Twohig Aoife, Murphy John F, McCarthy Anthony, Segurado Ricardo, Underdown Angela, Smyke Anna, McNicholas Fiona, Molloy Eleanor J
Department of Paediatrics, The National Maternity Hospital, Dublin, Ireland.
Perinatal Mental Health, The National Maternity Hospital, Dublin, Ireland.
Pediatr Res. 2021 Sep;90(3):617-624. doi: 10.1038/s41390-020-01262-z. Epub 2021 Jan 11.
There is increasing recognition of adverse mental health consequences of preterm birth and the impact on social-emotional development. However, the quality of the developing parent-infant relationship may be protective, with enhanced maternal sensitivity to infants' cues associated with improved outcomes.
Eighty mothers and their preterm infants born <32 weeks gestation were randomised to intervention and standard care groups. Intervention comprised reflective interview, observation of infant cues and video interaction guidance (VIG). The primary outcome, maternal sensitivity during play, was measured by the Child Adult Relationship Evaluation-Index. Secondary outcomes were infant social-emotional problems measured by the Ages and Stages Questionnaire-Social-Emotional version.
There was no statistically significant difference between the intervention and standard care groups in maternal sensitivity during play at 9 months corrected age (CA). In the secondary outcome analysis at 12 months CA, infants in the intervention group had fewer self-regulation problems than infants whose mothers received standard care. Per-protocol analysis revealed that infants whose mothers completed VIG had significantly fewer communication problems.
This early attachment-focussed intervention integrating VIG for mothers and their preterm infants did not enhance maternal sensitivity; however, there were effects on infant social-emotional problems at 12 months CA.
Preterm birth can adversely affect infant and parent mental health and the quality of the parent-infant relationship. Early intervention to support parent-infant interaction can have positive effects on infant social-emotional development. There was no statistically significant difference in maternal sensitivity during play at 9 months CA. However, there were fewer infant self-regulation and communication problems reported by mothers at 12 months CA following intervention. Further evaluations of attachment-focussed interventions in the neonatal intensive care unit are needed.
早产对心理健康的不良影响及其对社会情感发展的影响日益受到关注。然而，发展中的母婴关系质量可能具有保护作用，母亲对婴儿线索的敏感性增强与更好的结果相关。
80名母亲及其孕龄小于32周的早产婴儿被随机分为干预组和标准护理组。干预包括反思性访谈、观察婴儿线索和视频互动指导（VIG）。主要结局指标为玩耍期间的母亲敏感性，采用儿童成人关系评估指数进行测量。次要结局指标为通过年龄与发育阶段问卷-社会情感版测量的婴儿社会情感问题。
在矫正年龄（CA）为9个月时，干预组和标准护理组在玩耍期间的母亲敏感性方面无统计学显著差异。在CA为12个月时的次要结局分析中，干预组婴儿的自我调节问题少于母亲接受标准护理的婴儿。符合方案分析显示，母亲完成VIG的婴儿沟通问题显著较少。
这种针对母亲及其早产婴儿的以早期依恋为重点并整合VIG的干预措施并未提高母亲的敏感性；然而，在CA为12个月时对婴儿社会情感问题有影响。
早产会对婴儿和父母的心理健康以及母婴关系质量产生不利影响。支持母婴互动的早期干预可对婴儿社会情感发展产生积极影响。在CA为9个月时，玩耍期间的母亲敏感性无统计学显著差异。然而，干预后在CA为12个月时，母亲报告的婴儿自我调节和沟通问题较少。需要在新生儿重症监护病房对以依恋为重点的干预措施进行进一步评估。
