Abstract
BackgroundMaturation of multiple neurobehavioral systems, including autonomic regulation, is altered by preterm birth. The purpose of this study was to determine the long-term effects of Family Nurture Intervention (FNI) in the NICU on autonomic regulation of preterm infants and their mothers.MethodA subset of infants and mothers (48% of infants, 51% of mothers) randomly assigned to either standard are (SC), or SC plus the FNI in the NICU in a prior RCT (ClincalTrials.gov; NCT01439269) returned for follow-up assessments when the children were 4 to 5 years corrected age (CA). ECGs were collected for 10 minutes in mothers and their children while children were in their mothers’ laps. Heart rate, standard deviation for heart rate, respiratory sinus arrhythmia (RSA)–an index of parasympathetic regulation, and a measure of vagal efficiency were quantified.ResultsBoth children and mothers in the FNI group had significantly greater levels of RSA compared to the SC group (child: mean difference = 0.60, 95% CI 0.17 to 1.03, p = 0.008; mother: mean difference = 0.64, 95% CI 0.07 to 1.21, p = 0.031). In addition, RSA increased more rapidly in FNI children between infancy and the 4 to 5-year follow-up time point (SC = +3.11±0.16 loge msec2, +3.67±0.19 loge msec2 for FNI, p<0.05). These results show that the rate of increase in RSA from infancy to childhood is more rapid in FNI subjects.ConclusionAlthough these preliminary follow-up results are based on approximately half of subjects originally enrolled in the RCT, they suggest that FNI-NICU led to healthier autonomic regulation in both mother and child, when measured during a brief face-to-face socioemotional interaction. A Pavlovian autonomic co-conditioning mechanism may underly these findings that can be exploited therapeutically.
Highlights
10% of infants are born before 36 weeks in the US [1]
respiratory sinus arrhythmia (RSA) increased more rapidly in Family Nurture Intervention (FNI) children between infancy and the 4 to 5-year follow-up time point (SC = +3.11±0.16 loge msec2, +3.67±0.19 loge msec2 for FNI, p
The mean (±SE) increases in RSA during quiet sleep in infancy (QS) from ~40 weeks to those when awake at 4–5 years were +3.11±0.16 loge msec2 for standard care alone (SC) and +3.67±0.19 loge msec2 for FNI
Summary
These preterm infants are at risk for multiple adverse neurobehavioral outcomes [2, 3]. Paralleling these issues, preterm infants have altered function of the autonomic nervous system (ANS). Epigenetics, and the intrauterine environment, as well as the early postnatal experience, all shape the developing central and autonomic nervous systems. Dysfunction of these systems is implicated in the subsequent development of neuropsychiatric disorders and poorer physical health throughout the lifespan [7, 8]. The purpose of this study was to determine the long-term effects of Family Nurture Intervention (FNI) in the NICU on autonomic regulation of preterm infants and their mothers
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