Mother-Toddler Play Interaction in Extremely, Very Low Birth Weight, and Full-Term Children: A Longitudinal Study

Exploring predictors of interaction among low-birth-weight infants and their caregivers: a machine learning-based random forest approach

BACKGROUND

Quality caregiver-infant interaction is crucial for infant growth, health, and development. Traditional methods for evaluating the quality of caregiver-infant interaction have predominantly relied on rating scales or observational techniques. However, rating scales are prone to inaccuracies, while observational techniques are resource-intensive. The utilization of easily collected medical records in conjunction with machine learning techniques offers a promising and viable strategy for accurate and efficient assessment of caregiver-infant interaction quality.

METHODS

This study was conducted at a follow-up outpatient clinic at two tertiary maternal and infant health centers located in Shanghai, China. 68 caregivers and their 3-15-month-old infants were videotaped for 3-5 min during playing interactions in non-threatening environment. Two trained experts utilized the Infant CARE-Index (ICI) procedure to assess whether the caregivers were sensitive or not in a dyadic context. This served as the gold standard. Predictors were collected through Health Information Systems (HIS) and questionnaires, which included accessible features such as demographic information, parental coping ability, infant neuropsychological development, maternal depression, parent-infant interaction, and infant temperament. Four classification models with fivefold cross-validation and grid search hyperparameter tuning techniques were employed to yield prediction metrics. Interpretable analyses were conducted to explain the results.

RESULTS

The score of sensitive caregiver-infant interaction was 6.34 ± 2.62. The Random Forest model gave the best accuracy (83.85%±6.93%). Convergent findings identified infant age, care skills of infants, mother age, infant temperament-regulatory capacity, birth weight, positive coping, health-care-knowledge-of-infants, type of caregiver, MABIS-bonding issues, ASQ-Fine Motor as the strongest predictors of interaction sensitivity between infants and their caregiver.

CONCLUSIONS

The proposed method presents a promising and efficient approach that synergistically combines rating scales and artificial technology to detect important features of caregiver-infant interactions. This novel approach holds several implications for the development of automatic computational assessment tools in the field of nursing studies.

Infant-Directed Speech to Preterm Infants during the First Year Postpartum: The Influence of Preterm Birth Weight and Maternal Parenting Stress

Premature birth can increase the level of parenting stress (PS), especially in the case of parents of high-risk infants (extremely low birth weight (ELBW) and very low birth weight (VLBW)). Though published research has explored how maternal PS influences early dyadic interactions, limited research has focused on infant-directed speech (IDS), and no studies have investigated the link between prematurity severity based on birth weight and maternal IDS. This study, involving 100 mother-infant dyads, categorized into 30 ELBW premature infants, 30 VLBW premature infants, and 40 full-term (FT) ones, examined the impact of preterm birth weight and maternal parenting stress on IDS features during early interactions at 3 and 9 months postpartum. Maternal input was assessed using the CHILDES system, while parenting stress was evaluated using the Parenting Stress Index-Short Form. The results revealed that high-risk conditions (ELBW preterm birth and high parenting stress) at 3 months were associated with reduced affect-salient speech and increased questioning. IDS functional patterns, specifically the proportion of affect-salient speech and questions, were influenced by both birth weight groups and parenting stress levels at 3 months but not at 9 months. These findings highlight the need to assess, within the context of prematurity, both birth weight and parenting stress in clinical practice, offering insights for developing interventions supporting positive parent-infant interactions and facilitating infant development.

Preterm infant mental health in the neonatal intensive care unit: A review of research on NICU parent-infant interactions and maternal sensitivity

Caregiving relationships in the postnatal period are critical to an infant's development. Preterm infants and their parents face unique challenges in this regard, with infants experiencing separation from parents, uncomfortable procedures, and increased biologic vulnerability, and parents facing difficulties assuming caregiver roles and increased risk for psychological distress. To better understand the NICU parent-infant relationship, we conducted a review of the literature and identified 52 studies comparing observed maternal, infant, and dyadic interaction behavior in preterm dyads with full-term dyads. Eighteen of 40 studies on maternal behavior found less favorable behavior, including decreased sensitivity and more intrusiveness in mothers of preterm infants, seven studies found the opposite, four studies found mixed results, and 11 studies found no differences. Seventeen of 25 studies on infant behavior found less responsiveness in preterm infants, two studies found the opposite, and the remainder found no difference. Eighteen out of 14 studies on dyad-specific behavior reported less synchrony in preterm dyads and the remainder found no differences. We identify confounding factors that may explain variations in results, present an approach to interpret existing data by framing differences in maternal behavior as potentially adaptive in the context of prematurity, and suggest future areas for exploration.

Association of Neonatal Pain-Related Stress and Parent Interaction With Internalizing Behaviors Across 1.5, 3.0, 4.5, and 8.0 Years in Children Born Very Preterm

IMPORTANCE

Internalizing (anxiety and/or depressive) behaviors are prevalent in children born very preterm (24-32 weeks' gestation). Procedural pain-related stress in the neonatal intensive care unit (NICU) is associated with long-term internalizing problems in this population; however, whether positive parenting during toddlerhood attenuates development of internalizing behaviors across childhood is unknown.

OBJECTIVE

To investigate whether neonatal pain-related stress is associated with trajectories of internalizing behaviors across 1.5, 3.0, 4.5, and 8.0 years, and whether supportive parenting behaviors and lower parenting stress at 1.5 and 3.0 years attenuate this association.

DESIGN, SETTING, AND PARTICIPANTS

In this prospective longitudinal cohort study, preterm neonates (born at 24-32 weeks' gestation) were recruited from August 16, 2006, to September 9, 2013, with follow-up visits at ages 1.5, 3.0, 4.5, and 8.0 years. The study was conducted at BC Women's Hospital, Vancouver, Canada, with recruitment from a level III neonatal intensive care unit and sequential developmental assessments performed in a Neonatal Follow-up Program. Data analysis was performed from August to December 2021.

MAIN OUTCOMES AND MEASURES

Parental report of child internalizing behaviors on the Child Behavior Checklist at 1.5, 3.0, 4.5, and 8.0 years.

RESULTS

A total of 234 neonates were recruited, and 186 children (101 boys [54%]) were included in the current study across ages 1.5 (159 children), 3.0 (169 children), 4.5 (162 children), and 8.0 (153 children) years. After accounting for clinical factors associated with prematurity, greater neonatal pain-related stress was associated with more internalizing behaviors across ages (B = 4.95; 95% CI, 0.76 to 9.14). Higher parenting stress at age 1.5 years (B = 0.17; 95% CI, 0.11 to 0.23) and a less supportive parent environment (less sensitivity, structure, nonintrusiveness, nonhostility, and higher parenting stress; B = -5.47; 95% CI, -9.44 to -1.51) at 3.0 years were associated with greater internalizing problems across development to age 8.0 years.

CONCLUSIONS AND RELEVANCE

In this cohort study of children born very preterm, exposure to repetitive neonatal pain-related stress was associated with persistent internalizing behavior problems across toddlerhood to age 8.0 years. Supportive parenting behaviors during early childhood were associated with better long-term behavioral outcomes, whereas elevated parenting stress was associated with more child anxiety and/or depressive behaviors in this population. These findings reinforce the need to prevent pain in preterm neonates and inform future development of targeted parent-led behavioral interventions.

Lower Maternal Chronic Physiological Stress and Better Child Behavior at 18 Months: Follow-Up of a Cluster Randomized Trial of Neonatal Intensive Care Unit Family Integrated Care

OBJECTIVE

To assess whether Family Integrated Care (FICare) in the neonatal intensive care unit improves maternal chronic physiological stress and child behavior at 18 months of corrected age for infants born preterm.

STUDY DESIGN

Follow-up of a multicenter, prospective cluster-randomized controlled trial comparing FICare and standard care of children born at <33 weeks of gestation and parents, stratified by tertiary neonatal intensive care units, across Canada. Primary outcomes at 18 months of corrected age were maternal stress hormones (cortisol, ie, hair cumulative cortisol [HCC], dehydroepiandrosterone [DHEA]) assayed from hair samples. Secondary outcomes included maternal reports of parenting stress, child behaviors (Internalizing, Externalizing, Dysregulation), and observer-rated caregiving behaviors. Outcomes were analyzed using multilevel modeling.

RESULTS

We included 126 mother-child dyads from 12 sites (6 FICare sites, n = 83; 6 standard care sites, n = 43). FICare intervention significantly lowered maternal physiological stress as indicated by HCC (B = -0.22 [-0.41, -0.04]) and cortisol/DHEA ratio (B = -0.25 [-0.48, -0.02]), but not DHEA (B = 0.01 [-0.11, 0.14]). Enrollment in FICare led to lower child Internalizing (B = -0.93 [-2.33, 0.02]) and Externalizing behavior T scores (B = -0.91 [-2.25, -0.01]) via improvements to maternal HCC (mediation). FICare buffered the negative effects of high maternal HCC on child Dysregulation T scores (B = -11.40 [-23.01, 0.21]; moderation). For mothers reporting high parenting stress at 18 months, FICare was related to lower Dysregulation T scores via maternal HCC; moderated mediation = -0.17 (-0.41, -0.01).

CONCLUSIONS

FICare has long-term beneficial effects for mother and child, attenuating maternal chronic physiological stress, and improving child behavior in toddlerhood.

CLINICAL TRIAL REGISTRATION

NCT01852695.

A Study of Maternal Competence in Preterm Birth Condition, during the Transition from Hospital to Home: An Early Intervention Program's Proposal

The study was conducted with 104 mothers (average age 32.5 years, SD 6.1) of preterm infants (very and moderately preterm but still healthy) to monitor the perceived maternal role competence from the time of hospitalisation to post-discharge, in order to define an intervention program to support mothers during this transition. A targeted Q-Sort tool (Maternal Competence Q-Sort in preterm birth) was applied at two different times as a self-observation tool for parenting competence in neonatology. A tendency towards dysregulation of the maternal role competence was detected, mainly in terms of low self-assessment and was found to worsen during post-discharge, particularly with regard to caregiving ability. This study suggests the importance of accompanying parenting competence in preterm birth conditions, not only during hospitalisation in the Neonatal Intensive Care Unit (NICU) but also following discharge in order to promote the development of premature infants. This paper reports in the last part a specific integrated psychoeducational intervention program (psychologist and nurses), which we defined precisely in light of the suggestions offered by the study data on perceived maternal competence created with the Q-sort.

Controlling Parenting Behaviors in Parents of Children Born Preterm: A Meta-Analysis

OBJECTIVE

This meta-analysis tested whether parents of preterm-born children differ from parents of full-term-born children regarding controlling parenting.

METHODS

Databases of PubMed, Scopus, Web of Science, Open Access Theses and Dissertations, and Elton B. Stephens Company were searched for cross-sectional and prospective longitudinal studies examining controlling parenting in preterm-born children.

RESULTS

The meta-analysis included 27 independent data sets, derived from 34 studies, with a total of 8053 participants-3265 preterm and 4788 full-term children. Parents of children born preterm were more controlling than parents of children born full-term (Hedges' g = 0.29; 95% confidence interval: 0.19-0.39; z = 5.48; p < 0.001). Heterogeneity analysis indicated significant variation in effects between studies (Q = 148.46, p < 0.001), but the effects were not moderated by gestational age, birth weight, child age, child gender, parental education, type of parenting assessment method (observational vs parental self-report), parenting dimension measured (behaviors vs attitudes), type of controlling parenting (intrusiveness vs others), study design (cross-sectional vs longitudinal), year of publication, or geographical setting of the studies (America vs Europe).

CONCLUSION

Findings suggest that parents of children born preterm are at higher risk for engaging in controlling parenting strategies, stressing the importance of psychosocial follow-up support for these parents.

Maternal brain resting-state connectivity in the postpartum period

In the postpartum period, the maternal brain experiences both structural and functional plasticity. Although we have a growing understanding of the responses of the human maternal brain to infant stimuli, little is known about the intrinsic connectivity among those regions during the postpartum months. Resting-state functional connectivity (rsFC) provides a measure of the functional architecture of the brain based upon intrinsic functional connectivity (ie, the temporal correlation in blood oxygenation level dependent signal when the brain is not engaged in a specific task). In the present study, we used resting-state functional magnetic resonance imaging to examine how later postpartum months are associated with rsFC and maternal behaviours. We recruited a sample of 47 socioeconomically diverse first-time mothers with singleton pregnancies. Because the amygdala has been shown to play a critical role in maternal behaviours in the postpartum period, this was chosen as the seed for a seed-based correlation analysis. For the left amygdala, later postpartum months were associated with greater connectivity with the anterior cingulate gyrus, left nucleus accumbens, right caudate and left cerebellum (P < 0.05, false discovery rate corrected). Furthermore, in an exploratory analysis, we observed indications that rsFC between the left amygdala and left nucleus accumbens was positively associated with maternal structuring during a mother child-interaction. In addition, later postpartum months were associated with greater connectivity between the right amygdala and the bilateral caudate and right putamen. Overall, we provide evidence of relationships between postpartum months and rsFC in the regions involved in salience detection and regions involved in maternal motivation. Greater connectivity between the amygdala and nucleus accumbens may play a role in positive maternal behaviours.

Persistence of Effects of VLBW/PT Birth Status and Maternal Emotional Availability (EA) on Child EA Trajectories

Few studies have examined the longitudinal impact of birth status on the infant-mother relationship and on children's socio-emotional development. In the present study we investigated developmental patterns of such relationships [using the Emotional Availability (EA) Scales] in fullterm and VLBW/PT infants from infancy to emerging school age. Our objectives were to: (a) model the developmental trajectories of EA dimensions (maternal sensitivity, structuring, non-hostility; child responsiveness, involvement) in a VLBW/PT and fullterm sample, (b) identify potential effects of VLBW/PT status on these trajectories, and (c) determine whether the effects of VLBW/PT status on children's socio-emotional development (child EA) remained after accounting for the effect of maternal EA. Child-mother dyads (n = 109) were observed in home-based interactions (face-to-face and free play) when children were 6, 12, 18, and 57-months-old in fullterm (37-41 weeks, >2500 g; n = 48) and healthy VLBW/PT (26-32 weeks gestation, birth weight 800-1500 g, corrected for gestational age; n = 61) children. Developmental trajectories of maternal and child EA were assessed using multilevel growth modeling in Mplus. Results indicated that, even after controlling for maternal EA, there was a persistent negative effect of VLBW/PT birth status on child EA trajectories. Both initially and over time, VLBW/PT infants lagged behind their fullterm counterparts on levels of responsiveness and involvement with mothers. There was also a persistent positive effect of maternal EA (sensitivity and structuring) on child EA trajectories. Higher average levels of maternal sensitivity and structuring across time were also associated with higher and persistent levels of child responsiveness and involvement of their mothers. Importantly, results held after modeling both effects together, and after controlling for maternal education and child gender. Our results have implications for VLBW/PT children's development, the parent-child relationship, and integrating family level factors and relationship dimensions in early prevention and intervention programs.

Mother- and father-infant interactions at 3 months of corrected age: The effect of severity of preterm birth

Early interactions of 92 preterm infants with their mothers (n=54) and fathers (n=38) were explored at 3 months using CARE-Index. Results showed differences in interactions based on parent's gender, with higher control in mothers and unresponsiveness in fathers, while no effect of severity of birth weight emerged.