Rahkonen Petri, Heinonen Kati, Pesonen Anu-Katriina, Lano Aulikki, Autti Taina, Puosi Riina, Huhtala Ea, Andersson Sture, Metsäranta Marjo, Räikkönen Katri
Children's Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.
Scand J Psychol. 2014 Aug;55(4):311-8. doi: 10.1111/sjop.12133. Epub 2014 May 14.
Early mother-child interaction is one of the factors suggested to have an impact on neurocognitive development of extremely low gestational age (ELGA) children. Our aim was to examine associations of mother-child interaction with neurocognitive outcome, neurological impairments and neonatal brain injuries in ELGA children. A prospective study of 48 ELGA children, born before 28 gestational weeks (26.3 ± 1.2 weeks, birth weight 876 g ± 194 g), and 16 term controls. Brain MRI was performed at term-equivalent age. At two years of corrected age, the mother-child interaction was assessed in a structured play situation using the Erickson Scales and Mutually Responsive Orientation Scales. Neurocognitive outcome was assessed with Griffiths Mental Developmental Scales (GMDS) and Bayley Scales of Infant and Toddler Development - Third Edition (BSID-III) and with Hempel neurological examination. Among ELGA children, higher quality of dyadic relationship and maternal sensitivity, responsiveness, and supportiveness were associated with positive neurocognitive outcome measured both with GMDS and BSID-III (adjusted p < 0.05). This association remained after adjusting for mother's educational level. Neurological impairments at two years, white matter or gray matter abnormalities in MRI at term-equivalent age, and grade III-IV intraventricular hemorrhage during the neonatal period were not associated with mother-child interaction. This study emphasizes the importance of the quality of mother-child interaction after extremely preterm birth for neurocognitive development. Neonatal brain injury and neurological impairments were not associated with worse parent-child interaction after two years.
早期母婴互动是被认为会对极早产儿（ELGA）神经认知发育产生影响的因素之一。我们的目的是研究ELGA儿童的母婴互动与神经认知结局、神经功能障碍及新生儿脑损伤之间的关联。对48名孕28周前出生（孕龄26.3±1.2周，出生体重876 g±194 g）的ELGA儿童及16名足月儿对照进行了一项前瞻性研究。在足月相当年龄时进行脑部磁共振成像（MRI）检查。在矫正年龄2岁时，采用埃里克森量表和相互回应取向量表在结构化游戏情境中评估母婴互动。使用格里菲斯心理发展量表（GMDS）、贝利婴幼儿发展量表第三版（BSID-III）以及亨佩尔神经学检查评估神经认知结局。在ELGA儿童中，更高质量的二元关系以及母亲的敏感性、反应性和支持性与GMDS和BSID-III所测得的积极神经认知结局相关（校正p<0.05）。在对母亲的教育水平进行校正后，这种关联依然存在。2岁时的神经功能障碍、足月相当年龄时MRI中的白质或灰质异常以及新生儿期的III-IV级脑室内出血与母婴互动无关。本研究强调了极早产出生后母婴互动质量对神经认知发育的重要性。新生儿脑损伤和神经功能障碍与两年后的亲子互动较差无关。
