Skin-to-skin contact do not improve interaction between mother and preterm infant
January 23, 2020
Science Daily/Linköping University
Following a premature birth it is important that the parents and the infant quickly establish a good relationship. Researchers at Linköping University have studied the relationship between mothers and infants who have continuous skin-to-skin contact during the entire period from birth to discharge from the hospital. The results show that continuous skin-to-skin contact does not lead to better interaction between the mother and the infant. The study is published in the scientific journal Advances in Neonatal Care.
Every year some 15 million infants worldwide are born prematurely. Because the infants often require intensive care, it is common that they are separated from their parents, which can negatively affect the attachment between mother and infant.
For the parents, this separation can result in guilt and a sense of emptiness at not being able to be close to their newborn child. For the infant, losing closeness to the parents is one of the largest stress factors in early life. But skin-to-skin care against the parent's chest, instead of care in an incubator, can reduce stress.
"Skin-to-skin contact between parent and infant has proved to have positive effects for the infant's development -- but there are no clear results regarding the effect on the interaction between mother and infant. Which is why we wanted to study this," says Charlotte Sahlén Helmer, doctoral student at Linköping University, Sweden.
In the study, the researchers investigated the interaction between mothers and infants born prematurely -- between weeks 32 and 36. The study was carried out at two Swedish hospitals, where the parents are able to be with their infant around the clock. Thirty-one families took part. The families were split into two groups: one where the mother was to give the infant continuous SSC from birth until discharge, and one where the mother was to give the infant as much or as little SSC as she wanted to, or was able to.
After four months, the researchers followed up how the mothers interacted with their preterm infants. They found no significant differences in interaction between the continuous and the intermittent skin-to-skin contact groups. As regards the mother's attachment to the infant, the researchers could not see that skin-to-skin contact had any effect in terms of e.g. the mother's acceptance of or sensitivity to the infant. Nor was there a correlation between the number of hours of skin-to-skin contact and the quality of the interaction.
"Some people say that skin-to-skin contact automatically results in good attachment between mother and infant. Our study shows that this may not be the case. It may be a relief for the parents who are not able to keep their infant against their skin around the clock, to know that they can still have good interaction. But these results must be followed up with further studies," says Charlotte Sahlén Helmer.
The study is part of a larger project investigating the effects of skin-to-skin contact in preterm infants.
https://www.sciencedaily.com/releases/2020/01/200123095901.htm
Early education setback for summer premature births
August 13, 2019
Science Daily/University of Leeds
Children born as little as three weeks premature, who consequently fall into an earlier school year are more likely to experience significant setbacks in their education after their first year of school, according to new research published today in the journal Archives of Disease in Childhood.
Previous research has already shown that children born severely prematurely, more than ten weeks early, are more likely to suffer educational problems. But the new findings highlight the disadvantage children born moderate-to-late premature may face, who were thought to be at a lower risk.
New research, from the University of Leeds and Born in Bradford, looked at the complex interplay between the educational disadvantage of being born moderately premature, and when during the year a child was born, to understand whether extra support might be necessary for some children.
This was in response to conversations with schools participating in the Bradford Opportunity Area programme, a Department for Education initiative aimed at improving outcomes for children and young people in areas that face significantly higher barriers to social mobility compared to their peers in other parts of the country. They indicated this was a specific area they would value further research into, to help inform their decision making.
Co-author Dr Liam Hill, from the University of Leeds' School of Psychology, said: "Some children born prematurely not only have to contend with having spent less time developing in the womb but also have to start school a year earlier than they would have, had they been born on their due date. This amounts to having less time also developing outside of the womb at the point they start school.
"This can pose additional challenges right from the start of their education, and we found this can have an immediate impact on their performance, after just one year of school."
The researchers looked at more than 10,000 school children from the Born in Bradford birth cohort study and found that the odds of a child not achieving a 'Good Level of Development' at the end of reception, if they were born prematurely, were approximately twice as high as those for children born at full term.
The children found to be most at risk were those born prematurely in the summer months (June to August), who consequently started school a year earlier than expected. These children were three times less likely to reach a good level of development compared to other children born prematurely during the summer, whose early arrival didn't change the year they started school in.
The researchers also analysed data that suggested that holding premature children back from starting school by a year may not compensate for being born prematurely, although they did not test that directly.
Co-author Dr Katherine Pettinger, a neonatal doctor from Born in Bradford and the Bradford Teaching Hospitals NHS Foundation Trust, said: "Whilst it seems like an obvious solution, delayed entry for premature children is not likely to compensate for being born early, as we found that within a given school year, the risks to development faced by children born premature did not vary depending on when within that school year they were born.
"To try to better support this at risk group we instead suggest that schools should be informed which of their pupils were born prematurely so they can be given extra support, particularly early on in their schooling."
According to national guidelines, once discharged from hospital severely premature children are given follow up medical support, and it is recommended that their schools are informed of their circumstances. But for moderately premature children, born between three to eight weeks early, there is no routine follow up support offered, so schools are unlikely to be informed.
To try to tackle the problem the researchers suggest:
· Tailored advice is provided to families of premature children
· Learning resources are provided for teachers to support children born prematurely in the classroom
· Routine sharing of data between health and education services
As well as highlighting the risk for premature children who start school earlier than expected, the findings also show evidence for differences in development of children born prematurely at an earlier age than any previous studies. The researchers therefore argue that from an early age there is a complex interplay between health and education, which should help encourage education providers to move away from arbitrary decision making, towards a more targeted, personalised approach.
Mark Douglas, Head of Children's Services at Bradford City Council, added: "As a City of Research, Bradford City Council is committed to supporting the translation of research into policy and practice.
"This research is a great example of how we have used the latest evidence from Born in Bradford to improve the life chances for the children of Bradford, by introducing a smarter system to share information between our health and education services."
https://www.sciencedaily.com/releases/2019/08/190813180830.htm
Prenatal stress could affect baby's brain
October 8, 2019
Science Daily/King's College London
New research from King's College London has found that maternal stress before and during pregnancy could affect a baby's brain development.
In their study published in Biological Psychiatry, MRC Doctoral Researcher in Perinatal Imaging and Health, Alexandra Lautarescu and Head of Advanced Neuroimaging, Professor Serena Counsell, for the first time looked at the relationship between maternal stress and brain development in 251 premature babies.
They found evidence for impaired development of a white matter tract, the uncinate fasciculus, in babies whose mothers experienced more stress in the prenatal period.
The mothers completed a questionnaire which asked them about their experiences of stressful events, which ranged from everyday stress such as moving house or taking an exam to more severe stressors like experiencing bereavement, separation or divorce. A score of severity of stress was calculated based on how many stressors they experienced as well as how severe those stressors were. This is what was related to the baby's brain. The researchers used a medical imaging technique called diffusion tensor imaging that was specifically developed to look at the structure of the white matter. The white matter tract has previously been implicated in anxiety disorders -- adults that have an anxiety disorder may show changes in this tract.
"We found that in the mums that were more stressed during pregnancy and the period before birth, white matter was altered in the babies," said lead researcher Alexandra Lautarescu from King's College London.
Scientists say the study highlights the importance of providing support for expectant mothers, as previous studies have shown that interventions such as cognitive behavioural therapy can help mitigate adverse outcomes in the baby. Clinicians have an important role to play when speaking with expectant mothers. While questions are asked about depressive symptoms, few questions are asked about general stress and anxiety. Women who deal with stressful life events during pregnancy are not picked up by their GPs or by their health care providers very often.
"It is not diagnosed as often as it should be during pregnancy and we are trying to emphasise that maternal mental health during pregnancy can impact the baby's brain development which may impact on their outcomes later in life," Alexandra Lautarescu said. "No one is asking these women about stress and hence they don't receive any support.
"Antenatal services need to be aware that it is important to think about stress of the mums and we need to have some kind of support there for the mums who identify that they are stressed. If we try to help these women either during the pregnancy or in the early post-natal period with some sort of intervention this will not only help the mother, but may also prevent impaired brain development in the baby and improve their outcomes overall."
There is some evidence to suggest that if mothers experience poor mental health during pregnancy that leads to adverse outcomes in the baby -- obstetric outcomes, lower birth weight or premature birth. A mother's poor mental health may also lead to altered early behavior such as more frequent crying.
Further studies are needed to understand whether the observed changes in the brain development of these babies will lead to adverse outcomes later in life.
https://www.sciencedaily.com/releases/2019/10/191008094309.htm