Abstract
After birth, preterm infants face a stressful environment, which may negatively impact early brain development and subsequent neurobehavioral outcomes. This randomized controlled trial involving 45 women with infants <30-wk gestation, assessed the effectiveness of training parents in reducing stressful experiences. Intervention consisted of 10 sessions in the Neonatal Intensive Care Unit (NICU). Postintervention, at term-equivalent (40-wk postmenstrual age), magnetic resonance imaging (MRI) was performed to evaluate brain structure and development. Quantitative volumetric techniques were used to estimate overall and regional brain volumes for different tissue types including CSF, CGM, DNGM, UWM, and MWM. DTI was used to evaluate the integrity and maturation of white matter by ADC and FA. Maturation and connectivity of white matter, characterized by diffusion MR measures of ADC and FA, were significantly enhanced in the intervention group, who displayed greater restriction in ADC and increase in FA. There were no significant effects on either brain volumes or on short-term medical outcomes. Thus, sensitivity training for parents in the NICU is associated with improved cerebral white matter micro-structural development in preterm infants.
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Abbreviations
- ADC:
-
apparent diffusion coefficient
- CGM:
-
cortical gray matter
- CSF:
-
cerebrospinal fluid
- DNGM:
-
deep nuclear gray matter
- DTI:
-
diffusion tensor imaging
- FA:
-
fractional anisotropy
- MITP:
-
mother-infant transaction program
- MWM:
-
myelinated white matter
- NIDCAP:
-
Newborn Individualized Developmental Care and Assessment Program
- PLIC:
-
posterior limb of the internal capsule
- ROI:
-
region of interest
- UWM:
-
un-myelinated white matter
References
Saigal S, Doyle LW 2008 An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 371: 261–269
Inder TE, Warfield SK, Hong W, Huppi PS, Volpe JJ 2005 Abnormal cerebral structure is present at term in premature infants. Pediatrics 115: 286–294
Thompson DK, Wood SJ, Doyle LW, Warfield SK, Lodygensky GA, Anderson PJ, Egan GF, Inder TE 2008 Neonatal hippocampal volumes: prematurity, perinatal predictors, and 2-year outcome. Ann Neurol 63: 642–651
Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE 2006 Neonatal MRI to predict neurodevelopmental outcome in preterm infants. N Engl J Med 355: 685–694
Beauchamp MH, Thompson DK, Howard K, Doyle LW, Egan GF, Inder TE, Anderson PJ 2008 Preterm infant hippocampal volumes correlate with later working memory deficits. Brain 131: 2986–2994
Nosarti C, Rushe TM, Woodruff PW, Stewart AL, Rifkin L, Murray RM 2004 Corpus callosum size and very preterm birth: relationship to neuropsychological outcome. Brain 127: 2080–2089
Isaacs EB, Lucas A, Chong WK, Wood SJ, Johnson CL, Marshall C, Vargha-Khadem F, Gadian DG 2000 Hippocampal volume and everyday memory in children of very low birth weight. Pediatr Res 47: 713–720
Peterson BS, Vohr B, Staib LH, Cannistraci CJ, Dolberg A, Schneider KC, Katz KH, Westerveld M, Sparrow S, Anderson AW, Duncan CC, Makuch RW, Gore JC, Ment LR 2000 Regional brain volume abnormalities and long-term cognitive outcome in preterm infants. JAMA 284: 1939–1947
Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ, Simon NP, Wilson DC, Broyles S, Bauer CR, Delaney-Black V, Yolton KA, Fleisher BE, Papile LA, Kaplan MD 2000 Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network 1993–1994. Pediatrics 105: 1216–1226
Rickards AL, Kitchen WH, Doyle LW, Ford GW, Kelly EA, Callanan C 1993 Cognition, school performance and behavior in very low birth weight and normal birth weight children at 8 years of age: a longitudinal study. J Dev Behav Pediatr 14: 363–368
Als H, Duffy FH, McAnulty GB, Rivkin MJ, Vajapeyam S, Mulkern RV, Warfield SK, Huppi PS, Butler SC, Conneman N, Fischer C, Eichenwald EC 2004 Early experience alters brain function and structure. Pediatrics 113: 846–857
Newnham CA, Milgrom J, Skouteris H 2009 Effectiveness of a modified Mother-Infant Transaction Program on outcomes for preterm infants from 3 to 24 months of age. Infant Behav Dev 32: 17–26
Vázquez DM, Lopez JF, Van Hoers H, Watson SJ, Levine S 2000 Maternal deprivation regulates serotonin 1A & 2A receptors in the infant rat. Brain Res 855: 76–82
Carlson M, Earls F 2000 Social ecology and the development of stress regulation. In: Bergman LR, Cairns RB, Nilsson, Nystedt L (eds) Developmental Science and the Holistic Approach. Lawrence Erlbaum Associates, Mahwah, NJ, pp 229–248
Als H 1990 Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Training Guide. Children's Hospital, Boston, MA
Als H 1999 Reading the premature infant. In: Goldson (ed) Nurturing the Premature Infant: Developmental Interventions in the Neonatal Intensive Care Nursery. Oxford University Press, New York, NY, pp 18–85
Rauh VA, Nurcombe B, Achenbach T, Howell C 1990 The Mother-infant transaction program. Clin Perinatol 17: 31–45
Achenbach TM, Howell CT, Aoki MF 1993 Nine-year outcome of the Vermont Intervention Program for low-birthweight infants. Pediatrics 91: 45–55
Inder TE, Anderson NJ, Spencer C, Wells S, Volpe JJ 2003 White matter injury in the premature infant: a comparison between serial cranial sonographic and MR findings at term. AJNR Am J Neuroradiol 24: 805–809
Warfield S 1996 Fast k-NN classification for multichannel image data. Pattern Recognit Lett 17: 713–721
Warfield SK, Kaus M, Jolesz FA, Kilinis R 2000 Adaptive, template moderated, spatially varying statistical classification. Med Image Anal 4: 43–55
Stejskal EO, Tanner JE 1965 Spin diffusion measurements: spin echoes in the presence of a time-dependent field gradient. J Chem Phys 42: 288–292
Moher D, Schulz KF, Altman DG 2001 The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357: 1191–1194
Altman DG 1998 Adjustment for covariate imbalance. In: Armitage P, Colton T (eds) Encyclopedia of Biostatistics. John Wiley, Chichester, England, pp 1000–1005
Krishnan ML, Dyet LE, Boardman JP, Kapellou O, Allsop JM, Cowan F, Edwards AD, Rutherford MA, Counsell SJ 2007 Relationship between white matter apparent diffusion coefficients in preterm infants at term-equivalent age and developmental outcome at 2 years. Pediatrics 120: e604–e609
Rose SE, Hatzigeorgiou X, Strudwick MW, Durbridge G, Davies PS, Colditz PB 2008 Altered white matter diffusion anisotropy in normal and preterm infants at term-equivalent age. Magn Reson Med 60: 761–767
Volpe JJ 2009 Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol 8: 110–124
Mathur AM, Neil JJ, McKinstry RC, Inder TE 2008 Transport, monitoring and successful brain MR imaging in unsettled neonates. Pediatr Radiol 38: 260–264
Rangon C-M, Fortes S, Lelièvre V, Leroux P, Plaisant F, Joubert C, Lanfumey L, Cohen-Salmon C, Gressens P 2007 Chronic mild stress during gestation worsens neonatal brain lesions in mice. J Neurosci 27: 7532–7540
Kapoor A, Dunn E, Kostaki A, Andrews MH, Matthews SG 2006 Fetal programming of hypothalamo-pituitary-adrenal function: prenatal stress and glucocorticoids. J Physiol 572: 31–44
Macri S, Chiarotti F, Wurbel H 2008 Maternal separation and maternal care act independently on the development of HPA responses in male rats. Behav Brain Res 191: 227–234
Westrup B, Kleberg A, von Eichwald K, Stjernqvist K, Lagercrantz H 2000 A randomized controlled trial to evaluate the effects of the newborn individualized developmental care and assessment program in a Swedish setting. Pediatrics 105: 66–72
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We thank the families who took part in this study.
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Supported by a grant from the Financial Markets Foundation for Children.
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Milgrom, J., Newnham, C., Anderson, P. et al. Early Sensitivity Training for Parents of Preterm Infants: Impact on the Developing Brain. Pediatr Res 67, 330–335 (2010). https://doi.org/10.1203/PDR.0b013e3181cb8e2f
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DOI: https://doi.org/10.1203/PDR.0b013e3181cb8e2f
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