Systematic review shows the benefits of involving the fathers of preterm infants in early interventions in neonatal intensive care units.

AIM: This review identifies interventions involving the fathers of preterm infants that have been tested in neonatal intensive care units (NICU). It examines their effects on the fathers and infants and highlights any differences between fathers and mothers who took part in the same interventions. METHODS: A systematic search was performed in English from 1995 to 1 September 2020, using the CINAHL, Cochrane Central Register of Controlled Trials, Embase, PubMed and PsycINFO databases. We examined 14 peer-reviewed studies that investigated NICU interventions involving 478 fathers, whose 511 infants were born before 37 weeks of gestation. These included empirical studies with clinical outcomes. RESULTS: Studies on fathers' interventions in NICUs were limited and mainly restricted to basic skin-to-skin contact or tactile interventions. The interventions had similar general positive effects on mothers and fathers when it came to infant physiological and behavioural reactions. There was also evidence of a positive effect on the fathers, including their mental health. CONCLUSION: Including fathers as active partners in the care of their preterm newborn infants produced good outcomes for both of them. Further research is needed to develop new, multimodal and interactive interventions that provide fathers with positive contact with their preterm infants.

Changes in the vocal qualities of mothers and fathers are related to preterm infant's behavioural states.

AIM: Little is known about infant-directed speech addressed to preterm infants. The current study investigated the association between changes in preterm infant behavioural states and acoustical qualities of both maternal and paternal infant-directed speech. METHODS: The mothers and fathers of 11 preterm infants participated in the study. Parents in turn were asked to talk freely to their infant over a 5-minute period. A total of 72 audio sequences were selected and analysed as a function of the behavioural states. RESULTS: Acoustic analysis showed that the vocal qualities of both fathers' and mothers' speech were influenced by infant behaviour. Parental infant-directed speech was characterised by higher loudness and spectral related parameters when preterm infants were sleeping, or transiting from one state to another, than when they were awake. Furthermore, loudness and spectral flux were higher in maternal speech than in paternal speech and fathers used higher pitch, jitter and shimmer when they saw their preterm infant in an awake state, demonstrating that alertness in infants modulates the father's voice. CONCLUSION: More research is needed to know whether other social partners' vocal qualities may also be related to infant behavioural state as such findings would have implications for clinical practice.

Exposure to human voices has beneficial effects on preterm infants in the neonatal intensive care unit.

We reviewed the literature up to March 2016 on the effects of nonmaternal voices on preterm infants' clinical outcomes. Of the 11 studies that met the inclusion criteria, 10 focused on short-term outcomes and one looked at long-term effects. The studies mainly showed that vocal stimuli increased preterm infants' stability in terms of heart rate, respiratory rate, oxygen saturation and behavioural measures. Improvements in feeding skills were also reported. The methods and the measures used in the studies were heterogeneous, making it difficult to draw reliable conclusions. CONCLUSION: Vocal stimuli increased preterm infants' stability, but further studies are needed.

Update on Mental Health of Infants and Children of Parents Affected With Mental Health Issues.

This paper highlights the most recent publications, in the field of psychiatry, on offspring of patients with psychiatric illnesses such as schizophrenia and bipolar disorder, and then summarizes what we know about the progeny of adults with mood disorders, the most prevalent of parental disorders. Studies examining personality disorders and contextual factors such as stress and trauma are examined with a focus on the crucial question of development and attachment status in children. Findings converge to reveal that offspring of parents (generally mothers) with most major psychiatric disorders present a higher risk for all mental disorders, and a wide range of disorders are also found in children, adolescent, and finally adult offspring of mothers with mood and anxiety disorders. Developmental psychopathology and infant and child psychiatry have focused on early relationship formation through social interaction and attachment patterns as pathways affected by vulnerability or resilience factors. First year of life longitudinal studies following mothers and infants has shown that maternal psychopathology is positively correlated with higher risk of attachment issues. It would seem that pathology appears when adaptation to real-life contexts becomes difficult in association with an accumulation of negative individual characteristics and environmental circumstances. We suggest that in order to move forward psychiatry should embrace a developmental cascade model, which posits a cumulative pathway for the emergence of psychopathology in the developing child. We propose that we have sufficient knowledge today to start implementing multilevel approaches to enhance the health and mental health of the next generation.

Live maternal speech and singing have beneficial effects on hospitalized preterm infants.

AIM: To study the effects of live maternal speaking and singing on physiological parameters of preterm infants in the NICU and to test the hypothesis that vocal stimulation can have differential effects on preterm infants at a behavioural level. METHODS: Eighteen mothers spoke and sang to their medically stable preterm infants in their incubators over 6 days, between 1 and 2 pm. Heart rate (HR), oxygen saturation (OxSat), number of critical events (hypoxemia, bradycardia and apnoea) and change in behavioural state were measured. RESULTS: Comparisons of periods with and without maternal vocal stimulation revealed significantly greater oxygen saturation level and heart rate and significantly fewer negative critical events (p < 0.0001) when the mother was speaking and singing. Unexpected findings were the comparable effects of maternal talk and singing on infant physiological parameters and the differential ones on infant behavioural state. CONCLUSION: A renewed connection to the mother's voice can be an important and significant experience for preterm infants. Exposure to maternal speech and singing shows significant early beneficial effects on physiological state, such as oxygen saturation levels, number of critical events and prevalence of calm alert state. These findings have implications for NICU interventions, encouraging maternal interaction with their medically stable preterm infants.

Skin-to-skin SDF positioning: The key to intersubjective intimacy between mother and very preterm newborn-A pilot matched-pair case-control study.

Background: Skin-to-skin contact (SSC) has been widely studied in NICU and several meta-analyses have looked at its benefits, for both the baby and the parent. However, very few studies have investigated SSC' benefits for communication, in particular in the very-preterm newborn immediately after birth. Aims: To investigate the immediate benefits of Supported Diagonal Flexion (SDF) positioning during SSC on the quality of mother-very-preterm newborn communication and to examine the coordination of the timing of communicative behaviors, just a few days after birth. Subjects and study design: Monocentric prospective matched-pair case-control study. Thirty-four mothers and their very preterm infants (27 to 31 + 6 weeks GA, mean age at birth: 30 weeks GA) were assigned to one of the two SSC positioning, either the Vertical Control positioning (n = 17) or the SDF Intervention positioning (n = 17). Mother and newborn were filmed during the first 5 min of their first SSC. Outcome measures: Infants' states of consciousness according to the Assessment of Preterm Infants' Behavior scale (APIB). Onset and duration of newborns' and mothers' vocalizations and their temporal proximity within a 1-s time-window. Results: In comparison with the Vertical group, very preterm newborns in the SDF Intervention Group spent less time in a drowsy state and more in deep sleep. At 3.5 days of life, newborns' vocal production in SSC did not differ significantly between the two groups. Mothers offered a denser vocal envelope in the SDF group than in the Vertical group and their vocalizations were on average significantly longer. Moreover, in a one-second time-frame, temporal proximity of mother-very preterm newborn behaviors was greater in the SDF Intervention Group. Conclusion: Although conducted on a limited number of dyads, our study shows that SDF positioning fosters mother-very preterm newborn intimate encounter during the very first skin to skin contact after delivery. Our pioneer data sheds light on the way a mother and her very preterm vocally meet, and constitutes a pilot step in the exploration of innate intersubjectivity in the context of very preterm birth.

Perinatal mental health.

Pregnancy is the time during which physiological and psychological preparation for motherhood takes place. It has long been considered a blessed time, free of psychiatric disorders. However, there is now strong evidence that major depressive disorder may occur not only after birth but even during the prepartum. Most often, mental illness during this period is underestimated, not assessed, therefore not diagnosed, and consequently goes untreated. Reviewing the literature on the negative impact of both maternal and infant health in case of perinatal depression, we underline that recognizing and treating prenatal depression will lead to preventive and curative treatments for mothers, enhance infant health, and therefore positively influence mother-infant relationships.

Parental Perception of Vocal Contact with Preterm Infants: Communicative Musicality in the Neonatal Intensive Care Unit.

In this study, we evaluate mothers' subjective experience of speaking and singing to their infants while they are in their incubators. We also discuss the relevance of the theoretical framework of Communicative Musicality for identifying the underlying mechanisms that may help explain its beneficial effects, both for parents and infants. Nineteen mothers talked and sung to their stable preterm infants in the incubators, for 5 min each, in three sessions over a period of 6 days. After each session, mothers were asked to assess in a self-report questionnaire the ease and the effectiveness of addressing their infants by speaking and singing and their prior musical experience. Perceived ease and effectiveness in communication were found to increase progressively from one session to the next. Mothers rated the speech to be increasingly more effective. This intuitive mean of interaction between parents and infants could be encouraged and supported by the nurses and the medical staff. Furthermore, individual musical experience affects perceived ease of communicating vocally with infants after a premature birth and should thus be encouraged during pregnancy.

Cross-species parallels in babbling: animals and algorithms.

A key feature of vocal ontogeny in a variety of taxa with extensive vocal repertoires is a developmental pattern in which vocal exploration is followed by a period of category formation that results in a mature species-specific repertoire. Vocal development preceding the adult repertoire is often called 'babbling', a term used to describe aspects of vocal development in species of vocal-learning birds, some marine mammals, some New World monkeys, some bats and humans. The paper summarizes the results of research on babbling in examples from five taxa and proposes a unifying definition facilitating their comparison. There are notable similarities across these species in the developmental pattern of vocalizations, suggesting that vocal production learning might require babbling. However, the current state of the literature is insufficient to confirm this suggestion. We suggest directions for future research to elucidate this issue, emphasizing the importance of (i) expanding the descriptive data and seeking species with complex mature repertoires where babbling may not occur or may occur only to a minimal extent; (ii) (quasi-)experimental research to tease apart possible mechanisms of acquisition and/or self-organizing development; and (iii) computational modelling as a methodology to test hypotheses about the origins and functions of babbling. This article is part of the theme issue 'Vocal learning in animals and humans'.

Fostering mother-very preterm infant communication during skin-to-skin contact through a modified positioning.

BACKGROUND: Skin-to-skin contact (SSC) has been widely studied in NICU and several meta-analyses have looked at its benefits both for the baby and the parent. Very few studies however have investigated benefit for communication. AIMS: Investigate the immediate benefits of Supported Diagonal Flexion (SDF) positioning during SSC on the quality of mother - very-preterm infant communication and to gain insight into how mothers' and very-preterm infants' communicative behaviours are coordinated in time just a few days after birth. SUBJECTS AND STUDY DESIGN: Monocentric prospective matched-pair case-control study. Thirty-four mothers and their very preterm infants (27 to 31 + 6 weeks GA; mean age at birth 30: weeks GA) were assigned to one of the two SSC positioning, either the Vertical Control (n = 17) or the SDF Intervention positioning (n = 17). Mother and infant were filmed during the first 5 min of SSC, 15 days after the very first SSC (i.e. 18 days after very premature birth, i.e. on average 32.4 weeks GA). OUTCOME MEASURES: Infants' state of consciousness according to the Assessment of Preterm Infants' Behavior scale. Onset and duration of infants' and mothers' smiles, gazes and vocalizations, and their temporal proximity inside a 1-sec time-window. RESULTS: In the SDF Intervention Group, very preterm infants vocalized three times more and mothers vocalized, gazed at their baby's face, and smiled more than in the Vertical Control Group. Moreover, in a one-second time-frame, temporal proximity of mother-infant behaviours was greater in the SDF Intervention Group. CONCLUSIONS: Our study shows that SDF positioning creates more opportunities for mother-infant communication during SSC. SDF positioning fosters a greater multimodal temporal proximity thus supporting a more qualitative mother-infant communication.

Sensus Communis: Some Perspectives on the Origins of Non-synchronous Cross-Sensory Associations.

Adults readily make associations between stimuli perceived consecutively through different sense modalities, such as shapes and sounds. Researchers have only recently begun to investigate such correspondences in infants but only a handful of studies have focused on infants less than a year old. Are infants able to make cross-sensory correspondences from birth? Do certain correspondences require extensive real-world experience? Some studies have shown that newborns are able to match stimuli perceived in different sense modalities. Yet, the origins and mechanisms underlying these abilities are unclear. The present paper explores these questions and reviews some hypotheses on the emergence and early development of cross-sensory associations and their possible links with language development. Indeed, if infants can perceive cross-sensory correspondences between events that share certain features but are not strictly contingent or co-located, one may posit that they are using a "sixth sense" in Aristotle's sense of the term. And a likely candidate for explaining this mechanism, as Aristotle suggested, is movement.

Vocal responsiveness of preterm infants to maternal infant-directed speaking and singing during skin-to-skin contact (Kangaroo Care) in the NICU.

Vocalizations of full-term newborns occur in a short latency time during the neonatal period. Contingent response time of preterm babies is still unknown. An increase of preterm babies' vocalizations following exposure to parental speech was also observed. Mothers and babies co-modulate their vocalizations in preterm dyads. PURPOSE: To observe temporal features of maternal and infants' vocalizations in speaking and singing conditions in preterm dyads. METHODS: In a NICU mothers (N = 36) were invited to speak and to sing to their preterm infants during Kangaroo Care. Microanalysis of temporal units were performed with ELAN Software. RESULTS AND CONCLUSIONS: Preterm infants vocalize less often while their mothers speak and sing than during baseline and their vocalizations tend to be more alternating in the speaking condition and more overlapping in the singing condition. It is also concluded that preterm infants take more time to respond to maternal speaking than to maternal singing.

Early development of turn-taking in vocal interaction between mothers and infants.

Infants are known to engage in conversation-like exchanges from the end of the second month after birth. These 'protoconversations' involve both turn-taking and overlapping vocalization. Previous research has shown that the temporal organization of adult-infant turn-taking sequences is similar to that of adult verbal conversation. It has also been shown that young infants adjust the quality of their vocalization in response to the quality and timing of adult vocalization. We present new evidence of turn-taking interaction in infants aged between 8 and 21 weeks based on the analysis of 176 samples of naturalistic face-to-face interactions from 51 dyads. We found high levels of latched turns as well as frequent initiation of turn-taking by infants at these ages. Our data do not support the hypothesis that turn-taking ability increases with age between 2 and 5 months but do suggest that infants are active participants in turn-taking from the earliest age and that mothers adjust turn-taking formats to infants.

The human nature of culture and education.

Human cultures educate children with different strategies. Ancient hunter-gatherers 200,000 years ago, with bodies and brains like our own, in bands of a hundred well-known individuals or less, depended on spontaneous cooperative practice of knowledge and skills in a natural world. Before creating language, they appreciated beautiful objects and music. Anthropologists observe that similar living cultures accept that children learn in playful 'intent participation'. Large modern industrial states with millions of citizens competing in a global economy aim to instruct young people in scientific concepts and the rules of literacy and numeracy deemed important for employment with elaborate machines. Our psychobiological theories commonly assume that an infant starts with a body needing care and emotional regulation and a mind that assimilates concepts of objects by sensorimotor action and requires school instruction in rational principles after several years of cognitive development. Evidence from archeology and evolutionary anthropology indicates that Homo sapiens are born with an imaginative and convivial brain ready for the pleasure of shared invention and with a natural sense of beauty in handmade objects and music. In short, there are innate predispositions for culture for practicing meaningful habits and artful performances that are playfully inventive and seductive for companionship in traditions, and soon capable of grasping the clever purpose of shared tasks and tools. This knowledge of inventive human nature with esthetic and moral sensibilities has important implications for educational policy in our schools. WIREs Cogn Sci 2014, 5:173-192. doi: 10.1002/wcs.1276 CONFLICT OF INTEREST: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website.

Expressive timing in infant-directed singing between 3 and 6 months.

This longitudinal study compared the temporal characteristics of maternal singing at 3 and then at 6 months. Infant-directed (ID) singing is claimed to have different functions in preverbal communication. However few studies have focused on the specific characteristics of ID singing that change across the first months of life. We aimed to explore these changes between 3 and 6 months because musical routines become prominent in the repertoire of games parents and infants spontaneously play during a period referred to as 'the period of games'. We focused specifically on expressive timing because it reflects how mothers dynamically adapt their singing to their infant's states of attention and involvement. We aimed to determine whether the expressive timing cues of maternal singing would be different at 3 and then at 6 months. To this end, the interactions of 18 mother-infant dyads were recorded while mothers were singing a popular French playsong for their infant at 3 and then at 6 months. Acoustic analyses revealed that mothers showed final-lengthening and tempo slowing for both age groups, but marked the ends of the hierarchical structural units of the song more saliently with their 6-month-olds. Unexpectedly, infant sex was also found to affect maternal singing: more exaggerated phrase-lengthening patterns were observed in singing to girls.

Pregnancy, somatic complaints and depression: a French population-based study.

OBJECTIVE: Depression during pregnancy is today one of the greatest medical risks for expectant mothers and newborns. It is associated with numerous morbid conditions and with postnatal depression. Identifying depression during pregnancy is therefore a major public health concern, but screening for depression is not routinely carried out in somatic settings. We hypothesized that the presence of numerous somatic complaints contributes to the detection of an increased risk of depression during pregnancy. STUDY DESIGN: A cross-sectional study was conducted on 1000 consecutive pregnant women approached during OB/GYN visits at a general maternity hospital. They were asked to fill out a questionnaire, which contained the Edinburgh Postnatal Depression Scale (EPDS) and a checklist of 18 somatic complaints. RESULTS: The median number of somatic complaints was 5 (interquartile range 3-7). The risk of depression during the 2nd and 3rd trimesters was 18.3% (EPDS score > 10.5). Logistic regression revealed that when the somatic complaints total score moved from 3 to 7, the odds of moving from not-at-risk to at-risk for antenatal depression were multiplied by 2.91. CONCLUSION: Our results call for further research exploring somatic complaints and their link to depression during pregnancy. Until more knowledge is available, we suggest considering that women with a high number of somatic complaints during pregnancy are at high risk for depression and should be referred for further diagnostic clinical assessment and care.

Effects of familiarity and attentiveness of partner on 6-month-old infants' social engagement.

This study presents an ecological experiment investigating 6-month-olds' social engagement. Results show that infants look and smile more at a socially attending distant partner than at an inattentive partner and that their looking and smiling behavior is different when the inattentive partner is their mother.

What lies behind postnatal depression: is it only a mood disorder?

Postnatal depression (PND) is a common condition that has been extensively researched specifically because of its negative impact on the mother-infant relationship. Psychiatric research has looked at comorbidity of major depressive disorder and found it to be strongly associated with Axis II disorders. This study's principal aim was to investigate whether there is a greater incidence of personality disorder (PD) among a PND population than among a non-PND population at 3 months postpartum. A secondary aim was to define the different types of PD. Depression was assessed with the Montgomery and Asberg Depression Rating Scale (MADRS), and PD was assessed with the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) in 109 women with their 12-week-old infants. Twice as many depressed mothers had PD. The PND group presented a greater number of severe clinical symptoms than the nondepressed group (p < .002). Further research is necessary to reexamine the heterogeneity of PND and reassess its impact on infant development.

Imitation and repetition of prosodic contour in vocal interaction at 3 months.

This study investigates vocal imitation of prosodic contour in ongoing spontaneous interaction with 10- to 13-week-old infants. Audio recordings from naturalistic interactions between 20 mothers and infants were analyzed using a vocalization coding system that extracted the pitch and duration of individual vocalizations. Using these data, the authors categorized a sample of 1,359 vocalizations on the basis of 7 predetermined contours. Pairs of identical successive vocalizations were considered to be imitations if they involved both partners or repetitions if they were produced by the same partner. Results show that not only do mothers and infants imitate and repeat prosodic contour types in the course of vocal interaction but they do so selectively. Indeed, different contours are imitated and repeated by each partner. These findings suggest that imitation and repetition of prosodic contours have specific functions for communication and vocal development in the 3rd month of life.

Early detection of core deficits in autism.

The goal of this review of the research literature is to discuss approaches to the early detection of autism in infancy. Early detection would enable diagnoses to be made before 18 months of age rather than at 24-30 months, the age where diagnoses start to be made now. After summarizing the criteria for a deficit to be considered "core" to the disorder, the literature on research strategies used in early detection is examined. In order to guide the design of future studies, the review then turns to an overview of what is known about the processes of early social development in typically developing children that underlie the domains in which core deficits are manifested in young children with autism. The social domains covered in the review are those that show development in typically developing infants below 18 months of age: dyadic interaction and imitation; emotion discrimination; and attachment. The review concludes that all of these areas are worthy of investigation in young children, particularly those at higher risk of showing some of the core deficits of autism such as the infant siblings of children with autism.