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.

Greater brain response to emotional expressions of their own children in mothers of preterm infants: an fMRI study.

OBJECTIVE: The birth of a preterm infant and Neonatal Intensive Care Unit hospitalization constitute a potentially traumatic experience for mothers. Although behavioral studies investigated the parenting stress in preterm mothers, no study focused on the underlying neural mechanisms. We examined the effect of preterm births in mothers, by comparing brain activation in mothers of preterm and full-term infants. STUDY DESIGN: We used functional magnetic resonance imaging to measure the cerebral response of 10 first-time mothers of preterm infants (gestational age <32 weeks and/or birth weight <1500) and 11 mothers of full-term infants, viewing happy-, neutral- and distress-face images of their own infant, along with a matched unknown infant. RESULTS: While viewing own infant's face preterm mothers showed increased activation in emotional processing area (i.e., inferior frontal gyrus) and social cognition (i.e., supramarginal gyrus) and affiliative behavior (i.e., insula). CONCLUSION: Differential brain activation patterns in mothers appears to be a function of the atypical parenthood transition related to prematurity.

Language outcomes at 36 months in prematurely born children is associated with the quality of developmental care in NICUs.

OBJECTIVE: The aim of this study was to examine the relationship between the quality levels of NICU developmental care (DC) and language skills at 36 months in very preterm (VPT) children. STUDY DESIGN: Language skills of 78 VPT children from 19 NICUs and 90 full-term controls was assessed using a standardized language test. We compared children' language task performance by splitting NICUs into units with high- and low-quality of DC according to two main factors: (1) infant centered care (ICC), and (2) infant pain management (IPM). RESULTS: VPT children from low-care units with respect to ICC obtained lower scores in sentence comprehension, compared to children from high-care units. No differences were found between preterm children from high-quality ICC NICUs and full-term children. CONCLUSIONS: Findings suggest that higher quality of DC related to infant centered care can mitigate delays in language skills at 36 months in children born VPT.

Neonatal developmental care in infant pain management and internalizing behaviours at 18 months in prematurely born children.

BACKGROUND: Very preterm infants are exposed to adverse stressful experiences, which may result in long-term behavioural outcomes. The developmental care practices, including pain management and environmental support, can minimize the effects of stress exposure. However, developmental care quality levels may vary among Neonatal Intensive Care Units (NICUs) and little is known about how differences in developmental care quality affect long-term behavioural outcomes. The aim of this study was to examine the relation between quality levels NICUs developmental care and behaviour problems at 18 months corrected age in preterm children. METHODS: The behaviour of 134 preterm children from 22 NICUs and 123 full-term controls was examined using the questionnaire Child Behaviour Checklist 1½-5. We compared the behavioural profile of children by splitting NICUs into units with high- and low quality of developmental care according to two main care factors: (1) infant centered care (ICC) index, and (2) infant pain management (IPM) index. RESULTS: Preterm children from low-care units in IPM group reported higher scores in Internalizing Problems, compared to children from high-care units. No differences were found between preterm children from high-care in IPM and full-term children. No significant IPM effect was found for externalizing problems. No significant ICC effect emerged both for internalizing and externalizing problems. CONCLUSIONS: Findings suggest that higher quality of developmental care related to infant pain management can mitigate behavioural problems at 18 months in children born preterm, to such an extent that preterm children exhibit a behavioural profile similar to that displayed by full-term children.

Mothers are not fathers: differences between parents in the reduction of stress levels after a parental intervention in a NICU.

AIMS: The study examined the effects of a parental intervention to reduce parents' stress levels during the hospitalization of their very preterm infants in a NICU, taking into account possible differences between mothers and fathers. METHODS: Parents of infants born ≤ 32 weeks gestational age (GA) were randomly assigned to a standard support group (N = 21) or intervention group (N = 21). The intervention was based both on a joint observation method and infant massage provided by both parents. Parents' stress was assessed by the Parental Stressor Scale: Neonatal Intensive Care Unit, after the first week of admission and at the infant's discharge. RESULTS: At discharge, intervention group parents showed significantly lower levels of stress related to infants' appearance/behaviour and to parental role alteration (PRA) than those of the standard support group (p = 0.000). Overall, mothers reported more stress compared with fathers (p ≤ 0.05). The intervention was effective in reducing the stress-role alteration in mothers (p < 0.05), but not in fathers. CONCLUSIONS: Mothers reported more stress compared with fathers, above all for PRA. A parental intervention was effective in reducing stress-role alteration in mothers, but not fathers. Parental interventions should take into account that help for fathers could be different from help for mothers.

Electrophysiological analysis of cognitive slowing in subjects with mitochondrial encephalomyopathy.

Mitochondrial encephalomyopathies (MEs) are multisystemic inherited disorders affecting tissues with high energy requirement such as the muscle, retina and central nervous system. Progressive external ophthalmoplegia and myopathy are the most common features in adults, and cognitive impairment is rare. In many neurodegenerative disorders, ERPs have been effectively performed to record cognitive slowing on tasks with different amount of information. To analyze the evidence for possible cognitive slowing, a standard auditory oddball paradigm with a button-press response was applied. Participants were 11 non-demented patients affected by mitochondrial encephalomyopathy and 14 age-matched normal controls. This hypothesis was tested using two tasks of different difficulty (pure tone vs. phonetic stimuli). Reaction time (RT), performance (P) and event-related potentials (ERPs) were measured. RT and P were not significantly different between the groups. Patients showed significantly increased N2 latency and reduced P3 amplitude on both tasks. No difference was found in pure tone and phonetic task conditions. Results were interpreted as electrophysiological signs of cognitive slowing--particularly in relation to stimulus evaluation--irrespective of sensory problems, response selection and cognitive load. These findings suggest that in ME patients, there may be a possible dysfunction of neural mechanisms underlying cognitive events and ERP generation.

Deutsch's frequency anisotropy and ear advantage in a dichotic test of musical chords.

Deutsch [Music Perception 3(2), 127-154, 1985] outlined an effect of frequency anisotropy occurring in dichotic tests which may challenge the usual interpretation of such tests in terms of functional asymmetry of the cerebral hemispheres. This study is aimed at verifying the relevance of Deutsch's findings in the case of a dichotic test of musical chords. A single choice dichotic chord test was administered to two groups of subjects (N = 20, N = 28) with different levels of musical competence. The results show that the left ear advantage obtained cannot be explained on the basis of Deutsch's effect.