Stable home lives improve prospects for preemies
Medical challenges at birth less important than stressful home life in predicting future psychiatric health
August 26, 2019
Science Daily/Washington University School of Medicine
Researchers have found that as premature babies grow, their mental health may be related less to the medical challenges they face after birth than to the environment the babies enter once they leave the neonatal intensive care unit.
As they grow and develop, children who were born at least 10 weeks before their due dates are at risk for attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder and anxiety disorders. They also have a higher risk than children who were full-term babies for other neurodevelopmental issues, including cognitive problems, language difficulties and motor delays.
Researchers at Washington University School of Medicine in St. Louis who have been trying to determine what puts such children at risk for these problems have found that their mental health may be related less to medical challenges they face after birth than to the environment the babies enter once they leave the newborn intensive care unit (NICU).
In a new study, the children who were most likely to have overcome the complications of being born so early and who showed normal psychiatric and neurodevelopmental outcomes also were those with healthier, more nurturing mothers and more stable home lives.
The findings are published Aug. 26 in The Journal of Child Psychology and Psychiatry.
"Home environment is what really differentiated these kids," said first author Rachel E. Lean, PhD, a postdoctoral research associate in child psychiatry. "Preterm children who did the best had mothers who reported lower levels of depression and parenting stress. These children received more cognitive stimulation in the home, with parents who read to them and did other learning-type activities with their children. There also tended to be more stability in their families. That suggests to us that modifiable factors in the home life of a child could lead to positive outcomes for these very preterm infants."
The researchers evaluated 125 5-year-old children. Of them, 85 had been born at least 10 weeks before their due dates. The other 40 children in the study were born full-term, at 40 weeks' gestation.
The children completed standardized tests to assess their cognitive, language and motor skills. Parents and teachers also were asked to complete checklists to help determine whether a child might have issues indicative of ADHD or autism spectrum disorder, as well as social or emotional problems or behavioral issues.
It turned out the children who had been born at 30 weeks of gestation or sooner tended to fit into one of four groups. One group, representing 27% of the very preterm children, was found to be particularly resilient.
"They had cognitive, language and motor skills in the normal range, the range we would expect for children their age, and they tended not to have psychiatric issues," Lean said. "About 45% of the very preterm children, although within the normal range, tended to be at the low end of normal. They were healthy, but they weren't doing quite as well as the more resilient kids in the first group."
The other two groups had clear psychiatric issues such as ADHD, autism spectrum disorder or anxiety. A group of about 13% of the very preterm kids had moderate to severe psychiatric problems. The other 15% of children, identified via surveys from teachers, displayed a combination of problems with inattention and with hyperactive and impulsive behavior.
The children in those last two groups weren't markedly different from other kids in the study in terms of cognitive, language and motor skills, but they had higher rates of ADHD, autism spectrum disorder and other problems.
"The children with psychiatric problems also came from homes with mothers who experienced more ADHD symptoms, higher levels of psychosocial stress, high parenting stress, just more family dysfunction in general," said senior investigator Cynthia E. Rogers, MD, an associate professor of child psychiatry. "The mothers' issues and the characteristics of the family environment were likely to be factors for children in these groups with significant impairment. In our clinical programs, we screen mothers for depression and other mental health issues while their babies still are patients in the NICU."
Rogers and Lean believe the findings may indicate good news because maternal psychiatric health and family environment are modifiable factors that can be targeted with interventions that have the potential to improve long-term outcomes for children who are born prematurely.
"Our results show that it wasn't necessarily the clinical characteristics infants faced in the NICU that put them at risk for problems later on," Rogers said. "It was what happened after a baby went home from the NICU. Many people have thought that babies who are born extremely preterm will be the most impaired, but we really didn't see that in our data. What that means is in addition to focusing on babies' health in the NICU, we need also to focus on maternal and family functioning if we want to promote optimal development."
https://www.sciencedaily.com/releases/2019/08/190826104830.htm
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Music helps to build the brains of very premature babies
May 28, 2019
Science Daily/Université de Genève
To help the brains of very premature newborns develop as well as possible despite the stressful environment of intensive care, researchers propose an original solution: music written especially for them. And the first results are surprising: medical imaging reveals that the neural networks of premature infants who have listened to this music are developing much better.
In Switzerland, as in most industrialized countries, nearly 1% of children are born "very prematurely," i.e. before the 32nd week of pregnancy, which represents about 800 children yearly. While advances in neonatal medicine now give them a good chance of survival, these children are however at high risk of developing neuropsychological disorders. To help the brains of these fragile newborns develop as well as possible despite the stressful environment of intensive care, researchers at the University of Geneva (UNIGE) and the University Hospitals of Geneva (HUG), Switzerland, propose an original solution: music written especially for them. And the first results, published in the Proceedings of the National Academy of Sciences (PNAS) in the United States, are surprising: medical imaging reveals that the neural networks of premature infants who have listened to this music, and in particular a network involved in many sensory and cognitive functions, are developing much better.
The Neonatal Intensive Care Unit at the HUG welcomes each year 80 children born far too early -- between 24 and 32 weeks of pregnancy, i.e. almost four months ahead of schedule for some of them. The vast majority will survive, but half will later develop neurodevelopmental disorders, including learning difficulties, attentional or emotional disorders. "At birth, these babies' brains are still immature. Brain development must therefore continue in the intensive care unit, in an incubator, under very different conditions than if they were still in their mother's womb," explains Petra Hüppi, professor at the UNIGE Faculty of Medicine and Head of the HUG Development and Growth Division, who directed this work. "Brain immaturity, combined with a disturbing sensory environment, explains why neural networks do not develop normally."
A tailor-made music
The Geneva researchers started from a practical idea: since the neural deficits of premature babies are due, at least in part, to unexpected and stressful stimuli as well as to a lack of stimuli adapted to their condition, their environment should be enriched by introducing pleasant and structuring stimuli. As the hearing system is functional early on, music appeared to be a good candidate. But which music? "Luckily, we met the composer Andreas Vollenweider, who had already conducted musical projects with fragile populations and who showed great interest in creating music suitable for premature children," says Petra Hüppi.
Lara Lordier, PhD in neurosciences and researcher at the HUG and UNIGE, unfolds the musical creation process. "It was important that these musical stimuli were related to the baby's condition. We wanted to structure the day with pleasant stimuli at appropriate times: a music to accompany their awakening, a music to accompany their falling asleep, and a music to interact during the awakening phases." To choose instruments suitable for these very young patients, Andreas Vollenweider played many kinds of instruments to the babies, in the presence of a nurse specialized in developmental support care. "The instrument that generated the most reactions was the Indian snake charmers' flute (the punji)," recalls Lara Lordier. "Very agitated children calmed down almost instantly, their attention was drawn to the music!" The composer thus wrote three sound environments of eight minutes each, with punji, harp and bells pieces.
More efficient brain functional connections through music
The study was conducted in a double-blind study, with a group of premature infants who listened to the music, a control group of premature infants, and a control group of full-term newborns to assess whether the brain development of premature infants who had listened to the music would be more similar to that of full-term babies. Scientists used functional MRI at rest on all three groups of children. Without music, premature babies generally had poorer functional connectivity between brain areas than full-term babies, confirming the negative effect of prematurity. "The most affected network is the salience network which detects information and evaluates its relevance at a specific time, and then makes the link with the other brain networks that must act. This network is essential, both for learning and performing cognitive tasks as well as in social relationships or emotional management," says Lara Lordier.
In intensive care, children are overwhelmed by stimuli unrelated to their condition: doors open and close, alarms are triggered, etc. Unlike a full-term baby who, in utero, adjusts its rhythm to that of its mother, the premature baby in intensive care can hardly develop the link between the meaning of a stimulus in a specific context. On the other hand, the neural networks of children who heard Andreas Vollenweider's music were significantly improved: the functional connectivity between the salience network and auditory, sensorimotor, frontal, thalamus and precuneus networks, was indeed increased, resulting in brain networks organisation more similar to that of full-term infants.
When children grow up
The first children enrolled in the project are now 6 years old, at which age cognitive problems begin to be detectable. Scientists will now meet again their young patients to conduct a full cognitive and socio-emotional assessment and observe whether the positive outcomes measured in their first weeks of life have been sustained.
https://www.sciencedaily.com/releases/2019/05/190528095220.htm