Stroking in early mother-infant exchanges: The role of maternal tactile biography and interoceptive sensibility

Caress-like is a crucial component of caregiving and a key factor in mother-infant interactions. Mother's experience of touch during her own childhood (i.e., tactile biography) has been found to be related to maternal actual use of caress-like touch (i.e., stroking) during mother-infant exchanges. Evidence also suggests that maternal interoceptive sensibility (i.e., self-perceived sensitivity to inner-body sensations) might be related to sensitive caregiving abilities. However, further empirical investigation is needed to understand to what extent tactile biography and interoceptive sensibility have an impact on mothers' stroking when interacting with their infants. Using an online survey, this cross-sectional study explored the potential association between maternal tactile biography, interoceptive sensibility and use of touch for interaction with their own infants in a group of 377 Italian mothers (mean age = 33.29; SD = 4.79). We tested and compared a series of multivariate linear mediation models using maternal tactile biography as predictor, maternal use of affective touch as outcome variable and Multidimensional Assessment of Interoceptive Awareness (MAIA) subscale scores as mediators. We found that, if a mother had positive touch experiences in her own childhood, she may be more likely to use touch in a positive and nurturing way with her own infant (i.e., stroking). Furthermore, mothers' interoceptive sensibility in the form of attention regulation, self-regulation and body listening mediates the association between their past experiences of positive touch and their use of caress-like touch in mother-infant exchanges. This study highlights that maternal tactile biography is directly associated with mothers' use of caress-like touch and indirectly linked to it through the mediating role of interoceptive sensibility.

Skin-to-Skin Care and Spontaneous Touch by Fathers in Full-Term Infants: A Systematic Review

A series of studies have shown that mothers' early tactile behaviors have positive effects, both on full-term and preterm infants, and on mothers alike. Regarding fathers, research has focused mostly on paternal skin-to-skin care with preterm infants and has overlooked the tactile behavior effects with full-term newborns on infants' outcomes and on fathers themselves. The current systematic review considered the evidence regarding paternal tactile behaviors with full-term infants, including skin-to-skin care (SSC) and spontaneous touch (ST), during parent-infant interactions, and differentiated biophysiological, behavioral and psychological variables both in fathers and in infants. We also compared fathers' and mothers' tactile behaviors for potential differences. The few available studies suggest that paternal touch-SSC and ST-can have positive effects on fathers and infants alike. They also show that, despite some intrinsic differences, paternal touch is as pleasant as maternal touch. However, given the paucity of studies on the topic, we discuss why this field of research should be further explored.

Severity of developmental delay and parenting behavior in toddlers with neurodevelopmental disabilities

Introduction

The presence of a neurodevelopmental disability (ND) represents an adverse condition for child's development and parent-child relationship, and it is reasonable to assume that the severity of delay may influence parenting behavior. Previous research, however, did not specifically address this issue.

Methods

This cross-sectional study compared parental behaviors of mothers of toddlers with moderate/severe or mild/borderline developmental delay and mothers of toddlers with typical development, while considering maternal emotional states. A total of 88 dyads with children aged between 12 and 47 months participated in a 10-min video-recorded interaction then coded with the PICCOLO, a validated observation checklist that assesses four dimensions of parenting: affection, responsiveness, encouragement, and teaching. The mothers also fulfilled two standardized questionnaires assessing parental stress and presence of depressive symptoms. MANOVA and MANCOVA models were used to explore between-group differences in specific parenting dimensions, also considering parental stress.

Results

Mothers of toddlers with ND were less responsive than the comparison group, while the presence of a moderate/severe developmental delay specifically affected teaching behaviors. No differences emerged for affection and encouragement behaviors. Importantly, although mothers of toddlers with moderate/severe ND reported higher child-related dysfunctional interaction stress, this did not directly affect parenting behaviors.

Discussion

These findings highlight how the presence of a disability and the severity of developmental delay can affect specific dimensions of parenting (i.e., responsiveness, teaching) and might inform clinical practice and research on early parental interventions.

Infants' sex affects neural responses to affective touch in early infancy

Social touch is closely related to the establishment and maintenance of social bonds in humans, and the sensory brain circuit for gentle brushing is already active soon after birth. Brain development is known to be sexually dimorphic, but the potential effect of sex on brain activation to gentle touch remains unknown. Here, we examined brain activation to gentle skin stroking, a tactile stimulation that resembles affective or social touch, in term-born neonates. Eighteen infants aged 11-36 days, recruited from the FinnBrain Birth Cohort Study, were included in the study. During natural sleep, soft brush strokes were applied to the skin of the right leg during functional magnetic resonance imaging (fMRI) at 3 cm/s velocity. We examined potential differences in brain activation between males (n = 10) and females (n = 8) and found that females had larger blood oxygenation level dependent (BOLD) responses (brushing vs. rest) in bilateral orbitofrontal cortex (OFC), right ventral striatum and bilateral inferior striatum, pons, and cerebellum compared to males. Moreover, the psychophysiological interactions (PPI) analysis, setting the left and right OFC as seed regions, revealed significant differences between males and females. Females exhibited stronger PPI connectivity between the left OFC and posterior cingulate or cuneus. Our work suggests that social touch neural responses are different in male and female neonates, which may have major ramifications for later brain, cognitive, and social development. Finally, many of the sexually dimorphic brain responses were subcortical, not captured by surface-based neuroimaging, indicating that fMRI will be a relevant technique for future studies.

Exploring maternal touch in the infant’s first 18 months of Life: A study on an Italian sample

Affective touch is a crucial component of caregiving in early life and constitutes a key factor with a significant impact on infant later-life outcomes. The Parent-Infant Caregiving Touch Scale (PICTS) allows to quantify and qualify the caregiver's self-perception of touch in the first months of an infant's life. In the current study, we contributed to validation of the PICTS in the Italian language in order to explore whether early maternal touch would be associated with maternal emotional state, maternal history of affective touch experiences throughout the lifespan, and infants' sex and age. Data analyses were run on a sample of 377 Italian mothers (mean age = 33.29; SD = 4.79) participating in an online survey. Confirmatory factor analysis was applied. A three-dimensional structure of PICTS (i.e., stroking, affective communication, and holding) after removing one item out resulted in the best model in our sample. Maternal emotional state did not affect PICTS factor scores while maternal comfort and amount of affective touch experienced during adulthood was significantly associated with the stroking, affective communication, and holding factors. Regarding infants' dimensions, infants' sex and age were not associated with PICTS factor scores. Findings suggest that the PICTS Italian version is a good measurement of caregiver's self-perception of touch in early infancy and that maternal history of touch is associated with a mother's current use of touch.

A contribution to the Italian validation of the Parenting Interaction with Children: Checklist of Observations Linked to Outcome (PICCOLO)

Introduction

PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes) is an observational instrument designed to assess four domains of parenting interactions that promote early child development (Affection, Responsiveness, Encouragement, and Teaching). Although PICCOLO has been validated in the United States for children as young as 4 months of age, the current focus is on parents with children aged between 10 and 47 months. This study contributes to the validation of the Italian translation of the PICCOLO by testing its psychometric properties and examining whether factors such as the child's age and child's sex are related to the four domains of parenting interactions.

Methods

To these aims, 152 mothers of children aged 10-47 months from three Italian regions participated in the study.

Results

Results indicate that the PICCOLO Italian version has acceptable inter-rater agreement, split-half reliability, and stability over time. Furthermore, the Italian version confirmed the robustness of the factor structure proposed in the original version. While there were no significant differences by child gender on the domains of parenting interactions, the Affection scores decreased with age.

Discussion

Overall, these results demonstrate that the Italian version of the PICCOLO is a reliable measure of maternal interactions with children. The psychometric properties of the instrument make it appropriate for general research purposes and for assessment of parenting before and after support interventions.

Prelinguistic intersubjective and socio-communicative skills in infants with neurodevelopmental disabilities aged 0-36 months: A new assessment and parent support tool

Background

Although children with neurodevelopmental disability (NDD) present with several deficits, they partially share developmental impairments in prelinguistic intersubjective and socio-communicative skills, which are not easily assessed by conventional tests during the first years of life.

Aim

The current paper presents a new procedure to assess the prelinguistic intersubjective and socio-communicative skills of NDD children aged 0-36 months. A specific observation form template, called the Observation of Prelinguistic Intersubjective and Socio-Communicative Skills (OPISCoS) form, has been designed to systematically detect infant skills during daily routines (e.g., mealtime, playtime, desk activities). The OPISCoS form helps speech therapists to provide parents support to better perceive and understand early communicative signals from their children, avoiding the risk of excessive or reduced social stimulation.

Methods

The OPISCoS form is composed of three sections, namely, "Pragmatics and Communication," "Decoding," and "Expression," which are useful to delineate the communication abilities of children with NDD and are not tapped by traditional batteries. Vignettes from clinical practice illustrate and provide exemplifications for using the OPISCoS form with NDD infants and their parents.

Results

The OPISCoS form was reported for two children and showed potential in detecting disrupted communicative behaviors and planning specific early interventions. Further, we observed an improvement not only in children's communicative abilities improve but also in their interactions with parents. From a clinical point of view, the OPISCoS form (1) offers an observational perspective of prelinguistic intersubjective and socio-communicative skills in infants with NDD and (2) may be useful to practitioners to enhance parents' sensitivity to their infants' communicative behavior.

Conclusion

The OPISCoS form was developed in clinical practice and is based on a very preliminary description of a new observational procedure as integration for the assessment of NDD children. The OPISCoS form appears to be a useful tool for the clinical assessment of prelinguistic intersubjective and socio-communicative skills in NDD infants as well as for promoting the quality of early parenting.

Relations between bedtime parenting behaviors and temperament across 14 cultures

Objectives

The present study examined parental sleep-supporting practices during toddlerhood in relation to temperament across 14 cultures. We hypothesized that passive sleep-supporting techniques (e.g., talking, cuddling), but not active techniques (e.g., walking, doing an activity together), would be associated with less challenging temperament profiles: higher Surgency (SUR) and Effortful Control (EC) and lower Negative Emotionality (NE), with fine-grained dimensions exhibiting relationships consistent with their overarching factors (e.g., parallel passive sleep-supporting approach effects for dimensions of NE).

Methods

Caregivers (N = 841) across 14 cultures (M = 61 families per site) reported toddler (between 17 and 40 months of age; 52% male) temperament and sleep-supporting activities. Utilizing linear multilevel regression models and group-mean centering procedures, we assessed the role of between- and within-cultural variance in sleep-supporting practices in relation to temperament.

Results

Both within-and between-culture differences in passive sleep-supporting techniques were associated with temperament attributes, (e.g., lower NE at the between-culture level; higher within-culture EC). For active techniques only within-culture effects were significant (e.g., demonstrating a positive association with NE). Adding sleep-supporting behaviors to the regression models accounted for significantly more between-culture temperament variance than child age and gender alone.

Conclusion

Hypotheses were largely supported. Findings suggest parental sleep practices could be potential targets for interventions to mitigate risk posed by challenging temperament profiles (e.g., reducing active techniques that are associated with greater distress proneness and NE).

Tactile Biography Questionnaire: A contribution to its validation in an Italian sample

As the interest in the beneficial effects of positive touch experiences is rapidly growing, having reliable and valid tools to its assessment is essential. The Tactile Biography Questionnaire (TBQ) allows to quantify individual differences in affective touch experiences throughout life. The aim of this article is to present a contribution to its validation in the Italian population. Data analysis were run on a sample of 2040 Italian individuals (Females = 1342, 64%) participating in an on-line survey. Confirmatory Factor Analysis and invariance analyses for gender were applied. Concurrent validity was checked using two specific subscales of the Touch Avoidance Questionnaire (TAQ—i.e., Family and Stranger). The four-dimensional structure of the TBQ was confirmed in the overall sample and by gender. Also, the TBQ showed an excellent internal consistency and a good concurrent validity with TAQ. The present study suggests that the TBQ can be used to support healthcare professionals and researchers to assess experiences of affective touch in different settings.

Serotonin transporter gene methylation and emotional regulation in preschool children born preterm: A longitudinal evaluation of the role of negative emotionality in infancy

The aim of the study was to assess the contribution of negative emotionality at 3 months (T1) and serotonin transporter gene (SLC6A4) DNA methylation at 4.5 years of age (T2) to emotion regulation in pre-schoolers born very preterm and full-term. Forty one children (n = 21 born very preterm, n = 20 born full-term) participated in the study. Fretful behavior was assessed at T1 in response to the Face-to-FaceStill-Face (FFSF) paradigm. At T2, SLC6A4 DNA methylation was analyzed and emotion regulation was assessed using an observational procedure (i.e., the Pre-schooler Regulation of Emotional Stress, PRES). The very preterm group displayed higher emotion dysregulation during the PRES Reactivity phase than the full-term group. Higher levels of fretful behavior at 3 months were associated with greater emotional distress only for very preterm children with higher methylation at T2. No significant associations emerged in the full-term group. Despite current findings cannot be generalized owing to the relatively small sample size, this work provides preliminary longitudinal evidence about the link between negative emotionality during infancy, stress-linked epigenetic status at 4.5 years and emotion dysregulation in preschoolers born preterm.

Air pollution and neurodevelopmental skills in preschool- and school-aged children: A systematic review

Early life exposure to air pollution has been associated with neurodevelopmental disorders. Emerging evidence are highlighting a possible impact of air pollution on typically developing children. Thirty papers were included in this review to systematically evaluate the association between air pollutants exposure in prenatal and/or postnatal periods and specific neurodevelopmental skills (i.e. intellective functioning, memory and learning, attention and executive functions, verbal language, numeric ability and motor and/or sensorimotor functions) in preschool- and school-age children. Detrimental effects of air pollutants on children's neurodevelopmental skills were observed, although they do not show clinically relevant performance deficits. The most affected domains were global intellective functioning and attention/executive functions. The pollutants that seem to represent the greatest risk are PM2.5, NO₂ and PAHs. Prenatal exposure is primarily associated with child neurodevelopment at pre-school and school ages. Early exposure to air pollutants is related to adverse neurodevelopmental outcomes in the general population of children. Further research is needed to support stronger conclusions.

The role of maternal touch in the association between SLC6A4 methylation and stress response in very preterm infants

Very preterm (VPT) infants requiring hospitalization in the Neonatal Intensive Care Unit (NICU) are exposed to several stressful procedural experiences. One consequence of NICU-related stress is a birth-to-discharge increased serotonin transporter gene (SLC6A4) methylation that has been associated with poorer stress regulation at 3 months of age. Maternal touch is thought to support infants' stress response, but its role in moderating the effects of SLC6A4 methylation changes is unknown. The aim of this study was to assess the role of maternal touch in moderating the association between increased SLC6A4 methylation and stress response in 3-month-old VPT infants. Twenty-nine dyads were enrolled and at 3 months (age corrected for prematurity), participated in the Face-to-Face Still-Face paradigm to measure infants' stress response (i.e., negative emotionality) and the amount of maternal touch (i.e., dynamic and static). Results showed that low level of maternal touch is associated with high level of negative emotionality during social stress. Furthermore, during NICU stay SLC6A4 methylation in VPT exposed to low level of maternal touch at 3 months was associated with increased negative emotionality. Thus, low levels of maternal static touch can intensify the negative effects of SLC6A4 epigenetic changes on stress response in 3-month-old VPT infants.

Exploring the Contribution of Proximal Family Risk Factors on SLC6A4 DNA Methylation in Children with a History of Maltreatment: A Preliminary Study

The cumulative effects of proximal family risk factors have been associated with a high number of adverse outcomes in childhood maltreatment, and DNA methylation of the serotonin transporter gene (SLC6A4) has been associated with child maltreatment. However, the relationships between proximal family risk factors and SLC6A4 methylation remains unexplored. We examined the association among cumulative family risk factors, maltreatment experiences and DNA methylation in the SLC6A4 gene in a sample of 33 child victims of maltreatment. We computed a cumulative family risk (CFR) index that included proximal family risk factors, such as drug or alcohol abuse, psychopathology, parents’ experiences of maltreatment/abuse in childhood, criminal history, and domestic violence. The majority of children (90.9%) experienced more than one type of maltreatment. Hierarchical regression models suggested that the higher the CFR index score and the number of maltreatment experiences, and the older the children, the higher the SLC6A4 DNA methylation levels. Although preliminary, our findings suggest that, along with childhood maltreatment experiences per se, cumulative proximal family risk factors are seemingly critically associated with DNA methylation at the SLC6A4 gene.

Stress symptoms and resilience factors in children with neurodevelopmental disabilities and their parents during the COVID-19 pandemic

OBJECTIVE

This study examined the impact of the coronavirus disease 2019 (COVID-19) pandemic in Italy by specifically looking at the psychosocial response of children/adolescents with neurodevelopmental disabilities (NDD) and their parents, and explored which factors could potentially contribute to increasing or mitigating stress-related behaviors in children/adolescents as well as their parents' stress.

METHOD

An online anonymous survey was designed to investigate family demographic characteristics, COVID-19 outbreak and restriction-related variables, children/adolescents' behavioral regulation problems, parental stress, and resilience. Data were collected from 1,472 parents (83.1% mothers) of 1632 NDD children/adolescents (33.7% females).

RESULTS

Compared to pre-emergency, parents reported a significant increase in their children's behavioral regulation problems: Anxious/depressed behavior, Attention problems, and Aggressive behavior (p < .001), and they reported feeling more Overwhelmed and Burdened (p < .001) as parents but less Unfulfilled, Numbness, Devastated, and Angry (p < .001). A hierarchical stepwise regression analysis revealed that both behavioral regulation problems in NDD children/adolescents and parental stress are-at least partially-buffered by resilience factors in parents (Perception of self, Planned future, Family cohesion).

CONCLUSIONS

Results showed that behavioral regulation problems in children/adolescents with NDD and parental stress increased. However, parental resilience can act as a protective factor, counterbalancing parental difficulties in the care of their NDD children during the emergency. Identifying risk and protective factors impacting the psychosocial response ofchildren/adolescents with NDD and their parents is essential to implement appropriate support interventions both for parents and children/adolescents with NDD during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cultural contributors to negative emotionality: A multilevel analysis from the Joint Effort Toddler Temperament Consortium

This study advances the cross-cultural temperament literature by comparing temperament ratings of toddlers from 14 nations. Multilevel modeling (MLM) procedures were utilized to regress negative emotionality (NE) and component subscales on Hofstede’s cultural value dimensions while controlling for age and gender. More individualistic values were associated with lower NE, and component discomfort, fear, motor activity, perceptual sensitivity, and soothability scales. The discomfort subscale was negatively associated with power distance and positively associated with masculine cultural values. Higher ratings of shyness were related to a more long-term cultural orientation. Results illustrate the feasibility of an MLM approach to cross-cultural research and provide a new perspective on the intersection of culture and temperament development. Limitations and future implications are discussed.

Neuroimaging and DNA Methylation: An Innovative Approach to Study the Effects of Early Life Stress on Developmental Plasticity

DNA methylation plays a key role in neural cell fate and provides a molecular link between early life stress and later-life behavioral phenotypes. Here, studies that combine neuroimaging methods and DNA methylation analysis in pediatric population with a history of adverse experiences were systematically reviewed focusing on: targeted genes and neural correlates; statistical models used to examine the link between DNA methylation and neuroimaging data also considering early life stress and behavioral outcomes. We identified 8 studies that report associations between DNA methylation and brain structure/functions in infants, school age children and adolescents faced with early life stress condition (e.g., preterm birth, childhood maltreatment, low socioeconomic status, and less-than optimal caregiving). Results showed that several genes were investigated (e.g., OXTR, SLC6A4, FKBP5, and BDNF) and different neuroimaging techniques were performed (MRI and f-NIRS). Statistical model used ranged from correlational to more complex moderated mediation models. Most of the studies (n = 5) considered DNA methylation and neural correlates as mediators in the relationship between early life stress and behavioral phenotypes. Understanding what role DNA methylation and neural correlates play in interaction with early life stress and behavioral outcomes is crucial to promote theory-driven studies as the future direction of this research fields.

Mother-Infant Interaction Kinect Analysis (MIIKA): An automatic kinematic-based methodology for the investigation of interpersonal distance during early exchanges

Interpersonal distance is a core aspect of mother-child interaction. While conventional measures based on human coders do not fully capture the dynamics of this feature, computational methods provide automatic measures which can detect even small changes and more accurate estimates both spatially and temporally. Using RGB-D sensors (Microsoft Kinect V2), the present study describes a setup to automatically examine interpersonal distance during mother-child interactions, termed Mother-Infant Interaction Kinect Analysis (MIIKA). First, the laboratory setting and the data extraction method are described. By using an ad-hoc algorithm for kinematic data extraction, MIIKA returns three metrics: barycenter position (distance and velocity of approach and separation), movements (number of small, medium and large approaches and separations) and contributions (proportional contributions of mother and child to approaches and separations). Secondly, preliminary MIIKA metrics are described for a non-clinical mother-child dyad as an exemplification of the protocol. As interpersonal distance can be affected by contingent situations, we detected mother-infant full skeleton during three interactional contexts characterized by different kinds of dyadic exchanges: a free play session, a task-oriented activity and an emotionally arousing condition. Results highlighted similarities and differences between the three interactional contexts. MIIKA appears to be a promising setup to automatically examine interpersonal distance in early mother-child interactions.

Links between television exposure and toddler dysregulation: Does culture matter?

Television exposure in early childhood has increased, with concerns raised regarding adverse effects on social-emotional development, and emerging self-regulation in particular. The present study addressed television exposure (i.e., amount of time watching TV) and its associations with toddler behavioral/emotional dysregulation, examining potential differences across 14 cultures. The sample consisted of an average of 60 toddlers from each of the 14 countries from the Joint Effort Toddler Temperament Consortium (JETTC; Gartstein & Putnam, 2018). Analyses were conducted relying on the multi-level modeling framework (MLM), accounting for between- and within-culture variability, and examining the extent to which TV exposure contributions were universal vs. variable across sites. Effects of time watching TV were evaluated in relation to temperament reactivity and regulation, as well as measures of emotional reactivity, attention difficulties, and aggression. Results indicated that more time spent watching TV was associated with higher ratings on Negative Emotionality, emotional reactivity, aggression, and attention problems, as well as lower levels of soothability. However, links between TV exposure and both attention problems and soothability varied significantly between cultures. Taken together, results demonstrate that increased time spent watching television was generally associated with dysregulation, although effects were not consistently uniform, but rather varied as a function of culturally-dependent contextual factors.

Attachment-related dimensions in the epigenetic era: A systematic review of the human research

In recent years, an increasing number of studies documented potential links between parental care and epigenetic mechanisms. The present systematic review focuses on the potential association and interrelationship between attachment-related dimensions and DNA methylation in human studies. We performed a literature review using electronic databases such as PubMed, Scopus, Web of Science, and EBSCOhost. Thirteen papers were included in the review. Findings support significant associations between attachment-related dimensions and epigenetic status in studies which considered different populations, age ranges, attachment measures and peripheral tissues. Although research in this area is still under investigation, available results suggest that DNA methylation associated with attachment-related dimensions might affect the development of stress regulation system and social-emotional capacities, thus contributing to the emerging phenotypic outcomes. However, identifying mediator and moderator effects in the interrelationship between these parameters was problematic owing to heterogeneous methodologies. Finally, we discuss clinical implications, unanswered questions, and future directions for human development in epigenetics research.

Barriers and Facilitators to Conducting Kangaroo Mother Care in Italian Neonatal Intensive Care Units

PURPOSE

This work aimed to investigate obstacles and facilitators for carrying out Kangaroo Mother Care (KMC) across Italian NICUs.

DESIGN AND METHODS

A survey that investigated Unit's characteristics, policies toward parents and KMC practice and policies was carried out. Data from 86 NICUs (80.4%) was collected. Descriptive statistics and Multiple Regression Models were computed.

RESULTS

Eighty-one NICUs provided KMC. These NICUs had a less restricted parental access policies (chi² = 7.373, p = .007). More than the 70% of the units did not have adequate facilities for parents. KMC daily length was positively predicted (R² = 0.18, F = 7.91, p = .001) by repeated sessions and documentation of KMC.

CONCLUSION

The implementation of KMC is characterized by different barriers and facilitators that determine the parent's possibility to provide KMC. Structural factors (e.g., adequate space and facilities) can support families in providing KMC. A unique result of this survey is that KMC documentation on medical records appears critical for improving its practice.

PRACTICE IMPLICATIONS

Although most of the Italian units provide KMC as a routine practice, improving its practical support would be beneficial to its implementation. A more formalized approach to KMC may strengthen staff habits to consider KMC like a standard care treatment.

Early parenting intervention promotes 24-month psychomotor development in preterm children

AIM

Although parenting is key to promoting healthy development of at-risk preterm infants, parents have often restricted access to neonatal intensive care units (NICUs). This study aimed to assess the effect of an early parenting intervention on the psychomotor outcome in preterm children at 24 months of corrected age.

METHODS

Forty-two preterm children and their parents were consecutively recruited at a level III NICU in Northern Italy and randomly allocated to early intervention (two educational peer-group sessions and four individual infant observation sessions) or care as usual (no educational or infant observation sessions). During NICU stay, parents provided information on daily holding and skin-to-skin. Psychomotor development was measured at 24 months of corrected age using the Griffith Mental Development Scales.

RESULTS

There were no significant differences in socio-demographic and clinical variables between early intervention (n = 21; 13 females) and care as usual (n = 21; 12 females) groups. At 24 months of corrected age, children in the early intervention arm had greater scores for global psychomotor development as well as for Hearing-Speech and Personal-Social sub-scales, compared to those in the care as usual group.

CONCLUSION

The present NICU parenting intervention was found to be associated with better psychomotor outcomes in preterm children at 24-month age. The effects were especially evident for domains related to language and socio-emotional functioning. Results are promising and should be retested with more heterogeneous and representative preterm sample.

Sculpting Culture: Early Maternal Responsiveness and Child Emotion Regulation – A UK-Italy Comparison

Mother-infant interactions, including culturally specific features, have been found to predict child socio-emotional development (e.g., social communication and emotion regulation (ER)). However, research is lacking on the specific processes involved. We used a cross-cultural, longitudinal design, and a microanalytic coding approach to address this issue. Fifty-two mother-infant dyads were recruited from the UK ( N = 21) and Italy ( N = 31), representing Northern European and Mediterranean cultures, respectively. While these cultures share core features of parent-child relationships, their values about emotional expressiveness differ. We observed face-to-face mother-infant interactions at 2 months (T1), and coded infant socio-emotional behavior and maternal responses. Children were seen again at 2 years (T2), when their ER in the face of frustration, using the Barrier Task, was assessed, and the occurrence of different “mature” strategies (communicative and autonomous) coded. Results revealed common features of interactions at T1 (infant socio-emotional expressions, and maternal positive responses), but also cultural variation in the frequency of different infant cues (more pre-speech in UK infants, more smiles in Italians), and of maternal responses to them. While greater overall maternal responsiveness at T1 predicted more mature ER in general at T2, cultural differences in early responsiveness to specific infant behaviors predicted later group differences in children’s use of particular ER strategies, with UK children using more communicative strategies, and Italians more autonomous. Findings indicate that positive maternal behaviors that are common across cultures (e.g., responsiveness) promote overall successful child emotion regulation, while culturally specific features of interactions are associated with how child socio-emotional outcomes are expressed.

Early Parenting Intervention - Biobehavioral Outcomes in infants with Neurodevelopmental Disabilities (EPI-BOND): study protocol for an Italian multicentre randomised controlled trial

INTRODUCTION

Neurodevelopmental disability (ND) represents an adverse condition for infants' socio-emotional and behavioural development as well as for caregiving (eg, parental sensitivity) and mother-infant interaction. Adverse exposures are associated with altered neuroendocrine hormones concentrations (eg, oxytocin and cortisol) and epigenetic regulation (eg, methylation of stress-related genes), which in turn may contribute to less-than-optimal mother-infant interaction. Parental sensitivity is a protective factor for childrens' development and early parental interventions (eg, video-feedback intervention) can promote parental caregiving and better developmental outcomes in children. The present multi-centric and longitudinal randomised controlled trial aims to assess if and to which extent early VFI could benefit both infants and mothers in terms of behavioural outcomes as well as neuroendocrine and epigenetic regulation.

METHODS AND ANALYSIS

Dyads will be randomly assigned to the video-feedback Intervention Group or Control Group ('dummy' intervention: telephone calls). Infants with ND aged 3 to 18 months will be recruited from three major child neuropsychiatric units in northern Italy. A multi-layer approach to intervention effects will include videotapes of mother-infant interaction, maternal reports as well as saliva samples for hormones concentrations and target-gene methylation analysis (eg, BDNF, NR3C1, OXTR and SCL6A4) that will be obtained at each of the four assessment sessions: T₀, baseline; T₁, post-intervention; T₂, short-term follow-up (3 month); T₃, long-term follow-up (6 month). Primary effectiveness measures will be infant socio-emotional behaviour and maternal sensitivity. Neuroendocrine hormones concentrations and DNA methylation status of target genes will be secondary outcomes. Feasibility, moderation and confounding variables will be measured and controlled between the two groups.

ETHICS AND DISSEMINATION

Ethics approval has been obtained in all three participating units. Results of the main trial and each of the secondary endpoints will be submitted for publication in peer-reviewed journals and international conferences.

TRIAL REGISTRATION NUMBER

NCT03853564; Pre-results.

Evidence and Open Questions for the Use of Video-Feedback Interventions With Parents of Children With Neurodevelopmental Disabilities

The Video-Feedback Intervention (VFI) is a technique aimed at promoting positive parenting that has been found to be supportive of child development and parent-child interaction in different at-risk and clinical populations. The application of VFI with parents of children with neurodevelopmental disabilities (ND; e.g., cerebral palsy, sensory and/or psychomotor delay, and genetic syndromes) is growing. Nonetheless, no systematic review is currently available documenting whether this type of intervention improves children's developmental outcomes (e.g., behavioral stability and cognitive abilities), parental caregiving skills (e.g., responsive parenting), and parental emotional well-being (e.g., depressive symptomatology). In the present mini-review, 212 VFI records were retrieved from three databases (i.e., PubMed, Scopus, and Web of Science), and 10 papers were finally included. Abstracted information included age, diagnosis, methodological aspects (timing, setting, and themes), and child/parent outcomes. Significant improvements from pre- to post-VFI were observed in all studies. Specifically, the VFIs were significantly associated with better children developmental outcomes and parental caregiving skills. Inconsistent findings emerged for the VFI effects on parental emotional well-being. Overall, the current mini-review supports the potential effectiveness of parent-focused VFI interventions for parents of children with ND, despite the presence of open questions that need to be addressed in future clinical trials.

Pain-related increase in serotonin transporter gene methylation associates with emotional regulation in 4.5-year-old preterm-born children

AIM

The main goal of this study was to assess the association between pain-related increase in serotonin transporter gene (SLC6A4) methylation and emotional dysregulation in 4.5-year-old preterm children compared with full-term matched counterparts.

METHODS

Preterm (n = 29) and full-term (n = 26) children recruited from two Italian hospitals were followed-up from October 2011 to December 2017. SLC6A4 methylation was assessed from cord blood at birth from both groups and peripheral blood at discharge for preterm ones. At 4.5 years, emotional regulation (ie, anger, fear and sadness) was assessed through an observational standardised procedure.

RESULTS

Preterm children (18 females; mean age = 4.5, range = 4.3-4.8) showed greater anger display compared with full-term controls (14 females; mean age = 4.5, range = 4.4-4.9) in response to emotional stress. Controlling for adverse life events occurrence from discharge to 4.5 years and SLC6A4 methylation at birth, CpG-specific SLC6A4 methylation in the neonatal period was predictive of greater anger display in preterm children but not in full-term ones.

CONCLUSION

These findings contribute to highlight how epigenetic regulation of serotonin transporter gene in response to NICU pain exposure contributes to long-lasting programming of anger regulation in preterm children.

The body comes first. Embodied reparation and the co-creation of infant bodily-self

During infancy relational experiences of body-to-body exchanges (i.e., embodied interactions) contribute to the infant's bodily perception. Early embodied interactions are based on countless multimodal reciprocal exchanges, in which mother and infant contribute to interpersonal rhythmic cycles of co-regulation (i.e., attunement). However, it remains unclear how infants and their mothers actually accomplish attunement in their exchanges. Interactions between mothers and their infants typically fluctuate between attuned and misattuned states and recovery attunement states by a process called 'reparation'. Here, we discuss recent neuroscientific evidence that provides insight into the mechanisms underpinning the concepts of attunement and misattunement in early embodied interactions. We propose that a process of embodied reparation might be achieved within the dyad through tactile contact behaviors (e.g., skin-to-skin, affectionate touch) and maternal interoceptive sensitivity (i.e., ability to perceive internal input about the state of one's own body). We describe how these elements that mothers provide during embodied interactions with their infants, might contribute not only to bodily attunement, but also to co-create the infant bodily-self.

Understanding the role and function of maternal touch in children with neurodevelopmental disabilities

During the first years of life, maternal touch can serve different functions including facilitation of child's gaze orientation to faces which is a key precursor for social attention. Although children with neurodevelopmental disability (ND) may have reduced social skills, the role of maternal touch in contributing to gaze orientation to maternal face has not been explored in previous research. In the present study, we investigate the functions of maternal touch in dyads of mothers and children with ND, compared to dyads of children with typical development (TD). Micro-analytic 2-s coding of maternal touch (i.e., affectionate, playful, facilitating, holding, no touch) and children's gaze orientation (i.e., mother-oriented, object-oriented, non-oriented) occurred during 5-minute interactions between mothers and their 12-to-24-month-old ND and TD children. Dyads were paired for children chronological age and sex. Mothers of children with ND used more touch - especially facilitating and holding types -, compared to mothers of TD peers. Children with ND exhibited more non-orientated gaze compared to TD counterparts. Playful touch associated with increased mother-oriented gaze in children with ND, whereas affectionate and holding touch associated with greater mother-oriented gaze in TD children. Findings suggest that specific types of touch support children's attention to social partners.

Does preterm birth affect child temperament? A meta-analytic study

The present meta-analytic study was conducted to examine differences in temperament between preterm and full-term children, considering behavior style and psychobiological approaches. Moreover, we explored the potential moderators of the associations between prematurity and temperament. A systematic literature search was performed on PubMed, Scopus, Web of Science, and CINAHL. Twenty-two studies were analyzed. Preterm children showed a higher Activity level as well as lower Attentional Focusing and Attention Span/Persistence, in comparison with their full-term counterparts. Extremely preterm children showed a higher Activity level than other preterm levels. These findings support the conclusion that preterm children present with a less regulated temperament relative to those born full term.

Exploring the EEG mu rhythm associated with observation and execution of a goal-directed action in 14-month-old preterm infants

Electroencephalographic mu rhythm desynchronization is thought to reflect Mirror Neuron System (MNS) activity and represents an important neural correlate of the coupling between action execution and perception. It is still unclear if the MNS in human ontogeny is already available at the beginning of postnatal life and how early experience impacts its development. Premature birth provides a "natural condition" for investigating the effects of early, atypical extra-uterine experience on MNS. The main aim of the present study was to investigate whether the MNS activity is associated with prematurity. We compared the mu rhythm activity in preterm (PT) and full-term (FT) 14-month old infants during an action observation/execution (AO/AE) task. Mu rhythm desynchronization was computed over frontal, central, parietal and occipital regions. Both groups showed mu rhythm suppression in all the scalp regions during action execution. Different desynchronization patterns emerged during action observation. Specifically, FT infants showed mu suppression in the right frontal, bilateral parietal and occipital regions; whereas PT infants exhibited mu suppression only in the right parietal region. Overall, these preliminary findings indicate that an atypical extra uterine experience might have an impact on the MNS activity.

The dual nature of hypothalamic-pituitary-adrenal axis regulation in dyads of very preterm infants and their mothers

The co-regulation of the hypothalamic-pituitary-adrenal (HPA) axis in mother-infant dyads is thought to be key for infant and child development. Nonetheless, previous literature presents some inconsistencies that might at least partially be due to the presence of risk conditions and the use of different statistical approaches to measure HPA axis co-regulation. Very preterm (VPT) birth represents one of these risk conditions as the early foundation of mother-infant interaction is disrupted. Both VPT infants and their mothers present evidence of altered HPA axis regulation. Nonetheless, the comparison of mother-infant HPA axis co-regulation in VPT infants compared to full-term (FT) ones has not been previously investigated. In this study, 3-month-old (corrected age) VPT infants and FT counterparts with their mothers took part in a well-validated stress-inducing laboratory task (i.e., double Face-to-Face Still-Face, FFSF paradigm). Salivary cortisol samples were obtained before (Baseline) and after (Early reactivity, Late reactivity and Recovery) the FFSF procedure. Dyadic HPA axis co-regulation was assessed at each sample time-point (i.e., in-moment coupling) as well as across samples (i.e., in-time synchrony). Significant in-moment coupling emerged at Baseline, Late reactivity and Recovery for FT infants' dyads only. An overlying pattern of salivary cortisol trajectories emerged between mothers and infants in the VPT group, whereas a more complex pattern of reciprocal and complementary co-regulation was found for FT infants' dyads. Although both groups gave evidence of HPA axis co-regulation, dyads of VPT infants appear to be less able to adapt reciprocally and dynamically to stressful conditions. These findings suggest that multiple approaches to account for dyadic HPA axis co-regulation should be used in order to depict the complex pattern of biological rhythms coordination in mother-infant dyads.

Telomere length and salivary cortisol stress reactivity in very preterm infants

During the Neonatal Intensive Care Unit (NICU) stay, very preterm (VPT) infants are exposed to life-saving yet pain-inducing skin-breaking procedures (i.e., NICU pain-related stress) which contribute to the programming of hypo-responsive HPA axis development during the first months of life. Unfortunately, to date the mechanisms linking NICU pain-related stress and altered HPA axis regulation are only limitedly known. Telomere length (TL) regulation is an epigenetic mechanism previously shown to be affected by early stress exposures and capable of associating with HPA axis reactivity in children. In VPT infants, NICU pain-related stress was found to associate with decreased TL from birth to discharge, but there is no evidence for the association between TL and HPA axis in these infants. In this study, we prospectively examined the relationship between NICU pain-related stress and HPA axis reactivity to an age-appropriate socio-emotional condition (i.e., the Still-Face Procedure, SFP) in healthy VPT infants at 3-month corrected age. NICU pain-related stress was computed as the ratio between the number of skin-breaking procedures and length of NICU stay. A differential score (i.e., ∆TL) was obtained subtracting TL at birth from TL at discharge. A normalized (log10) cortisol reactivity index (CRI) was obtained by averaging post-stress (20 min after SFP) salivary cortisol sample on baseline value. A regression model controlling for neonatal and socio-demographic confounders showed that ∆TL was the only significant predictor of CRI. Although preliminary, these findings contribute to our knowledge of the mechanisms linking early exposures to adversity and later in life regulation of the HPA axis in VPT infants.

Methodological Challenges in Developmental Human Behavioral Epigenetics: Insights Into Study Design

Developmental human behavioral epigenetics (DHBE) holds potential for contributing to better understanding of how early life exposures contribute to human developmental trajectories and to inform clinical practice and early interventions. Nonetheless, DHBE research to date is challenged by two major issues: (a) the frequent use of retrospective study designs; and (b) the major focus on epigenetic variations associated with early life adversities, rather than protective care exposures. In order for DHBE research to maintain its promises, these issues need to be addressed in a systematic way according to a careful methodological planning of study design. In this contribution, we provide pragmatic insights on methodological aspects that should be dealt with while designing DHBE studies. We propose different study designs for the retrospective and prospective investigation of both adversity- and care-related epigenetic variations. Examples from available scientific literature are provided to better describe the advantages and the limitations of each study design.

Maternal sensitivity is associated with configural processing of infant's cues in preterm and full-term mothers

BACKGROUND

Prematurity may affect mother-infant bonding and alter maternal sensitivity to infant's cues. Efficient perception of infants' facial and bodily cues is a crucial aspect of maternal sensitivity and may be challenged by prematurity, as infants' signals may not be easily intelligible. However, it is still unexplored how premature birth impacts the maternal ability to perceive infants' signals.

AIMS

To investigate whether prematurity influences the perceptual sensitivity of mothers to infants' cues and, in particular, the configural processing of the faces and bodies of familiar and unfamiliar infants.

STUDY DESIGN

The inversion effect paradigm was used to evaluate the configural vs. detail-based processing of the face and body of own or others' infants. Preterm mothers were compared to full-term mothers with either low or high maternal sensitivity.

PARTICIPANTS

Forty-three healthy full-term and twenty-one preterm mothers of infants aged about six months.

OUTCOME MEASURES

Maternal sensitivity during dyadic interaction, gestational age, accuracy and reaction time in a delayed matching-to-sample task of upright vs. inverted body and face stimuli (i.e., inversion effect).

RESULTS

Preterm mothers were found to be less sensitive than the full-term ones. Higher maternal sensitivity during dyadic interaction was associated with lower inversion effect for unfamiliar as compared to own infants' bodies. However, preterm mothers and full-term mothers with low sensitivity showed comparable inversion effect in perceiving unfamiliar infants' faces or bodies.

CONCLUSIONS

Preterm birth per se does not directly affect body configural processing, but it may be associated to reduced maternal sensitivity, ultimately leading to a less refined perception of own infant's cues.

Very preterm birth is associated with PLAGL1 gene hypomethylation at birth and discharge

AIM

Recent findings show that DNA methylation is susceptible to very preterm (VPT) birth and to the experience of the early stay in the neonatal intensive care unit. The aim of the study was to compare PLAGL1 methylation between VPT and full-term (FT) infants at birth as well as between VPT infants at discharge and FT infants at birth.

METHODS

DNA was collected from cord blood of 56 VPT and 27 FT infants at birth and from peripheral blood in VPT infants at neonatal intensive care unit discharge. Sociodemographic and neonatal variables were considered.

RESULTS

PLAGL1 methylation at birth and at discharge were highly correlated in VPT infants. Lower methylation emerged in VPT infants at birth and discharge compared to FT counterparts.

CONCLUSION

PLAGL1 hypomethylation emerged as a potential epigenetic mark of VPT birth. Future research is warranted to assess the functional consequences of PLAGL1 diminished methylation in VPT infants' development.

NICU Network Neurobehavioral Scale: 1-month normative data and variation from birth to 1 month

BackgroundThe Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is a standardized method for infant neurobehavioral assessment. Normative values are available for newborns, but the NNNS is not always feasible at birth. Unfortunately, 1-month NNNS normative data are lacking.AimsTo provide normative data for the NNNS examination at 1 month and to assess birth-to-one-month changes in NNNS summary scores.Study designThe NNNS was administered at birth and at 1 month within a longitudinal prospective study design.SubjectsA cohort of 99 clinically healthy full-term infants were recruited from a well-child nursery.Outcome measuresBirth-to-1-month NNNS variations were evaluated and the association of neonatal and sociodemographic variables with the rate of change of NNNS summary scores were investigated.Results and conclusionsNNNS scores from the 10th to the 90th percentile represent a range of normative performance at 1 month. A complex pattern of stability and change emerged comparing NNNS summary scores from birth to 1 month. Orienting, Regulation, and Quality of movements significantly increased, whereas Lethargy and Hypotonicity significantly decreased. Birth-to-1-month changes in NNNS performance suggest improvements in neurobehavioral organization. These data are useful for research purposes and for clinical evaluation of neurobehavioral performance in both healthy and at-risk 1-month-old infants.

The Face-to-Face Still-Face (FFSF) Paradigm in Clinical Settings: Socio-Emotional Regulation Assessment and Parental Support With Infants With Neurodevelopmental Disabilities

Background: The Face-to-Face Still-Face (FFSF) paradigm is a well-acknowledged procedure to assess socio-emotional regulation in healthy and at-risk infants. Although it was developed mainly for research purposes, the FFSF paradigm has potential clinical implications for the assessment of socio-emotional regulation of infants with neurodevelopmental disabilities (ND) and to supporting parenting. Aim: The present paper describes the application of the FFSF paradigm as an evaluation and intervention tool in clinical practice with infants with ND and their parents. Methods: Theoretical and methodological insights for the use of the FFSF paradigm in the clinical setting are provided. Single-case vignettes from clinical practice further illustrate and provide exemplifications for the use of the FFSF with infants with ND and their parents. Results: From a clinical point of view, the use of the FFSF paradigm (1) offers a unique observational perspective on socio-emotional regulation in infants with ND and (2) enhances parents' sensitivity to their infants' behavior. Discussion: The FFSF paradigm appears to be a useful tool for clinical assessment of socio-emotional regulation in infants with ND and promote the quality of parenting and early parent-infant interaction.

Do mothers sound good? A systematic review of the effects of maternal voice exposure on preterm infants' development

Preterm infants are hospitalized in the Neonatal Intensive Care Unit (NICU) and are precociously separated from their mothers. Although developmental care interventions are meant to facilitate mother-infant bonding, physical contact is not always possible. Maternal voice exposure has been proposed as a way to foster maternal closeness and support postnatal bonding. Here we present a systematic review on maternal voice effects on preterm infants' development. Literature search occurred on 4 databases (PubMed, Scopus, Web of Science and CINAHL). Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines have been adopted and standardized quality appraisal has been carried on. Wide differences emerged in infants' characteristics and maternal voice exposure methods. Inconsistency emerged for physiological outcomes (e.g., heart rate variability, oxygen saturation, number of critical alarm events), whereas a robust pattern of findings emerged for feeding behaviors, as well as cognitive and neurobehavioral development. Maternal voice appears to be a non-noxious intervention, which is consistent with developmental care and which can be embedded in developmental care strategies.

Pain exposure associates with telomere length erosion in very preterm infants

Very preterm (VPT) infants (gestational age < 32 weeks) require long-lasting hospitalization in the Neonatal Intensive Care Unit (NICU), even in absence of severe morbidities. During NICU stay, life-saving interventions occur and include invasive and painful skin-breaking procedures (NICU-related stress), which constitute a major early adverse experience for VPT infants. Telomeres are repeat-sequence at the end of chromosomes, which shorten with age and are highly susceptible to life adversities: the exposure to early adverse experiences is associated with shorter telomere length (TL). Nonetheless, previous research did not assess longitudinally the association between NICU-related stress and TL in VPT infants. In the present study, leukocyte TL was assessed from cord blood at birth in 46 VPT infants and in a group of 31 full-term (FT) infants, as well as at NICU discharge in VPTs only. NICU-related stress was measured as the number of skin-breaking procedures occurring throughout the NICU stay. A significant difference emerged for TL between VPT infants and FT counterparts at birth. TL decreased from birth to discharge in VPT infants, although the change was not significant in the group as a whole. The amount of NICU-related stress emerged as the primary predictor of TL erosion in VPT infants, even controlling for neonatal and clinical confounders. Furthermore, VPT infants exposed to high NICU-related stress exhibited a marked and significant decrease in TL, whereas VPT exposed to low NICU-related stress exhibited a non-significant increase. The present study confirms previous evidence of longer telomeres in VPT infants at birth compared to FT controls. Moreover, NICU-related stress emerged as a key regulator of TL erosion from birth to discharge in VPT infants. Future research is warranted to further explore TL erosion in VPT infants and the factors associated with individual differences in NICU-related stress susceptibility at the epigenetic level.

Developmental care, neonatal behavior and postnatal maternal depressive symptomatology predict internalizing problems at 18 months for very preterm children

OBJECTIVE

To provide a prospective developmental model for behavioral outcomes in preterm infants in relation to developmental care (DC) practices and postnatal maternal depression.

STUDY DESIGN

A longitudinal, multicenter, follow-up study conducted in 25 Italian tertiary neonatal intensive care units (NICUs). Participants were 162 healthy very preterm infants and their mothers. The level of quality of DC was assessed for each hospital. Infant's neurobehavioral profile was evaluated twice: at discharge (T1) and at 18 months for behavioral problems (T3). Maternal depressive symptomatology was measured at T1 and at 6 months (T2).

RESULTS

Low-quality DC in NICUs was associated with lower levels of infant neurobehavioral adaptability and higher levels of maternal depressive symptoms. Maternal depressive symptomatology in conjunction with higher infant dysregulation predicted more internalizing problems at 18 months of age.

CONCLUSION

DC interventions and postnatal maternal depression, as well as infant behavior have an impact on short- and long-term infant outcomes.

From early stress to 12-month development in very preterm infants: Preliminary findings on epigenetic mechanisms and brain growth

Very preterm (VPT) infants admitted to Neonatal Intensive Care Unit (NICU) are at risk for altered brain growth and less-than-optimal socio-emotional development. Recent research suggests that early NICU-related stress contributes to socio-emotional impairments in VPT infants at 3 months through epigenetic regulation (i.e., DNA methylation) of the serotonin transporter gene (SLC6A4). In the present longitudinal study we assessed: (a) the effects of NICU-related stress and SLC6A4 methylation variations from birth to discharge on brain development at term equivalent age (TEA); (b) the association between brain volume at TEA and socio-emotional development (i.e., Personal-Social scale of Griffith Mental Development Scales, GMDS) at 12 months corrected age (CA). Twenty-four infants had complete data at 12-month-age. SLC6A4 methylation was measured at a specific CpG previously associated with NICU-related stress and socio-emotional stress. Findings confirmed that higher NICU-related stress associated with greater increase of SLC6A4 methylation at NICU discharge. Moreover, higher SLC6A4 discharge methylation was associated with reduced anterior temporal lobe (ATL) volume at TEA, which in turn was significantly associated with less-than-optimal GMDS Personal-Social scale score at 12 months CA. The reduced ATL volume at TEA mediated the pathway linking stress-related increase in SLC6A4 methylation at NICU discharge and socio-emotional development at 12 months CA. These findings suggest that early adversity-related epigenetic changes might contribute to the long-lasting programming of socio-emotional development in VPT infants through epigenetic regulation and structural modifications of the developing brain.

Study Protocol for the Preschooler Regulation of Emotional Stress (PRES) Procedure

Background: Emotional stress regulation (ESR) rapidly develops during the first months of age and includes different behavioral strategies which largely contribute to children’s behavioral and emotional adjustment later in life. The assessment of ESR during the first years of life is critical to identify preschool children who are at developmental risk. Although ESR is generally included in larger temperament batteries [e.g., the Laboratory Temperament Assessment Battery (Lab-TAB)], there is no standardized observational procedure to specifically assess and measure ESR in preschool aged children.

Aim: Here, we describe the development of an observational procedure to assess ESR in preschool aged children [i.e., the Preschooler Regulation of Emotional Stress (PRES) Procedure] and the related coding system.

Methods: Four Lab-TAB emotional stress episodes (i.e., the Stranger, the Perfect Circle, the Missing Sticker, and the Transparent Box) have been selected. Independent coders developed a list of ESR codes resulting in two general indexes (i.e., active engagement and stress level) and five specific indexes (i.e., anger, control, fear, inhibition, sadness). Finally, specific actions have been planned to assess the validity and the coding system reliability of PRES procedure.

Ethics and Dissemination: The study has been approved by the Ethical Committee of the Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (Italy). The PRES validation and reliability assessment as well as its use with healthy and at-risk populations of preschool children will be object of future scientific publications and international conference presentations.

Maternal Sensitivity Buffers the Association between SLC6A4 Methylation and Socio-Emotional Stress Response in 3-Month-Old Full Term, but not very Preterm Infants

BACKGROUND

Very preterm (VPT) infants are hospitalized in Neonatal Intensive Care Units (NICUs) and are exposed to life-saving procedures eliciting pain-related stress. Recent research documented that pain-related stress might result in birth-to-discharge increased methylation of serotonin transporter gene (SLC6A4) in VPT infants, leading to poorer stress regulation at 3 months of age in VPT infants compared to their full-term (FT) counterparts. Maternal sensitivity is thought to support infants' stress response, but its role in moderating the effects of altered SLC6A4 methylation is unknown.

MAIN AIM

To assess the role of maternal sensitivity in moderating the association between altered SLC6A4 methylation and stress response in 3-month-old VPT and FT infants.

METHODS

53 infants (27 VPTs, 26 FTs) and their mothers were enrolled. SLC6A4 methylation was obtained from peripheral blood samples at NICU discharge for VPT infants and from cord blood at birth for FT infants. At 3 months (age corrected for prematurity), both groups participated to the face-to-face still-face (FFSF) paradigm to measure both infants' stress response (i.e., negative emotionality) and maternal sensitivity.

RESULTS

Maternal sensitivity did not significantly differ between VPT and FT infants' mothers. In VPT infants, higher SLC6A4 methylation at hospital discharge associates with higher negative emotionality during the FFSF. In FT infants, SLC6A4 methylation and maternal sensitivity significantly interacted to predict stress response: a positive significant association between SLC6A4 methylation and negative emotionality emerged only in FT infants of less-sensitive mothers.

DISCUSSION

Although no differences emerged in caregiving behavior in the two groups of mothers, maternal sensitivity was effective in moderating the effects of SLC6A4 methylation in FT infants, but not in VPT infants at 3 months. Speculatively, the buffering effect of maternal sensitivity observed in FT infants was disrupted by the altered early mother-infant contact due to NICU stay of the VPT group. These findings indirectly support that the effects of maternal sensitivity on infants' socio-emotional development might be time dependent, and that mother-infant interventions in the NICU need to be provided precociously within a narrow sensitive period after VPT birth.

Preterm behavioral epigenetics: A systematic review

Behavioral epigenetics is revealing new pathways that lead individuals from early adversity exposures to later-in-life detrimental outcomes. Preterm birth constitutes one of the major adverse events in human development. Preterm infants are hospitalized in the Neonatal Intensive Care Unit (NICU) where they are exposed to life-saving yet pain-inducing procedures and to protective care. The application of behavioral epigenetics to the field of preterm studies (i.e., Preterm Behavioral Epigenetics, PBE) is rapidly growing and holds promises to provide valid insights for research and clinical activity. Here, the evidence of the epigenetic correlates of prenatal adversities, NICU-related environment and development of preterm infants is systematically reviewed. The findings suggest that a number of prenatal adverse (e.g., maternal depression and stress) and post-natal (e.g., NICU-related pain-related stress) events affect the developmental trajectories of preterm infants and children via epigenetic alterations of imprinted and stress-related genes. Nonetheless, the potential epigenetic vestiges of early care and protective interventions in NICU have not been investigated yet and this represents a fascinating challenge for future PBE research.

Parents' presence and parent-infant closeness in 11 neonatal intensive care units in six European countries vary between and within the countries

Aim

Little is known about the amount of physical parent–infant closeness in neonatal intensive care units (NICUs), and this study explored that issue in six European countries.

Methods

The parents of 328 preterm infants were recruited in 11 NICUs in Finland, Estonia, Sweden, Norway, Italy and Spain. They filled in daily diaries about how much time they spent in the NICU, in skin‐to‐skin contact (SSC) and holding their babies in the first two weeks of their hospitalisation.

Results

The parents' NICU presence varied from a median of 3.3 (minimum 0.7–maximum 6.7) to 22.3 (18.7–24.0) hours per day (p < 0.001), SSC varied from 0.3 (0–1.4) to 6.6 (2.2–19.5) hours per day (p < 0.001) and holding varied from 0 (0–1.5) to 3.2 (0–7.4) hours per day (p < 0.001). Longer SSC was associated with singleton babies and more highly educated mothers. Holding the baby for longer was associated with gestational age. The most important factor supporting parent–infant closeness was the opportunity to stay overnight in the NICU. Having other children and the distance from home to the hospital had no impact on parent–infant closeness.

Conclusion

Parents spent more time in NICUs if they could stay overnight, underlining the importance that these facilities play in establishing parent–infant closeness.