Department of Neonatology, Children's Hospital, University of Cologne, Köln, Germany.
J Perinatol. 2011 Jun;31(6):404-10. doi: 10.1038/jp.2010.139. Epub 2010 Dec 9.
Close contact of mother and child in the first hours after birth is essential for the establishment of a secure attachment behavior in term infants. To date, studies investigating whether a 'sensitive period' also exists for very low birth weight (VLBW) preterm infants are lacking.
Attachment patterns of 62 VLBW infants were assessed using the 'strange situation' setting and correlated with the time mothers saw their child for the first time. Furthermore, maternal and infant covariates possibly influencing the attachment behavior were analyzed. As maternal factors the mother's age, social status and pregnancy history were recorded and at three time points (time 1, 2 and 3 (t-1, t-2 and t-3)), a semi-structured interview, a depression and a social support questionnaire were performed. As infant factors neonatal basic data, ventilation time and length of hospital stay were recorded. Disease severity was scored using the clinical risk index for babies, score for neonatal acute physiology (SNAP), SNAP perinatal extension and nursery neurobiological risk score. At time points t-2 and t-3, the infants were examined using the second edition of Bayley scales of infant development.
In all, 53.2% of the children showed a secure, 33.9% an insecure-avoidant, 3.2% an insecure-ambivalent and 9.7% an insecure-disorganized attachment behavior. Preterm infants whose mothers had seen them within 3 h after birth had a higher rate of secure attachment than preterm infants with no early contact (76 versus 41%, P=0.009). Firstborns showed a significantly higher rate of insecure attachment behavior (93 versus 67%, P=0.01). No influence on attachment behavior was shown for any other maternal or infant factor.
Our results support the hypothesis that the first hours after birth are a 'sensitive period' for the development of attachment behavior in VLBW infants. When a mother is enabled to see her infant shortly after birth, the 'sensitive period' right after birth may be used to help forming an important basis for the secure attachment of the preterm infant.
母婴在出生后最初几小时的密切接触对于足月婴儿建立安全依恋行为至关重要。迄今为止，缺乏研究调查极低出生体重（VLBW）早产儿是否存在“敏感时期”。
使用“陌生情境”设置评估 62 名 VLBW 婴儿的依恋模式，并将其与母亲首次见到孩子的时间相关联。此外，还分析了可能影响依恋行为的母婴协变量。作为母亲的因素，记录了母亲的年龄、社会地位和妊娠史，并在三个时间点（时间 1、2 和 3（t-1、t-2 和 t-3））进行了半结构化访谈、抑郁和社会支持问卷。作为婴儿的因素，记录了新生儿基本数据、通气时间和住院时间。疾病严重程度使用婴儿临床风险指数、新生儿急性生理学评分（SNAP）、SNAP 围产期扩展和新生儿神经生物学风险评分进行评分。在时间点 t-2 和 t-3，使用第二版贝利婴幼儿发育量表对婴儿进行检查。
在所有婴儿中，53.2%表现出安全依恋，33.9%表现出不安全回避，3.2%表现出不安全矛盾，9.7%表现出不安全失调。出生后 3 小时内见过母亲的早产儿比没有早期接触的早产儿更有可能出现安全依恋（76%比 41%，P=0.009）。第一胎的婴儿表现出明显更高的不安全依恋行为发生率（93%比 67%，P=0.01）。没有其他母婴因素对依恋行为产生影响。
我们的结果支持这样一种假设，即出生后最初几小时是 VLBW 婴儿依恋行为发展的“敏感时期”。当母亲能够在出生后不久看到她的婴儿时，出生后立即的“敏感时期”可能被用来帮助形成早产儿安全依恋的重要基础。
