Neurodevelopmental and school performance of very low-birth-weight infants: a seven-year longitudinal study.

The changing patterns of neurologic and developmental functioning between 1 and 7 years of age were studied in very low-birth-weight infants (birth weight less than or equal to 1,500 g). Subjects included 42 infants born in 1975 who were followed for 7 years. Based on the 1-year neurologic assessment, 22 infants were classified as normal, 12 as suspect, and eight as abnormal. The three groups did not differ in birth weight, gestational age, sex, or Hollingshead socioeconomic status (SES) score. The neurologic findings at 7 years of age were significantly related to the neurologic examination findings at 1 year of age. Seventy-seven percent of the normal group, 58% of the suspect group, and 100% of the abnormal group remained in the same neurologic category at 7 years of age. Children in the abnormal group had the greatest improvement in cognitive functioning between 1 and 7 years of age but did not achieve the IQ level of children in the normal group. Forty-five percent of the normal group, 75% of the suspect group, and 100% of the abnormal group had poor visual-motor integration. Fifty-eight percent of the suspect group and 87% of the abnormal group were reading below age level. Of the total sample, 54% required special education or resource help at 7 years of age, and the three groups differed significantly in their need for a special educational plan (P less than .05). These data indicate that a neurologic classification at 1 year of age provides a guide for monitoring very low-birth-weight infants and can be helpful in alerting school personnel to potential needs.

Determinants of mother-infant interaction in adolescent mothers.

Mother-infant interactions of adolescent and nonadolescent mothers are compared, and the impact of maternal age, ego development, education, and child care support on these interactions is examined. Thirty primiparous, white, lower- to middle-class mothers (half less than or equal to 17 years) and their healthy full-term infants (8 months) were studied. Interactions were videotaped during face-to-face interactions and teaching sessions. Child care support and ego development were assessed. During face-to-face interactions, only one difference was found between adolescent and nonadolescent mothers: nonadolescent mothers showed more positive affect toward infants. During teaching, nonadolescent mothers talked more, showed more positive affect toward infants, and demonstrated tasks more often. Individual differences during face-to-face interactions were more related to mothers' ego development and support whereas teaching interactions were mostly associated with maternal age. Thus, maternal age was a stronger predictor of interactive style during teaching. This may partially explain noted cognitive deficits in infants of teenage mothers. However, individual differences among all mothers in ego development, education, and support were significantly related to interactions. Thus, teenage mothers with less education and support and lower ego development may represent a higher risk subgroup of adolescent mothers providing less optimal care-giving environments for their infants.

Adolescent development and transitions to motherhood.

OBJECTIVE: To use both qualitative and quantitative methods to examine the experience of motherhood during adolescence and to evaluate developmental influences on the concept of maternal role. DESIGN: (1) A grounded theory approach was initially used to generate a hypothesis. Focus groups and individual interviews were analyzed for concept and theme. (2) A quantitative method using correlational analysis was used to test the hypothesis generated by qualitative study. A structured interview using five specific, scored questions about self and about motherhood was used to examine the relationship between developmental complexity of responses to questions about self and questions about motherhood. SETTING AND PARTICIPANTS: The qualitative study involved group and individual interviews with 42 teenage mothers. The quantitative study involved individual interviews with 25 mothers, ages 14 to 18 years, at an innercity clinic for young parents and their infants. Race and ethnicity were heterogeneous, and 100% received Aid to Families With Dependent Children. RESULTS: The major hypothesis generated from the qualitative analysis was that an adolescent mother's conceptualization of her maternal role is related to her own psychosocial and cognitive development. The quantitative study revealed a strong correlation between the developmental complexity of responses to questions about self and the complexity of responses to questions about motherhood (r2 = .81). CONCLUSION: The experience of motherhood and the conceptualization of the maternal role in adolescence is related to young mothers' psychosocial cognitive development.

Developmental outcome as a function of the goodness of fit between the infant's cry characteristics and the mother's perception of her infant's cry.

OBJECTIVE: To determine whether the "goodness of fit" between infant cry characteristics and the mother's perception of the cry is related to developmental outcome at 18 months of age. DESIGN: This was a prospective, longitudinal study from birth to 18 months performed in a blinded manner. SETTING: The study was conducted in a maternity hospital, including normal and special care nurseries and a laboratory for developmental follow-up. PATIENTS: The 121 term and preterm infants and their mothers were selected to meet medical criteria. MEASUREMENT: Acoustic analysis of 1-month infant cry and the mother's perception of the same cry was used to divide subjects into four groups representing matches and mismatches between infant cry characteristics and maternal cry perception. Primary outcome measures of cognitive, language, motor, and neurologic outcome were administered at 18 months. Caretaking environment measures were also recorded. RESULTS: Statistically significant (P < .05) findings showed that matched groups scored higher on measures of language and cognitive performance than infants in the mismatch groups, with a particular advantage for infants in the matched group in which mothers accurately perceived the higher-pitched cries of their infants. There were no differences between the groups in biologic or sociodemographic factors. Group differences were observed in social support and maternal self-esteem. CONCLUSIONS: Matches and mismatches between infant cry characteristics at 1 month and the mother's perception of the cry are related to cognitive and language outcome at 18 months in term and preterm infants. This relation is probably due to transactional processes in which developmental outcome is affected by the clarity of the infants' signals and by the ability of the mother to accurately perceive her infant's signals. The mother's ability to read her infant's cues may be affected by factors such as social support and self-esteem.

Behavioral responsiveness in preterm infants with intraventricular hemorrhage.

Preterm infants with varying degrees of intraventricular hemorrhage (none, n = 21; grade I to II, n = 22; grade II to IV, n = 24) and a group of full-term infants (n = 21) were compared with regard to behavioral responsiveness and parental reports of the infant's temperament. Behavioral responsiveness was assessed during the presentation of 15 visual, auditory, and tactile stimuli at 3 months of age (corrected age for preterm infants). Summary scores for positive and negative responsiveness, as well as sociability, soothability, and overall activity levels, were derived from behavioral observations by coders who were unaware of the infant's characteristics. The Bates Infant Characteristic Questionnaire was completed by the main care giver and scored on four summary variables: fussy-difficult, unadaptable, dull, and unpredictable. Preterm infants, regardless of the presence or severity of intraventricular hemorrhage, showed less positive responses and less overall activity in response to stimulation. Infants with grade I to II intraventricular hemorrhage were less sociable and more difficult to soothe than full-term control infants. Individual differences in positive, negative, sociability, and soothability were related to the questionnaire scores of fussy-difficult and unadaptability. Both prematurity and degree of intraventricular hemorrhage affect behavioral responsiveness and these individual differences are related to parental reports of the infant's temperament.

Behavioral intervention and post-natal growth in full-term intrauterine growth retarded (IUGR) infants.

The purpose of this study was twofold: (1) to describe the patterns of post-natal growth in full-term infants as a function of IUGR and (2) to assess the impact of an individualized behavioral feeding intervention with the mothers on these patterns of infant growth. Eighty-eight (88) full-term infants, including 54 with IUGR, half of whom received behavioral intervention were included. Weight, length, skinfold thickness, head circumference and Ponderal Index were measured at birth and at 1, 4, 8, 12, and 18 months. Results show positive intervention effects between birth and 1 month in weight, length, skinfold thickness, and Ponderal Index. However, there were no intervention effects at subsequent ages. No evidence was found for catch-up growth in full-term IUGR infants in weight, length, and head circumference. We conclude that an individualized behavioral feeding intervention can accelerate early growth in IUGR infants, but the positive effects on growth are only seen while the intervention lasts (between birth and 1 month). On most parameters of physical growth, there is no lasting catch-up growth over the first 18 months in IUGR full-term infants.

Psychological distress in mothers of preterm infants.

The purpose of this study was to identify infant and maternal characteristics that predict psychological distress among mothers of preterm infants admitted to the neonatal intensive care unit (NICU). Infant characteristics included birth weight, gestational age, and ventilatory support, and maternal characteristics included age, parity, and socioeconomic status. Mothers (n = 142) completed questionnaires including a demographic form, the Parental Stressor Scale, and the Symptom Checklist 90-R. In hierarchical regression analyses, maternal NICU-specific distress was more strongly predicted by infant characteristics [F(3,135) = 6.80, p < .05] with maternal variables covaried. Maternal general psychological distress was more strongly predicted by maternal characteristics [F(3,135) = 6.05, p < .05]) with infant variables covaried. Twenty-eight percent of mothers reported clinically significant psychological distress compared with 10% in a normative population. Psychological distress among mothers of preterm infants appears to be common and deserves clinical consideration. The use of standardized questionnaires as part of the assessment process may improve case identification and psychosocial service delivery in the NICU.

Factors affecting parents' perceptions of temperament in early infancy.

Parents' perceptions of temperament in their three-month-old infants were examined in relation to prenatally measured parental characteristics and to objective indices of infant behavior at three months. Infant behavior and parental characteristics appear to make independent contributions to parents' perceptions in early infancy.

[Early intervention in infants with intrauterine growth retardation: its effects on neuropsychological development]. / Intervención temprana en infantes con retraso en crecimiento intrauterino: sus efectos en el desarrollo neuropsicológico.

Forty-eight term infants in a tertiary center in Puerto Rico during 1985-86 were monitored prospectively since birth completing a neuropsychological evaluation using the Mental Developmental Index of Bayley Scales. All infants were free from perinatal complications and chronic diseases by clinical evaluation. 25 infants with intrauterine growth retardation (IUGR) and 23 adequate for gestational age (AGA) infants were evaluated. Fourteen IUGR infants were controls and eleven IUGR infants were intervened. However, all AGA infants were used as controls. Mother-infant relationship at one month was scored and none of intervened infants had poor neuropsychological behavior with normal or near normal MDI values. Other relationships and possible explanations are discussed in the article.

Developmental outcome of minority infants: a process-oriented look into our beginnings.

This article reviews the literature on the development of children of minority status from birth to 3 years of age (infants). 5 major sources of influence on the developmental outcome of minority infants are proposed: cultural beliefs and caregiving practices, health status and health care practices, family structure and characteristics, socioeconomic factors, and biological factors. It is suggested that differences exist between minority and Anglo families in their developmental goals and interactions during the infancy period. The health status of some minority groups places these infants in an at-risk category for neurodevelopmental problems. The family context is characterized by younger mothers, a higher percentage of single heads of households, but also large, extended families. Socioeconomic factors have a pervasive influence on both infants and parents, and the contribution of biological factors is suggested but poorly understood. It is concluded that these factors act synergistically to place these infants in alternative (not necessarily deviant) developmental pathways, or in "at-risk" categories for neurodevelopmental problems, while canalization processes are operating to insure that major developmental milestones are achieved.

The social ecology and early parenting of Caucasian adolescent mothers.

Social characteristics, maternal behaviors, and the home environments of Caucasian adolescent and nonadolescent mothers were investigated in a sample of 50 primiparous low- and middle-class women and their 4-month-old infants. The mothers were interviewed about their child-care network and about stressful life events that may have occurred since the infant's birth. The HOME inventory was completed and videotapes of 2 hours of home observations were coded to assess maternal proximity, verbalizations, activity, and physical contact with the infant. Interview data indicated that adolescent mothers relied more frequently on other teenagers and other network members for help in child care than nonadolescent mothers. In addition, they also received more frequent support from their mothers and less frequent help from their partner's and partner's mother and siblings than nonadolescent mothers. During the home visit, they were less verbal with their infants and scored significantly lower on the Responsiveness and Maternal Involvement subscales as well as on the total HOME inventory; these results were replicated on subgroups matched for socioeconomic status, emphasizing the unique social context and parenting practices of teenage mothers.

Perception of infant cries in adolescent and adult mothers.

Deficits in parenting behavior in adolescent mothers could be due to the adolescent mother's perception of her infant's behavior. The aim of this study was to compare how adolescent and adult mothers perceive the crying behavior of their newborns. The 19 adolescent and 18 adult mothers listened to a tape recording of their infants' crying and rated the characteristics of the cry on 12 seven-point scales. The sample included newborns with normal growth and newborns with compromised growth. Acoustic characteristics of the cries were extracted by computer. Adult mothers rated the cries of their infants with compromised growth toward the negative end of the scales. By contrast, adolescent mothers rated the cries of their infants with compromised growth toward the positive end of the scales. Acoustic analysis showed that the cries of the infants with compromised growth were higher pitched and more variable than the cries of infants with normal growth. Correlations between the cry ratings and the acoustic analysis showed that for adult mothers, higher pitched and more variable cries were associated with negative ratings. For adolescent mothers, higher pitched and more variable cries were associated with more positive ratings. The findings suggest that adolescent mothers differ in the perception of their infant's behavior, which may have implications for later parenting behavior.

The social context of teenage childbearing: effects on the infant's care-giving environment.

PIP: 50 low-middle socioeconomic status (SES), primiparous, US Caucasian mothers and their full-term healthy infants were included in a study of the effects of maternal age and the social context on the home environment, and maternal behaviors of adolescent and older mothers, as well as the stability of the care-giving environment. At 4 months, support systems and life stress were assessed, as well as the home environment and maternal behaviors. At 2 years, a similar home visit was conducted in a subsample. Adolescent mothers had less education, lower SES, and a different child care support system. They also differed in the home environment and maternal behaviors at 4 months. Some of these differences disappeared when maternal education and SES, or child care support and life stress, were controlled. Moderate correlations were observed between 4 months and 2 years home environment and maternal verbalizations. Thus, a combination of maternal age and other social factors mediate the negative characteristics of the adolescent mother's care-giving environment, which is relatively stable during the infancy period.^ieng