Abstract
ObjectivesThe principal aim was to investigate the feasibility of assessing mother-infant interactions at discharge and at 6 months infant corrected age in singletons born before 32 weeks of gestation. The secondary aims were to describe these interactions and their disorders, explore the association between maternal emotional state and the interactions, and assess the relationship between disordered interactions and infant social withdrawal behaviour.MethodsOLIMPE is an ancillary study of the population-based study EPIPAGE 2, which recruited preterm neonates in France in 2011. 163 dyads participated at discharge and 148 at 6 months. Interactions were observed with the Attachment During Stress (ADS) scale, which includes two behavioural subscales, for the mother (m-ADS) and her infant (i-ADS). Two professionals independently completed the ADS scales for one third of the observations. Maternal emotional state was assessed using self-administered questionnaires of depression, anxiety, and stress. Infant’s social withdrawal behaviour at 6 months was measured by the Alarm Distress Baby scale.ResultsAt discharge, 15.3% of the m-ADS scales and 43.3% of the i-ADS scales had at least one unobserved component. At 6 months, all items on both scales were noticeable in >90% of the dyads. Reliability, estimated by the kappa coefficient, ranged between 0.39 and 0.76 at discharge, and between 0.21 and 0.69 at 6 months. Disordered interactions were indicated on 48.6% of the m-ADS scales and 36.5% of the i-ADS scales at discharge. At 6 months, these rates were 32.6% and 26.0%. Disordered interactions at 6 months were associated with identified disorder at discharge. Insecure infant attachment was not influenced by maternal mental health but was strongly associated with infant social withdrawal behaviour.ConclusionsThe ADS scale can be used to screen for early interaction disorders after premature birth and may help to target dyads that would most benefit from early intervention.
Highlights
Improvements in perinatal care, including technical practices in neonatal intensive care units (NICUs) and management of high-risk pregnancies, have led to an increase in the survival rate of very preterm infants [1]
OLIMPE is an ancillary study of the population-based study EPIPAGE 2, which recruited preterm neonates in France in 2011. 163 dyads participated at discharge and 148 at 6 months
Disordered interactions were indicated on 48.6% of the m-Attachment During Stress (ADS) scales and 36.5% of the i-ADS scales at discharge
Summary
Improvements in perinatal care, including technical practices in neonatal intensive care units (NICUs) and management of high-risk pregnancies, have led to an increase in the survival rate of very preterm infants [1]. Admission to the NICU means intensive technical care and a long stay in an incubator, which limits parental proximity to their newborn. Alterations in the quality of the mother-infant interaction and maternal attachment representations have been reported, indicating a more mother-controlling dyadic pattern of interaction than after a term birth [13, 19, 20]. This pattern has been associated with infant’s behavioural symptoms, eating difficulties, and lower interest or abilities for social communication in the first two years of life [13]. The early identification of maternal or parental interaction patterns that signal risk for infant development could prompt supportive intervention at a very early age: while the infant is still in the NICU and/or shortly after discharge to home
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