Aoife Twohig1,2,3,4,5, John F Murphy6, Anthony McCarthy7,8, Ricardo Segurado9, Angela Underdown10, Anna Smyke11, Fiona McNicholas12,8, Eleanor J Molloy13,14,15,16,17. 1. Department of Paediatrics, The National Maternity Hospital, Dublin, Ireland. aoife.twohig@gmail.com. 2. Perinatal Mental Health, The National Maternity Hospital, Dublin, Ireland. aoife.twohig@gmail.com. 3. National Children's Research Centre, Children's Health Ireland, Crumlin, Dublin, Ireland. aoife.twohig@gmail.com. 4. Child Psychiatry, Children's Health Ireland, Crumlin, Dublin, Ireland. aoife.twohig@gmail.com. 5. School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland. aoife.twohig@gmail.com. 6. Department of Paediatrics, The National Maternity Hospital, Dublin, Ireland. 7. Perinatal Mental Health, The National Maternity Hospital, Dublin, Ireland. 8. School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland. 9. CSTAR, University College Dublin, Dublin, Ireland. 10. Formerly Warwick Medical School, University of Warwick, Coventry, UK. 11. Section of Child and Adolescent Psychiatry, School of Medicine, Tulane University, New Orleans, LA, USA. 12. Child Psychiatry, Children's Health Ireland, Crumlin, Dublin, Ireland. 13. National Children's Research Centre, Children's Health Ireland, Crumlin, Dublin, Ireland. 14. Department of Neonatology, Children's Health Ireland, Crumlin, Dublin, Ireland. 15. Department of Paediatrics, Coombe Women and Infants' University Hospital, Dublin, Ireland. 16. Department of Paediatrics, Children's Health Ireland, Tallaght, Dublin, Ireland. 17. Dublin School of Medicine, Trinity College Dublin, Dublin, Ireland.
Abstract
BACKGROUND: There is increasing recognition of adverse mental health consequences of preterm birth and the impact on social-emotional development. However, the quality of the developing parent-infant relationship may be protective, with enhanced maternal sensitivity to infants' cues associated with improved outcomes. METHODS: Eighty mothers and their preterm infants born <32 weeks gestation were randomised to intervention and standard care groups. Intervention comprised reflective interview, observation of infant cues and video interaction guidance (VIG). The primary outcome, maternal sensitivity during play, was measured by the Child Adult Relationship Evaluation-Index. Secondary outcomes were infant social-emotional problems measured by the Ages and Stages Questionnaire-Social-Emotional version. RESULTS: There was no statistically significant difference between the intervention and standard care groups in maternal sensitivity during play at 9 months corrected age (CA). In the secondary outcome analysis at 12 months CA, infants in the intervention group had fewer self-regulation problems than infants whose mothers received standard care. Per-protocol analysis revealed that infants whose mothers completed VIG had significantly fewer communication problems. CONCLUSIONS: This early attachment-focussed intervention integrating VIG for mothers and their preterm infants did not enhance maternal sensitivity; however, there were effects on infant social-emotional problems at 12 months CA. IMPACT: Preterm birth can adversely affect infant and parent mental health and the quality of the parent-infant relationship. Early intervention to support parent-infant interaction can have positive effects on infant social-emotional development. There was no statistically significant difference in maternal sensitivity during play at 9 months CA. However, there were fewer infant self-regulation and communication problems reported by mothers at 12 months CA following intervention. Further evaluations of attachment-focussed interventions in the neonatal intensive care unit are needed.
BACKGROUND: There is increasing recognition of adverse mental health consequences of preterm birth and the impact on social-emotional development. However, the quality of the developing parent-infant relationship may be protective, with enhanced maternal sensitivity to infants' cues associated with improved outcomes. METHODS: Eighty mothers and their preterm infants born <32 weeks gestation were randomised to intervention and standard care groups. Intervention comprised reflective interview, observation of infant cues and video interaction guidance (VIG). The primary outcome, maternal sensitivity during play, was measured by the Child Adult Relationship Evaluation-Index. Secondary outcomes were infant social-emotional problems measured by the Ages and Stages Questionnaire-Social-Emotional version. RESULTS: There was no statistically significant difference between the intervention and standard care groups in maternal sensitivity during play at 9 months corrected age (CA). In the secondary outcome analysis at 12 months CA, infants in the intervention group had fewer self-regulation problems than infants whose mothers received standard care. Per-protocol analysis revealed that infants whose mothers completed VIG had significantly fewer communication problems. CONCLUSIONS: This early attachment-focussed intervention integrating VIG for mothers and their preterm infants did not enhance maternal sensitivity; however, there were effects on infant social-emotional problems at 12 months CA. IMPACT: Preterm birth can adversely affect infant and parent mental health and the quality of the parent-infant relationship. Early intervention to support parent-infant interaction can have positive effects on infant social-emotional development. There was no statistically significant difference in maternal sensitivity during play at 9 months CA. However, there were fewer infant self-regulation and communication problems reported by mothers at 12 months CA following intervention. Further evaluations of attachment-focussed interventions in the neonatal intensive care unit are needed.