Music processing in preterm and full-term newborns: A psychophysiological interaction (PPI) approach in neonatal fMRI.

Neonatal Intensive Care Units (NICU) provide special equipment designed to give life support for the increasing number of prematurely born infants and assure their survival. More recently NICU's strive to include developmentally oriented care and modulate sensory input for preterm infants. Music, among other sensory stimuli, has been introduced into NICUs, but without knowledge on the basic music processing in the brain of preterm infants. In this study, we explored the cortico-subcortical music processing of different types of conditions (Original music, Tempo modification, Key transposition) in newborns shortly after birth to assess the effective connectivity of the primary auditory cortex with the entire newborn brain. Additionally, we investigated if early exposure during NICU stay modulates brain processing of music in preterm infants at term equivalent age. We approached these two questions using Psychophysiological Interaction (PPI) analyses. A group of preterm infants listened to music (Original music) starting from 33 weeks postconceptional age until term equivalent age and were compared to two additional groups without music intervention; preterm infants and full-term newborns. Auditory cortex functional connectivity with cerebral regions known to be implicated in tempo and familiarity processing were identified only for preterm infants with music training in the NICU. Increased connectivity between auditory cortices and thalamus and dorsal striatum may not only reflect their sensitivity to the known music and the processing of its tempo as familiar, but these results are also compatible with the hypothesis that the previously listened music induces a more arousing and pleasant state. Our results suggest that music exposure in NICU's environment can induce brain functional connectivity changes that are associated with music processing.

Preterm infant showed better object handling skills in a neonatal intensive care unit during silence than with a recorded female voice.

AIM: This study compared whether preterm infants showed better tactile abilities during silence or when they heard a prerecorded female voice at different intensities. METHODS: We studied 74 preterm infants of 28-35 weeks' postconceptional age who were admitted to a French neonatal intensive care unit from 2014 to 2017. They were presented with wooden objects, one smooth and one angled, at various points during silence (n = 26) or while listening to a female voice at +5 (n = 24) or +15 decibels (n = 24) inside their incubator. We compared the conditions to see if there was any difference in how the infants handled the objects and also compared familiar and unfamiliar objects. RESULTS: The preterm infants showed better handling skills and only displayed effective discrimination, during silence. We found that 27.1% of the infants exposed to female voices failed to get habituated to the object, compared to 7.7% in the silence condition (p < 0.05) and success during the voice conditions required more trials (6.1 vs. 5.3) than the silence condition (p = 0.05). The different voice intensities made no difference. CONCLUSION: Being exposed to a female voice had a negative impact on preterm infants' tactile sensory learning, regardless of its intensity.

The integration of visual context information in facial emotion recognition in 5- to 15-year-olds.

The current study investigated the role of congruent visual context information in the recognition of facial emotional expression in 190 participants from 5 to 15years of age. Children performed a matching task that presented pictures with different facial emotional expressions (anger, disgust, happiness, fear, and sadness) in two conditions: with and without a visual context. The results showed that emotions presented with visual context information were recognized more accurately than those presented in the absence of visual context. The context effect remained steady with age but varied according to the emotion presented and the gender of participants. The findings demonstrated for the first time that children from the age of 5years are able to integrate facial expression and visual context information, and this integration improves facial emotion recognition.

Multisensory Texture Perception in Individuals with Williams Syndrome.

The sensory profile of people with Williams syndrome (WS) is characterised by atypical visual and auditory perceptions that affect their daily lives and learning. However, no research has been carried out on the haptic perception, in particular in multisensory (visual and haptic) situations. The aim of this study was to evaluate the communication of texture information from one modality to the other in people with WS. Children and adults with WS were included, as well as typically developing (TD) participants matched on chronological age (TD-CA), and TD children matched on mental age (TD-MA). All participants (N = 69) completed three matching tasks in which they had to compare two fabrics (same or different): visual, haptic and visuo-haptic. When the textures were different, the haptic and visual performances of people with WS were similar to those of TD-MA participants. Moreover, their visuo-haptic performances were lower than those of the two TD groups. These results suggest a delay in the acquisition of multisensory transfer abilities in individuals with WS. A positive link between MA and visual and visuo-haptic abilities only in people with WS suggests that they could benefit from an early intervention to develop their abilities to process and transfer multisensory information.

Maternal Voice and Tactile Stimulation Modulate Oxytocin in Mothers of Hospitalized Preterm Infants: A Randomized Crossover Trial.

Prematurity is a major risk factor for perinatal stress and neonatal complications leading to systemic inflammation and abnormal mother-infant interactions. Oxytocin (OT) is a neuropeptide regulating the inflammatory response and promoting mother-infant bonding. The release of this hormone might be influenced by either vocal or tactile stimulation. The main objective of the current randomized, crossover, clinical trial was to assess the salivary OT/cortisol balance in mothers following the exposure of their baby born preterm to two types of sensorial interventions: maternal voice without or with contingent tactile stimulation provided by the mother to her infant. Among the 26 mothers enrolled, maternal voice intervention alone had no effect on OT and cortisol levels in the mothers, but when associated with tactile stimulation, it induced a significant increase in maternal saliva oxytocin (38.26 ± 30.26 pg/mL before vs 53.91 ± 48.84 pg/mL after, p = 0.02), particularly in the mothers who delivered a female neonate. Maternal voice intervention induced a significant reduction in cortisol and an increase in OT levels in mothers when the maternal voice with a tactile stimulation intervention was performed first. In conclusion, exposure to the maternal voice with a contingent tactile stimulation was associated with subtle changes in the maternal hormonal balance between OT and cortisol. These findings need to be confirmed in a larger sample size and may ultimately guide caregivers in providing the best intervention to reduce parental stress following preterm delivery.

Intermanual transfer of shapes in preterm human infants from 33 to 34 + 6 weeks postconceptional age.

This study investigated the ability of preterm infants to learn an object shape with one hand and discriminate a new shape in the opposite hand (without visual control). Twenty-four preterm infants between 33 and 34 + 6 gestational weeks received a tactile habituation task with either their right or left hand followed by a tactile discrimination task in the opposite hand. The results confirmed that habituation occurred for both shapes and both hands. Infants subsequently held the novel shape longer in the opposite hand. The results reveal that preterm infants are capable of intermanual transfer of shape information. In spite of the immaturity of the corpus callosum in preterm infants, its development seems to be sufficient to allow some transfer of information between both hands.

Emotion knowledge in neurotypical children and in those with down syndrome.

This research aimed to assess two components of emotion knowledge (EK): receptive EK with face emotion identification and matching tasks, and emotion situation knowledge with the emotion attribution task (EAT). Study 1 assessed the development of EK in 265 neurotypical (NT) children (4-11 years), divided into four age groups. Overall, results showed a significant improvement of EK with age in the NT population for the three tasks, especially between the ages of 4/5 and 6/7. Children were less successful at the EAT in comparison to the other two tasks, indicating that receptive EK develops earlier than emotion situation knowledge. The presence of visual context (EAT) does not help to improve our children's overall facial emotion recognition, especially for anger and sadness, while these emotions are well recognized in isolated facial expressions (emotion identification). Study 2 compared EK between 32 children with Down syndrome (CA: M = 13 years, SD = 2.13) and 32 NT children (CA: M = 5.3 years, SD = 1.36): matched on a vocabulary task. Children with DS had more difficulties in EK than NT children. They had lower performances on the identification and the EAT tasks, while exhibited similar performances to their NT controls on the emotion matching task. Moreover, good abilities to identify emotion expressions seem to be a prerequisite for successful face-context recognition in NT children, but not in children with DS. Difficulties encountered by children with DS could result from executive dysfunction when dealing with complex visual information in addition to emotion processing difficulties.

Sensitivity to Emotion Intensity and Recognition of Emotion Expression in Neurotypical Children.

This study assessed two components of face emotion processing: emotion recognition and sensitivity to intensity of emotion expressions and their relation in children age 4 to 12 (N = 216). Results indicated a slower development in the accurate decoding of low intensity expressions compared to high intensity. Between age 4 and 12, children discriminated high intensity expressions better than low ones. The intensity of expression had a stronger impact on overall face expression recognition. High intensity happiness was better recognized than low intensity up to age 11, while children 4 to 12 had difficulties discriminating between high and low intensity sadness. Our results suggest that sensitivity to low intensity expressions acts as a complementary mediator between age and emotion expression recognition, while this was not the case for the recognition of high intensity expressions. These results could help in the development of specific interventions for populations presenting socio-cognitive and emotion difficulties.

Influence of swaddling on tactile manual learning in preterm infants.

BACKGROUND AND AIM: Swaddling is a well-known technique in developmental care programs as there is some evidence that swaddling is an appropriate stress-reducing method for preterm infants in the NICU. However, no experimental study has investigated the influence of swaddling in a learning context. This study aimed to assess the impact of swaddling on tactile manual abilities in preterm infants. METHODS: Two phases were introduced for all infants: habituation (successive presentation of the same object, prism or cylinder in the left hand), followed by discrimination (presentation of a new-shaped object). The infants were assigned to one of the two conditions (swaddled; non-swaddled). RESULTS: Forty preterm infants were included (between 28 and 35 weeks' postconceptional age). First, swaddled and non-swaddled infants exhibited similar tactile habituation abilities. However, all infants needed more time and more trials to habituate to the cylinder than to the prism. Second, they all exhibited an effective discrimination, but the importance of the increase in holding time for the new-shaped object varied according to the habituated-shape and the condition. Moreover, stress intensity was higher in non-swaddled infants during tactile exploration. Finally, infants with greater previous swaddling experience during the week preceding the test took more time and more trials to habituate to the object, regardless of the condition. CONCLUSION: Swaddling preterm infants during sensory learning did not influence the tactile memorization process but would improve the use of their attentional resources. Swaddling seems to provide favorable conditions for sensory learning by improving attention to tactile stimuli. CLINICAL TRIAL REGISTRATION: This trial, EMMASENS, has been registered at www.clinicaltrials.gov (identifier NCT04315428).

[Communicating with premature newborns through touch]. / Communiquer par le toucher avec le nouveau-né prématuré.

How does the premature newborn perceive the outside world? The first sense developed by the foetus is touch. Through the physiology of sensoriality and brain maturation, touch can constitute an essential vector in communicating with and caring for the premature child.

Relation between processing facial identity and emotional expression in typically developing school-age children and those with Down syndrome.

The main purposes of this research were to examine the relation between the processing of face identity and emotion expressions and then discern the significance of emotional expressions using Bruce et al. tasks. Two studies were conducted. Study 1 examined 225 typically developing (TD) children age 4 to 12. Results suggested that early recognition of complete faces and interpretation of emotional expression might depend on local processing abilities, while the recognition of masked faces and emotion expression matching seemed to share configural processing. Study 2 compared 22 children with Down syndrome (DS) to two TD groups matched on mental age (MA group) and chronological age (CA group). Results showed that children with DS processed the identity of complete faces (local processing) similarly to the MA and CA groups. In contrast, their performances for masked faces (configural processing) indicated a developmental delay as they were only comparable to the MA group. Children with DS were also able to identify the emotion expressions according to labels as well as the two control groups, while they had more difficulties on the matching condition. Furthermore, specific difficulties in processing the surprise expression were observed, rather than general difficulties in encoding emotion expressions. Finally, their performances on emotion matching tasks seemed to be supported by local information processing, which might explain their lower scores compared to CA controls that mainly used configural information. These results could aid in the development of targeted interventions for DS to improve their social skills.

Effects of an Early Postnatal Music Intervention on Cognitive and Emotional Development in Preterm Children at 12 and 24 Months: Preliminary Findings.

Preterm birth is associated with a higher prevalence of neurodevelopmental deficits. Indeed, preterm children are at increased risk for cognitive, behavioral, and socio-emotional difficulties. There is currently an increasing interest in introducing music intervention in neonatal intensive care unit (NICU) care. Several studies have shown short-term beneficial effects. A recent study has shown that listening to a familiar music (heard daily during the NICU stay) enhanced preterm infants' functional connectivity between auditory cortices and subcortical brain regions at term-equivalent age. However, the long-term effects of music listening in the NICUs have never been explored. The aim of this study was to evaluate at 12 and 24 months the effects of music listening in the NICU on cognitive and emotional development in preterm children by comparing them to a preterm control group with no previous music exposure and to a full-term group. Participants were 44 children (17 full-term and 27 preterm). Preterm children were randomized to either music intervention or control condition (without music). The preterm-music group regularly listened to music from 33 weeks postconceptional age until hospital discharge or term-equivalent age. At 12 months, children were evaluated on the Bayley Scales of Infant and Toddler Development, Third Edition, then with 4 episodes of the Laboratory Temperament Assessment Battery (assessing expressions of joy, anger, and fear, and sustained attention). At 24 months, the children were evaluated with the same tests, and with 3 additional episodes of the Effortful Control Battery (assessing inhibition). Results showed that the scores of preterm children, music and control, differed from those of full-term children for fear reactivity at 12 months of age and for anger reactivity at 24 months of age. Interestingly, these significant differences were less important between the preterm-music and the full-term groups than between the preterm-control and the full-term groups. The present study provides preliminary, but promising, scientific findings on the beneficial long-term effects of music listening in the NICU on neurodevelopmental outcomes in preterm children, and more specifically on emotion mechanisms at 12 and 24 months of age. Our findings bring new insights for supporting early music intervention in the NICU.

Social knowledge and social reasoning abilities in a neurotypical population and in children with Down syndrome.

Social knowledge refers to the ability to analyze and reason about social situations in relation to social rules which are essential to the development of social skills and social behavior. The present research aimed to assess these abilities with the "Social resolution task" in a neurotypical population of 351 children (4 to 12 years) and 39 young adults, and in 20 participants (10 to 18 years) with Down syndrome. Results showed that young children aged 4 to 6 were well able to distinguish between appropriate and inappropriate social behavior but they had significantly more difficulties in judging and identifying social cues for the transgression of conventional rules than for moral ones. Between age 4 and 8, their social reasoning was mainly based on factual answers, while older children showed significantly more social awareness, making more reference to emotional and social consequences for the "victims". The representation of a more universal applicability of social rules seemed to develop later in childhood, as of age 8. In contrast, participants with Down syndrome exhibited significantly more difficulties in judging, identifying and reasoning about transgression of social rules without social awareness. In conclusion, the results have shown that social reasoning abilities develop throughout childhood. Social awareness seems to have a long developmental course, which includes a sensibility about welfare and intersubjectivity, critical for the development of prosocial behavior. The clinical population with difficulties in social interaction and socio-emotional behavior could benefit from an early assessment and from learning social reasoning abilities to improve social skills.

Fragility of haptic memory in human full-term newborns.

BACKGROUND: Numerous studies have established that newborns can memorize tactile information about the specific features of an object with their hands and detect differences with another object. However, the robustness of haptic memory abilities has already been examined in preterm newborns and in full-term infants, but not yet in full-term newborns. This research is aimed to better understand the robustness of haptic memory abilities at birth by examining the effects of a change in the objects' temperature and haptic interference. METHODS: Sixty-eight full-term newborns (mean postnatal age: 2.5 days) were included. The two experiments were conducted in three phases: habituation (repeated presentation of the same object, a prism or cylinder in the newborn's hand), discrimination (presentation of a novel object), and recognition (presentation of the familiar object). In Experiment 1, the change in the objects' temperature was controlled during the three phases. RESULTS AND CONCLUSION: Results reveal that newborns can memorize specific features that differentiate prism and cylinder shapes by touch, and discriminate between them, but surprisingly they did not show evidence of recognizing them after interference. As no significant effect of the temperature condition was observed in habituation, discrimination and recognition abilities, these findings suggest that discrimination abilities in newborns may be determined by the detection of shape differences. Overall, it seems that the ontogenesis of haptic recognition memory is not linear. The developmental schedule is likely crucial for haptic development between 34 and 40 GW.

Sound Interferes with the Early Tactile Manual Abilities of Preterm Infants.

Premature birth is a sudden change of the sensory environment of a newborn, while their senses are still in development, especially in the stressful and noisy environment of the NICU. The study aimed to evaluate the effect of noise on the early tactile manual abilities of preterm infants (between 29 and 35 weeks PCA). Infants were randomly assigned to one of the two conditions: Silence and Noise. For each condition, two phases were introduced: a habituation phase (repeated presentation of the same object, prism or cylinder), followed by a test phase (presentation of the familiar or a novel object). In the Silence condition, they received the tactile habituation and test phases: In the Noise condition, they went through the same phases, while an alarm sounded. Sixty-three preterm infants were included. They displayed a strong and effective ability to memorize tactile manual information and to detect the difference between two shape features, but this ability seems to be impaired by the concomitant exposure to an alarm sound. This study is the first to highlight the effect of a negative stimulus on sensory functioning in premature infants. It reinforces the importance of developing environmental measures to lower the sound level in NICUs.

Social reasoning abilities in preterm and full-term children aged 5-7years.

BACKGROUND: Literature has evidenced behavioral and socio-emotional problems in preterm children, as well as long-term difficulties to establish and maintain social relationships in preterm population. Several studies have shown relations between behavior and social reasoning abilities in typically developing children and adults. AIM: The present study aimed to investigate the social understanding and social reasoning abilities in preterm children aged between 5 and 7years in comparison to their full-term peers. STUDY DESIGN: A social resolution task (SRT) was used to assess abilities to judge, identify and reason about others' behavior in relation to conventional and moral rules knowledge. SUBJECTS: 102 preterm children and 88 full-term children were included in the study. RESULTS: Compared with their full-term peers, preterm children exhibited difficulties to understand and reason about inappropriate social behavior, particularly for situations related to the transgression of conventional rules. They used more irrelevant information and exhibited less social awareness when reasoning about the transgression of social rules. The only significant predictor for global SRT and social reasoning scores was the mental processing composite of the K-ABC, but the part of the variance of the SRT that could be explained by the general cognitive abilities was relatively small. CONCLUSION: Preterm children demonstrated poorer social knowledge and social reasoning abilities compared with full-term children at early school age. Improving such abilities may reduce behavioral difficulties and peer relationship problems often described in the preterm population. These findings emphasize the need to early identify children at risk for impaired social development.

Altered Amygdala Development and Fear Processing in Prematurely Born Infants.

CONTEXT: Prematurely born children have a high risk of developmental and behavioral disabilities. Cerebral abnormalities at term age have been clearly linked with later behavior alterations, but existing studies did not focus on the amygdala. Moreover, studies of early amygdala development after premature birth in humans are scarce. OBJECTIVE: To compare amygdala volumes in very preterm infants at term equivalent age (TEA) and term born infants, and to relate premature infants' amygdala volumes with their performance on the Laboratory Temperament Assessment Battery (Lab-TAB) fear episode at 12 months. PARTICIPANTS: Eighty one infants born between 2008 and 2014 at the University Hospitals of Geneva and Lausanne, taking part in longitudinal and functional imaging studies, who had undergone a magnetic resonance imaging (MRI) scan at TEA enabling manual amygdala delineation. OUTCOMES: Amygdala volumes assessed by manual segmentation of MRI scans; volumes of cortical and subcortical gray matter, white matter and cerebrospinal fluid (CSF) automatically segmented in 66 infants; scores for the Lab-TAB fear episode for 42 premature infants at 12 months. RESULTS: Amygdala volumes were smaller in preterm infants at TEA than term infants (mean difference 138.03 mm(3), p < 0.001), and overall right amygdala volumes were larger than left amygdala volumes (mean difference 36.88 mm(3), p < 0.001). White matter volumes were significantly smaller (p < 0.001) and CSF volumes significantly larger (p < 0.001) in preterm than in term born infants, while cortical and subcortical gray matter volumes were not significantly different between groups. Amygdala volumes showed significant correlation with the intensity of the escape response to a fearsome toy (rs = 0.38, p = 0.013), and were larger in infants showing an escape response compared to the infants showing no escape response (mean difference 120.97 mm(3), p = 0.005). Amygdala volumes were not significantly correlated with the intensity of facial fear, distress vocalizations, bodily fear and positive motor activity in the fear episode. CONCLUSION: Our results indicate that premature birth is associated with a reduction in amygdala volumes and white matter volumes at TEA, suggesting that altered amygdala development might be linked to alterations in white matter connectivity reported in premature infants. Moreover, our data suggests that such alterations might affect infants' fear-processing capabilities.

The effect of postnatal age on the early tactile manual abilities of preterm infants.

BACKGROUND: Although preterm infants possess early tactile manual abilities, the influence of the postnatal experience has not yet been systematically examined. AIMS: To investigate whether early tactile manual habituation, discrimination and recognition (following interference) of shape in preterm infants are modified by postnatal age. STUDY DESIGN: Prospective study. SUBJECTS: Forty preterm infants were assessed from the post-conceptional age (PCA) of 34 weeks. Two groups were made up according to postnatal age (PNA): low PNA (PNA≤10 days of life) and high PNA (PNA≥12 days of life). OUTCOME MEASURES: An object (prism or cylinder) was presented repeatedly in the left hand, and holding times of the object were recorded during each trial. RESULTS: Holding time was shorter for all preterm infants following successive presentation of the same object irrespective of postnatal age range. In the discrimination phase, the mean holding time for the novel object was longer than holding times in the last two habituation trials, in both PNA groups. Finally, the mean holding time of the familiar object presented in the recognition phase was shorter than the holding time of the novel object presented previously, but only in the low PNA group. CONCLUSIONS: Tactile manual habituation and discrimination of shape information is present in preterm infants at a post-conceptional age of 34 weeks, independently of postnatal age. However, tactile manual recognition of familiar shapes following interference is affected by length of postnatal experience. The significance of this last result is discussed in detail.

Emotional and effortful control abilities in 42-month-old very preterm and full-term children.

BACKGROUND: Very preterm (VP) infants are at greater risk for cognitive difficulties that may persist during school-age, adolescence and adulthood. Behavioral assessments report either effortful control (part of executive functions) or emotional reactivity/regulation impairments. AIMS: The aim of this study is to examine whether emotional recognition, reactivity, and regulation, as well as effortful control abilities are impaired in very preterm children at 42 months of age, compared with their full-term peers, and to what extent emotional and effortful control difficulties are linked. STUDY DESIGN: Children born very preterm (VP; < 29 weeks gestational age, n=41) and full-term (FT) aged-matched children (n=47) participated in a series of specific neuropsychological tests assessing their level of emotional understanding, reactivity and regulation, as well as their attentional and effortful control abilities. RESULTS: VP children exhibited higher scores of frustration and fear, and were less accurate in naming facial expressions of emotions than their aged-matched peers. However, VP children and FT children equally performed when asked to choose emotional facial expression in social context, and when we assessed their selective attention skills. VP performed significantly lower than full terms on two tasks of inhibition when correcting for verbal skills. Moreover, significant correlations between cognitive capacities (effortful control) and emotional abilities were evidenced. CONCLUSIONS: Compared to their FT peers, 42 month-olds who were born very preterm are at higher risk of exhibiting specific emotional and effortful control difficulties. The results suggest that these difficulties are linked. Ongoing behavioral and emotional impairments starting at an early age in preterms highlight the need for early interventions based on a better understanding of the relationship between emotional and cognitive difficulties.

Tactile sensory capacity of the preterm infant: manual perception of shape from 28 gestational weeks.

OBJECTIVE: Recent studies have shown that from the postconceptional age of 33 weeks, preterm infants are able to memorize tactile information about the shape of an object by using their hands, and can detect differences with another shape. This study aimed to investigate tactile abilities earlier on in development, in very preterm and mildly preterm human infants. METHODS: Infants were assigned to 2 groups according to postconceptional age: very preterm (before 32 weeks) and mildly preterm (from 32 to 33+6 weeks). The test consisted of the repeated presentation of an object (prism or cylinder) in the left hand. The experiment was conducted in 3 phases: habituation (repeated presentation of the same object), discrimination (presentation of a novel object), followed by recognition (presentation of the familiar object). RESULTS: Forty-eight newborns were recruited (24 very preterm; 24 mildly preterm). During habituation, each infant showed a decrease in the holding time of the object. Then, when a novel shape was put into the preterm newborn's hand, holding time increased. Finally, when the familiar shape was presented again, the holding time decreased. Preterm infants can memorize by touch specific features that differentiate prism and cylinder shapes, discriminate between them, and recognize them after interference. CONCLUSIONS: From 28 weeks, and from the first days of life, the preterm newborn is endowed with tactile sensory capacities. The tactile stimulations that are presented to preterm infants during their hospitalization should be adapted while respecting their sleep-wake rhythms.