Infant responses to impending collision: optical and real.

Twenty-four infants ranging in age from 2 to 11 weeks responded to symmetrically expanding shadows, which optically specify an approaching object, with an integrated avoidance response and upset. This response did not occur for asymmetrically expanding shadows nor for contracting shadows that specify an object on a miss path and a receding object. The response was observed in all the infants regardless of age, and the addition of kinetic depth information to the displays did not increase the intensity or likelihood of the response. In a second experiment, seven infants defensively reacted to the approach of a real object except when it was on a miss path.

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.

The Still-Face: A Greater Challenge for Infants of Mothers With Borderline Personality Disorder.

The main aim of this study was to ascertain whether infants as young as 3 months of age, whose mothers suffer from borderline personality disorder (BPD), are already at risk of greater dysregulation than infants of mothers without BPD when faced with a minor stressful experience. Nineteen mothers diagnosed with BPD and 41 controls with no history of psychopathology and their 3-month-old infants were observed using Tronick's Face-to-Face Still-Face paradigm. The authors found that infants whose mothers have BPD express less positive vocalizations and less nonautonomic self-regulation than infants of mothers with no psychopathology. The stress of the Still-Face episode affects their gaze and self-regulation behaviors more strongly than those of infants of controls. The Reunion episode seems particularly challenging for mothers with BPD, who show fewer smiles and an increase in intrusive behavior. Because infants and their mothers with BPD are already dysregulated at 3 months postpartum, envisaging very early intervention seems warranted.

Cocaine exposure is associated with subtle compromises of infants' and mothers' social-emotional behavior and dyadic features of their interaction in the face-to-face still-face paradigm.

Prenatal cocaine and opiate exposure are thought to subtly compromise social and emotional development. The authors observed a large sample of 236 cocaine-exposed and 459 nonexposed infants (49 were opiate exposed and 646 nonexposed) with their mothers in the face-to-face still-face paradigm. Infant and maternal behaviors were microanalytically coded. No opiate-exposure effects were detected. However, mothers of cocaine-exposed infants showed more negative engagement than other mothers. The cocaine-exposed dyads also showed higher overall levels of mismatched engagement states than other dyads, including more negative engagement when the infants were in states of neutral engagement. Infants exposed to heavier levels of cocaine showed more passive-withdrawn negative engagement and engaged in more negative affective matching with their mothers than other infants. Although effect sizes were small, cocaine exposure, especially heavy cocaine exposure, was associated with subtly negative interchanges, which may have a cumulative impact on infants' later development and their relationships with their mothers.

Neuromotor development of cocaine-exposed and control infants from birth through 15 months: poor and poorer performance.

OBJECTIVE: The objective of this study is to describe the longitudinal course of motor development of a group of infants exposed to cocaine in utero and an unexposed control group. METHODS: Subjects included 28 in utero-exposed infants and 22 unexposed infants matched for race, income of the family, and mother's educational level. Infants were evaluated at 1 month with the Alberta Infant Motor Scale (AIMS), at 4 months with the AIMS and Movement Assessment of Infants (MAI), at 7 months with the AIMS and MAI, and at 15 months with the Peabody Developmental Motor Scales (PDMS). RESULTS: At 4 months, compared with the unexposed infants, a significantly larger proportion of the exposed infants fell below the 50th percentile on the AIMS and had greater proportion of suspicious risk scores on the MAI. At 7 months infants in the exposed group had lower AIMS and MAI scores than the control group. There was no difference between groups on the motor scales at 1, 4, or 15 months. At all ages more infants in both groups scored significantly less than the expected norms on all scales. Performance was unrelated to a cumulative risk index made up of demographic, medical, and social factors. Almost all subjects had risk scores that placed them at extremely high levels of risk. Performance may have been related to a difference in weight between groups at 7 months and to decreasing weights for both groups by 15 months. CONCLUSION: In utero cocaine exposure has a significant, although relatively small, effect on infant motor performance late in infancy. However, regardless of exposure status, these infants had poor performance that may be accounted for by a heavy accumulation of risk factors associated with poverty.

Late dose-response effects of prenatal cocaine exposure on newborn neurobehavioral performance.

OBJECTIVE: To determine in a representative sample of full-term urban newborns of English-speaking mothers whether an immediate or late dose-response effect could be demonstrated between prenatal cocaine exposure and newborn neurobehavioral performance, controlling for confounding factors. METHODS: The Neonatal Behavioral Assessment Scale (NBAS) was administered by masked examiners to a total sample of 251 clinically healthy, full-term infants at 2 days and/or 17 days. Three in utero cocaine exposure groups were defined: heavily exposed (n = 44, > 75th percentile self-reported days of use during pregnancy and/or > 75th percentile of meconium benzoylecognine concentration); lightly exposed (n = 79, less than both 75th percentiles); and unexposed (n = 101, no positive biological or self-report marker). At the 3-week examination there were 38 heavily exposed, 73 lightly exposed, and 94 unexposed infants. Controlling for infant birth weight, gestational age, infant age at the time of examination, mothers' age, perinatal risk, obstetric medication, and alcohol, marijuana, and cigarette use, a regression analysis evaluated the effects of levels of cocaine exposure on NBAS performance. RESULTS: No neurobehavioral effects of exposure on the newborn NBAS cluster scores or on the qualifier scores were found when confounders were controlled for at 2 to 3 days of age. At 3 weeks, after controlling for covariates, a significant dose effect was observed, with heavily exposed infants showing poorer state regulation and greater excitability. CONCLUSIONS: These findings demonstrate specific dose-related effects of cocaine on 3-week neurobehavioral performance, particularly for the regulation of arousal, which was not observed in the first few days of life.

Regional obstetric anesthesia and newborn behavior: effect over the first ten days of life.

This study examined the effects of carefully controlled amounts of analgesic premedications and anesthetics administered to mothers during delivery on the behavior of the newborn over the first ten days of life. The subjects were selected to minimize the synergistic effects of medication and other stress factors, such as abnormalities of pregnancy, labor, or delivery. The effects of these drugs on the behavior of these infants was small. The data provide a picture of the behavioral recovery of a group of minimally stressed newborns.

The neonatal behavioral assessment scale as a biomarker of the effects of environmental agents on the newborn.

The organization of the newborn's brain and the nature of the effects of toxins and pollutants conspire to produce complex and difficult problems for the assessment of the behavioral effects of environmental agents. The newborn's brain can be characterized as relatively undifferentiated, and more vulnerable to, but potentially more capable of recovery from, the effects of environmental agents specific to this time period than it will be later in development. Environmental agents tend to have nonspecific, possibly subtle, effects that invade many areas of newborn functioning. These characteristics of the newborn and the behavioral effects of teratogens make assessment at this point in development difficult. Further exacerbating this difficulty is the nature of development. Development is critically dependent on the care the newborn receives. Distortions of a newborn's behavior can produce disturbances in the caretaking environment, and these caretaking disturbances can amplify the original behavioral distortion and produce other distortions. Attention to these types of effects must be built into an assessment. These considerations lead to the conclusion that an apical assessment of newborn behavior is required. The most standardized, valid, and reliable instrument currently available is the Neonatal Behavioral Assessment Scale developed by Brazelton. It assesses the integrated actions of the infant that function to regulate simultaneously the infant's internal state and exchanges with the animate (caretaking) and inanimate environment. The scale uses a set of reflex and behavioral items to assess the critical domains of infant functioning (e.g., the infant's ability to control his states of consciousness).(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of maternal psychiatric illness on infant development.

Maternal depression and anxiety are associated with compromises in infant and maternal social and emotional functioning. In this paper, we briefly review the literature on this topic and present some preliminary findings on a group of mothers in treatment for major depressive disorder, panic disorder, or obsessive-compulsive disorder. The findings suggest that the symptom reports of treated mothers with established DSM diagnoses were similar overall to those of control mothers. However, the mothers' psychiatric illness had a compromising effect on their interactions with their infants and on their infants' social and emotional functioning. The implications of these results are discussed.

Maternal and infant health: effects of moderate reductions in postpartum length of stay.

BACKGROUND: The Newborns' and Mothers' Health Protection Act of 1996 prohibits payers from restricting "benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours." The law recognizes the basic right of women and physicians to make decisions about aptness of discharge timing. OBJECTIVE: To provide data as a basis for decisions about aptness of discharge timing by studying the effect of voluntary, moderate reductions in length of postpartum hospital stay on an array of maternal and infant health outcomes. DESIGN: A prospective cohort study. Patients were surveyed by telephone at 3 and 8 weeks postpartum. SETTING: A teaching hospital where 38% of the patients are in a managed care health plan with a noncompulsory reduced stay program offering enhanced prepartum and postpartum services, including home visits. PATIENTS: Consecutive mothers discharged after vaginal delivery during a 3-month period. MAIN OUTCOME MEASURES: The outcomes were health services use within 21 days, breast-feeding, depression, sense of competence, and satisfaction with care. Multivariate analyses adjusted for sociodemographic factors, payer status, services, and social support. RESULTS: Of 1364 eligible patients, 1200 (88%) were surveyed at 3 weeks; of these 1200, 1015 (85%) were resurveyed at 8 weeks. The mean length of stay was 41.9 hours (SD, 12.2 hours). Of patients going home in 30 hours or less, 60.8% belonged to a managed care health plan. The length of stay was not related to the outcomes, except that women hospitalized shorter than 48 hours had more emergency department visits than those staying 40 to 48 hours (adjusted odds ratio, 5.78; 95% confidence interval, 1.19-28.05). CONCLUSIONS: When adequate postpartum outpatient care is accessible, a moderately shorter length of postpartum stay after an uncomplicated vaginal delivery had no adverse effect on an array of outcomes. Researchers and policy makers should seek to better define the content of postpartum services necessary for achieving optimal outcomes for women and newborns; funding should be available to provide such services, regardless of the setting in which they are provided.

Infant health care use and maternal depression.

OBJECTIVE: To determine whether women who frequently bring their neonates for problem-oriented primary care visits or emergency department visits are at elevated risk of having depressive symptoms. DESIGN: Analysis of 2 prospective cohort studies of mothers and their infants: (1) a telephone interview study of mothers and infants after birth at an urban teaching hospital (the hospital cohort) and (2) the 1988 National Maternal and Infant Health Survey, a nationally representative sample of women who had live births in 1988. PARTICIPANTS: A total of 1015 women in the hospital cohort surveyed at 3 and 8 weeks post partum and 6779 women with data from the national survey. MAIN OUTCOME MEASURE: Depressive symptoms above the Center for Epidemiologic Studies Depression Scale cutoff score of 15. RESULTS: After controlling for sociodemographic variables and parity, women exhibited high levels of depressive symptoms if their infants had more than 1 problem-oriented primary care visit (hospital cohort: odds ratio, 2.0 [95% confidence interval, 1.1-4.3]; national survey cohort: odds ratio, 2.0 [95% confidence interval, 1.5-3.0]). Women were more likely to have high levels of depressive symptoms if their infants had even 1 emergency department visit (hospital cohort: odds ratio, 3.2 [95% confidence interval, 1.5-6.9]). Frequent well-child visits were not associated with maternal depressive symptoms. CONCLUSIONS: Neonatal health care use patterns predict women at risk for postpartum depression. Recognition of these signature patterns of service use by pediatric health care providers may facilitate early diagnosis and treatment of postpartum depression and improve outcomes for women and their families.

A prospective study of the oxytocin challenge test and newborn neurobehavioral outcome.

In a prospective study, infants of high-risk mothers delivered over a 1-year period were evaluated by clinical, biochemical, and behavioral methods. Of 67 newborns whose mothers had oxytocin challenge tests (OCTs), 54 were delivered after negative tests, and 13 after positive tests. Infants with positive OCTs had poor state organization and reflexive performance when compared with negative-OCT babies. These infants also showed evidence of intrauterine malnutrition, but did not have any greater asphyxiation than the negative OCT group. These results are consistent with the hypothesis that a positive OCT implies pathological placental respiratory insufficiency, which may be superimposed, in many instances, on impairment in utero of the placenta's nutritional function. The clinical manifestation of such dysfunction is the alteration in subtle neonatal neurobehavior.

Specificity of infants' response to mothers' affective behavior.

Mother-infant face-to-face interaction is central to infant socioemotional development. Little has been known about the mechanisms that mediate the mother's influence. Findings are reviewed from a series of laboratory studies that suggest the major functional components of a mother's behavior are its affective quality and its contingent relationship to her baby's behavior. Quality of mother's affective expression accounted for individual differences in the behavior of thirteen 7-month-old infants living in multiproblem families. Infants' response was specific to the type of affective expression mothers displayed. Flat, withdrawn maternal affective expression was associated with infant distress. Intrusive maternal expression was associated with increased gaze aversion. Lack of contingent responsiveness was common to all but four mothers. Findings suggest that withdrawn or intrusive maternal affective expression, together with lack of contingent responsiveness, may in part be responsible for the risk-status of infants in multiproblem families.

Emotions and emotional communication in infants.

Important advances have recently been made in studying emotions in infants and the nature of emotional communication between infants and adults. Infant emotions and emotional communications are far more organized than previously thought. Infants display a variety of discrete affective expressions that are appropriate to the nature of events and their context. They also appreciate the emotional meaning of the affective displays of caretakers. The emotional expressions of the infant and the caretaker function to allow them to mutually regulate their interactions. Indeed, it appears that a major determinant of children's development is related to the operation of this communication system. Positive development may be associated with the experience of coordinated interactions characterized by frequent reparations of interactive errors and the transformation of negative affect into positive affect, whereas negative development appears to be associated with sustained periods of interactive failure and negative affect.

Prenatal drug exposure and maternal and infant feeding behaviour.

OBJECTIVE: To evaluate feeding difficulties and maternal behaviour during a feeding session with 1 month old infants prenatally exposed to cocaine and/or opiates. METHODS: The study is part of the maternal lifestyle study, which recruited 11 811 subjects at four urban hospitals, then followed 1388 from 1 to 36 months of age. Exposure to cocaine and opiates was determined by maternal interview and meconium assay. At the 1 month clinic visit, biological mothers were videotaped while bottle feeding their infants. This sample included 364 exposed to cocaine, 45 exposed to opiates, 31 exposed to both drugs, and 588 matched comparison infants. Mothers were mostly black, high school educated, and on public assistance. Videotapes were coded without knowledge of exposure status for frequency, duration and quality of infant sucking, arousal, feeding problems, and maternal feeding activity and interaction. RESULTS: No cocaine effects were found on infant feeding measures, but cocaine-using mothers were less flexible (6.29 v 6.50), less engaged (5.77 v 6.22), and had shorter feeding sessions (638 v 683 seconds). Opiate exposed infants showed prolonged sucking bursts (29 v 20 seconds), fewer pauses (1.6 v 2.2 per minute), more feeding problems (0.55 v 0.38), and increased arousal (2.59 v 2.39). Their mothers showed increased activity (30 v 22), independent of their infants' feeding problems. CONCLUSIONS: Previous concerns about feeding behaviour in cocaine exposed infants may reflect the quality of the feeding interaction rather than infant feeding problems related to prenatal exposure. However, opiate exposed infants and their mothers both contributed to increased arousal and heightened feeding behaviour.

Gender differences in emotional expressivity and self-regulation during early infancy.

Eighty-one 6-month-old infants and their mothers were videotaped in Tronick's face-to-face still-face paradigm to evaluate gender differences in infant and maternal emotional expressivity and regulation. Male infants had greater difficulty than female infants in maintaining affective regulation during each episode, including the still face. Mother-son dyads had higher synchrony scores than mother-daughter dyads but took longer in repairing interactive errors. In addition, maternal affect, matching, rate of change between matching and mismatching states, and synchrony in the play preceding the still face differentially mediated male and female infants' responses to the still face and reunion play. The developmental implications of these gender differences are discussed.

Prenatal cocaine exposure, child development, and the compromising effects of cumulative risk.

On the whole, the literature suggests that toddlers and young children who are exposed prenatally to cocaine exhibit few, if any, consistent differences in developmental functioning compared with demographically similar, nonexposed, age-matched controls. The paucity of cocaine-related findings does not mean that prenatally cocaine-exposed children are free from developmental problems. Cocaine-exposed infants may well have specific deficits that are masked by confounding factors in study designs; however, more important is the worrisome finding that the average performance of both drug-exposed and nonexposed children in the literature tends to be poorer than expectations for age. This problem likely stems from the fact that most study children in the literature (regardless of exposure status) come from low-income backgrounds and consequently have been exposed to multiple medical and social risk factors associated with long-term poverty. The fact that exposure to multiple risk factors has powerful, compromising effects on children's outcomes may overshadow any specific effects of prenatal cocaine exposure. The problem of high cumulative risk in the literature raises both methodologic and clinical issues. To disentangle the relationship among prenatal cocaine exposure and other comorbid risk factors in predicting children's outcomes, investigators in future studies should recruit samples with varying levels of accumulated risk. This increased range of risk will also permit researchers to evaluate the interaction of exposure status and risk status and identify specific protective factors that may contribute to resilient outcomes for these infants. This information will be helpful in the design and timing of intervention services for these high-risk infants and their families. On a clinical level, when exposed children present for interventional services, professionals must not limit their remedial efforts to drug treatment alone. Rather, clinicians should also view prenatal drug exposure as a possible marker for the presence of multiple medical and social risk factors (e.g., maternal psychopathology, social isolation, child maltreatment, domestic violence, or inadequate caregiving). Because any of these factors may place children in developmental jeopardy, these comorbid risk factors must be considered, together with prenatal drug exposure, and, when possible, treated. Although confronting this wide range of problems may seem overwhelming, many conditions associated with poverty are treatable. Moreover, from the perspective of the cumulative risk model, interventions are most likely to succeed if they attempt to reduce the overall burden of risk rather than targeting single risks.

Protective apathy, a hypothesis about the behavioral organization and its relation to clinical and physiologic status of the preterm infant during the newborn period.

This article describes the behavioral organization and its change in relation to physiologic and clinical variables in a group of infants whose birthweight was less than 1.5 kg and who were experiencing and recovering from acute cardiorespiratory illness. The authors used the Brazelton Premature Sale, which was designed for use with a wide range of gestational ages (27 to 35 weeks). Examinations began 1 week after birth and were obtained serially during the initial recovery period of these infants.

The neurobehavioral organization of Efe (pygmy) infants.

The neurobehavioral organization of 16 Efe Mbuti (pygmy) infants was examined over the first weeks of life using the Brazelton Neonatal Behavioral Assessment Scale. Mbuti infants are the smallest well-grown, full-term infants in the world, i.e., length and weight below the 10th percentile but ponderal index above the 50th percentile. The Efe infants are a relatively isolated population that allows for an evaluation of ethnic differences in newborn behavior; their small stature permits the examination of the relations among size, neurobehavioral organization, and morbid processes. The neurobehavioral organization of the Efe was compared with three groups of full-term infants: two full-statured, well-grown groups of infants, one African, one United States; and a group of symmetrically growth-retarded infants whose weight and length were proportionally compromised in utero. The behavioral organization of the Efe infants was found to be similar to the neurobehavior of the well-grown infants and superior to the group of growth-retarded infants. No unique neurobehavioral features were found compared with the other groups. These findings suggest that neurobehavioral organization has a universal form and that expected small size per se does not compromise infant behavior.

The impact of perinatal and neonatal events on the early behavior of the extremely premature human.

Observations were performed on 45 very low birth weight (VLBW) newborns at 7 and 21 days of life, using a Neonatal Behavioral Assessment Scale specifically modified for the extremely premature infant. Findings were analyzed using multiple and stepwise regression techniques to determine the influence of intrapartum and neonatal factors which might influence neurobehavior . Perinatal asphyxial descriptors accounted for significant variance on day 7 behavior; however, their impact was muted for day 21. At this time, jaundice and postnatal nutrition revealed a prominent and independent behavioral influence on the VLBW survivor.