩子,et al.  デベロプメンタルケアの実際 Newborn Individualized Developmental Care and Assessment Program(NIDCAP) (特集 デベロプメンタルケア) , 2003 .

[28]  F. Duffy,et al.  Early experience alters brain function and structure. , 2004, Pediatrics.

[29]  Hong Wang,et al.  Abnormal Cerebral Structure Is Present at Term in Premature Infants , 2005, Pediatrics.

[30]  H. Skouteris,et al.  Effectiveness of a modified Mother-Infant Transaction Program on outcomes for preterm infants from 3 to 24 months of age. , 2009, Infant behavior & development.

[31]  S. Rose,et al.  Altered white matter diffusion anisotropy in normal and preterm infants at term‐equivalent age , 2008, Magnetic resonance in medicine.