Early Infant Development Research Articles

Maternal attachment insecurity is a potent predictor of depressive symptoms in the early postnatal period

Maternal attachment insecurity is a potent predictor of depressive symptoms in the early postnatal period

Early Infant Development and Intervention for Autism Spectrum Disorder.

The objective is to overview recent findings on early detection/diagnosis of autism spectrum disorders, as well as clinical trials of early interventions for toddlers at risk for/diagnosed with autism spectrum disorder. Prospective studies of infants at high risk of autism spectrum disorder have yielded significant advances in understanding early development in autism spectrum disorder. Findings from prospective studies indicate that abnormalities in social communication and repetitive behaviors emerge during the second year, whereas additional "prodromal features" (motor and sensory abnormalities) emerge in the first year. Subsequently, exciting progress has been made in establishing the efficacy of autism spectrum disorder-specific interventions for toddlers as young as 15 months. Finally, efforts occur to characterize autism spectrum disorder-specific characteristics in genetic syndromes with concurrent autism spectrum disorder symptomatology. Substantial progress in characterizing early developmental trajectories as well as the identification of specific behavioral markers has aided early detection. Work remains to ensure that research findings are translated into clinical practice for uptake in the health care system.

Dyadic co-regulation, affective intensity and infant's development at 12 months: A comparison among extremely preterm and full-term dyads

Extremely low gestational age children (ELGA, born below 28 weeks of GA) represent the most at-risk preterm group in terms of survival, developmental sequelae and rates of impairment and cognitive delays. However, the impact of an extremely preterm birth on mother–infant co-regulation and affective intensity which may affect early infant's development has not been investigated. Based on a relational dynamic system approach, our study aimed to investigate the quality of co-regulation and affective intensity during spontaneous play interaction in 20 mother–infant ELGA dyads compared to 20 full-term (FT) dyads at 12 months (corrected age for ELGA infants). Relationships between the quality of dyadic co-regulation and the infant's level of cognitive, motor and language development were also investigated. The quality of dyadic co-regulation was assessed using the Revised Relational Coding System (R-RCS) by Fogel et al. (2003), the mothers’ and infants’ affective intensity was coded using a coding system by Lunkenheimer, Olson, Hollenstein, Sameroff, and Winter (2011). Infants’ development was assessed using the Bayley Scales (BSID-III, 2006). With respect to FT dyads, ELGA dyads were characterised by less frequent symmetric and more frequent unilateral co-regulation patterns and by less positive and more neutral affective intensity of both infants and mothers. Cognitive, motor and language scores were lower in ELGA infants than in FT infants. Symmetrical co-regulation was related to motor scores in ELGA infants, and to cognitive scores in FT infants. Our findings contribute to the literature by demonstrating the difficulties of ELGA mother–infant dyads at 12 months in sharing the symmetric co-regulation and positive affective intensity and how symmetric co-regulation is strictly related to motor development in ELGA infants. Based on these findings, intervention programmes to foster joint attention, active involvement and positive affective intensity in ELGA dyads and infants’ development in the first year of life should be designed.

Profiling of Human Milk miRNA

Breastmilk has been recently identified as a rich source of miRNA with potential regulatory functions in the infant. We compared the miRNA content of breastmilk with that of circulating blood in lactating women, with the aim to shed light into the potential functions of these milk molecules and their origin. Breastmilk and blood samples were collected from 10 mothers in month 2 of lactation. miRNA was analyzed from the cellular and lipid fraction of breastmilk as well as maternal peripheral blood mononucleated cells (PBMCs) and plasma using the TaqMan OpenArray system for 770 different human miRNAs. The total miRNA content of breastmilk and blood was high, particularly in the breastmilk cellular fraction and PBMCs. More than 293 miRNA species were detected in breastmilk cells, 233 in the breastmilk lipids, 169 in blood plasma and 345 in PBMCs. Single correlation analysis showed that within milk cells, milk lipids, and PBMCs, miRNA expression levels were similar among participants. In plasma, marked inter‐individual variation in single miRNA species was observed. Cluster analysis indicated that the miRNA profiles of breastmilk cells and lipids grouped together; however, differences were seen between PBMCs and plasma, with the latter showing the most variable miRNA composition. This study confirms the rich miRNA nature of human breastmilk. Our comparisons between blood and milk miRNA suggest that a proportion of milk miRNA may be derived from the maternal bloodstream, whilst some may originate from the breast epithelium. Given the recently identified stability and function of food‐derived miRNA in regulating mammalian genes, we propose that breastmilk is a rich source of miRNA, which may contribute to early infant development.

Early influence of auditory stimuli on upper-limb movements in young human infants: an overview.

Given that the auditory system is rather well developed at the end of the third trimester of pregnancy, it is likely that couplings between acoustics and motor activity can be integrated as early as at the beginning of postnatal life. The aim of the present mini-review was to summarize and discuss studies on early auditory-motor integration, focusing particularly on upper-limb movements (one of the most crucial means to interact with the environment) in association with auditory stimuli, to develop further understanding of their significance with regard to early infant development. Many studies have investigated the relationship between various infant behaviors (e.g., sucking, visual fixation, head turning) and auditory stimuli, and established that human infants can be observed displaying couplings between action and environmental sensory stimulation already from just after birth, clearly indicating a propensity for intentional behavior. Surprisingly few studies, however, have investigated the associations between upper-limb movements and different auditory stimuli in newborns and young infants, infants born at risk for developmental disorders/delays in particular. Findings from studies of early auditory-motor interaction support that the developing integration of sensory and motor systems is a fundamental part of the process guiding the development of goal-directed action in infancy, of great importance for continued motor, perceptual, and cognitive development. At-risk infants (e.g., those born preterm) may display increasing central auditory processing disorders, negatively affecting early sensory-motor integration, and resulting in long-term consequences on gesturing, language development, and social communication. Consequently, there is a need for more studies on such implications.

Preterm small-for-gestational age children: predictive role of gestational age for mental development at the age of 2 years.

The aim of the study was to compare the cognitive development of very low birth weight (VLBW) preterm SGA children and preterm AGA children at the age of 2 years. The hypothesis was that SGA children are at an additional risk for deficits in cognitive function. Additionally, the impact of neonatal risk factors and the parents' profession on the early cognitive development was analysed. Cognitive function of 107 preterm infants with a gestational age of 24-35 weeks was assessed with the Mental Bayley Scales of Infant Development at the age of 2 years (mean±SEM). The results of SGA (n=38) and AGA (n=69) children were compared as well as neonatal risk factors and parental education. There was a linear regression between the Mental Bayley Scales result and gestational age for preterm infants with a gestational age of 24-32 weeks. SGA and AGA children did not differ significantly in their cognitive function at the age of 2 years. A strong association was found between the parents' profession and cognitive development. Among the neonatal risk factors, bronchopulmonary dysplasia was a strong predictor of mental development. Cognitive development of two-year-old preterm children with a gestational age of 24-32 weeks was mainly related to their gestational age. Being born preterm and small for gestational age was not additionally associated with cognitive deficits at the age of 2 years. The parents' profession had a significant impact on the cognitive development. The role of the parents' profession on the early development of preterm infants should be elucidated in further studies.

Breaking the Chain of Abuse: A Therapeutic Approach for Adolescent Mothers and Their Children

Background: Becoming a mother when one is still an adolescent interrupts the process of adolescent development. These difficulties are made more serious by the traumatic effects of the previous experiences of mistreatment and/or abuse. The child’s development is threatened by the fact that, in addition to being a possible target for the re-enactment of the mistreatment, she also serves as a container for the needs and projections of her mother, and is not able to mentalize. Method: This article examines the psychodynamic aspects of maternity in these adolescents, the interrelation between mother and child and their effects on the emotional development of the child. It describes and illustrates with case examples a therapeutic approach that focusses on the mother–child dyad. The treatment method is designed for children aged 0 to 2.5 and their adolescent mothers. It takes into account the difficulty of reaching adolescent mothers with traditional psychotherapy and integrates the acquisitions of the attachment theory and the studies of the early infant development. The therapeutic interventions (once a week for 60 minutes over two years) take place at the mother’s home. The therapists’ interventions are designed to help the mother recognize the child’s needs and signals, correct the distortions in the perceptions of the child, diminish splitting, promote the emergence of conflict in the relationship and elaborate instead of acting out them, getting in touch with one’s split off traumatic experiences and give voice to the baby. Results: The presentation of some case material will demonstrate the methodological approach, show the improvement in the relationship between mother and child, its transformations and the mother’s new capacity of mentalization. Conclusion: The treatment encourages the mothers to take back the projections they had been subjecting their children to, reprocess their own traumatic experiences and, consequently, resume their adolescent development, as well as providing support for the children, thereby breaking the chain of abuse. Keywords: Adolescents, pregnancy, mothers and infants, psychotherapy, attachment.

Maternal anxiety and infants' hippocampal development: timing matters

Exposure to maternal anxiety predicts offspring brain development. However, because children's brains are commonly assessed years after birth, the timing of such maternal influences in humans is unclear. This study aimed to examine the consequences of antenatal and postnatal exposure to maternal anxiety upon early infant development of the hippocampus, a key structure for stress regulation. A total of 175 neonates underwent magnetic resonance imaging (MRI) at birth and among them 35 had repeated scans at 6 months of age. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) at week 26 of pregnancy and 3 months after delivery. Regression analyses showed that antenatal maternal anxiety did not influence bilateral hippocampal volume at birth. However, children of mothers reporting increased anxiety during pregnancy showed slower growth of both the left and right hippocampus over the first 6 months of life. This effect of antenatal maternal anxiety upon right hippocampal growth became statistically stronger when controlling for postnatal maternal anxiety. Furthermore, a strong positive association between postnatal maternal anxiety and right hippocampal growth was detected, whereas a strong negative association between postnatal maternal anxiety and the left hippocampal volume at 6 months of life was found. Hence, the postnatal growth of bilateral hippocampi shows distinct responses to postnatal maternal anxiety. The size of the left hippocampus during early development is likely to reflect the influence of the exposure to perinatal maternal anxiety, whereas right hippocampal growth is constrained by antenatal maternal anxiety, but enhanced in response to increased postnatal maternal anxiety.

Role of parenteral lipid emulsions in the preterm infant

Parenteral nutrition (PN) is necessary for infants unable to receive adequate calories enterally due to prematurity, decreased bowel length, or functional intestinal disorders. While PN can be life saving, its use is associated with significant risks of sepsis from catheter-associated infections and progressive liver dysfunction from prolonged use. The preterm infant population is at highest risk for these complications due to the presence of multiple comorbidities and immaturity of the biliary system. Strong data has implicated parenteral lipids in the multifactorial pathogenesis of PN-associated liver disease (PNALD). However, lipids are essential in early infant development, particularly in the neurocognitive development of preterm infants. Substitution of the lipid source from soybean oil to fish oil has emerged as a safe and efficacious treatment of PNALD, with marked improvements in morbidity and mortality. Knowledge of the developmental needs and physiologic limitations of preterm infants is crucial to optimizing parenteral lipid administration to nurture growth, and minimize and treat associated complications. The purpose of this review is to provide an overview of lipid requirements of the preterm infant and discuss the role of parenteral lipid emulsions in the management of PNALD and other diseases of prematurity.

Visual function in preterm infants: visualizing the brain to improve prognosis

Considerable development of the visual system occurs in the third trimester of life, a time when very preterm-born infants are in a neonatal intensive care unit (NICU). Their very early birth during a period of rapid and marked neurodevelopment and their clinical course makes them a very high-risk population. A range of different events impacts brain development and the visual system, leading to significant long-term visual dysfunction. Improved neuroimaging techniques provide an important window on the early brain and visual system development of these vulnerable infants. Greater understanding of the etiology of visual impairment subsequent to preterm birth and the timing of critical processes will allow early recognition and the earlier implementations of interventions. In the longer term, this will help clinicians optimize NICU practice to reduce the incidence of visual dysfunction in these children.

Early neurobehavioral development of preterm infants

The aim of the present study was to assess the very early neurobehavioral development of preterm infants and to examine differences regarding sex. Two-hundred and two preterm infants were assessed by the Neurobehavioral Assessment of the Preterm Infant (NAPI), which was carried out at 32-37 weeks post-conceptional age in the hospital setting. The infants' performance was compared to a norm-referenced sample and a comparison between groups regarding sex was also done. In comparison to the NAPI norm-reference, the preterm infants showed less muscular tonicity on the scarf sign, less vigor and spontaneous movement, higher alertness and orientation, weaker cry, and more sleep state. There was no statistical difference between males and females preterm infants at NAPI performances.

From Communications Game to Cities Tango

The paper first discusses early work that predated internet art and that was concerned with active audience participation in electronic art and describes the path of development of the first author’s artworks that have looked at human to human communication through electronic (computer) systems from 1970 until today. The fundamental concept has been to make artworks that explore human communication through conversations using restricted languages. The initial inspiration was a set of studies of early infant language development. The paper goes on to describe the latest developments in this series of artworks: Cities Tango.

Sensory-motor problems in Autism.

Despite being largely characterized as a social and cognitive disorder, strong evidence indicates the presence of significant sensory-motor problems in Autism Spectrum Disorder (ASD). This paper outlines our progression from initial, broad assessment using the Movement Assessment Battery for Children (M-ABC2) to subsequent targeted kinematic assessment. In particular, pronounced ASD impairment seen in the broad categories of manual dexterity and ball skills was found to be routed in specific difficulties on isolated tasks, which were translated into focused experimental assessment. Kinematic results from both subsequent studies highlight impaired use of perception-action coupling to guide, adapt and tailor movement to task demands, resulting in inflexible and rigid motor profiles. In particular difficulties with the use of temporal adaption are shown, with “hyperdexterity” witnessed in ballistic movement profiles, often at the cost of spatial accuracy and task performance. By linearly progressing from the use of a standardized assessment tool to targeted kinematic assessment, clear and defined links are drawn between measureable difficulties and underlying sensory-motor assessment. Results are specifically viewed in-light of perception-action coupling and its role in early infant development suggesting that rather than being “secondary” level impairment, sensory-motor problems may be fundamental in the progression of ASD. This logical and systematic process thus allows a further understanding into the potential root of observable motor problems in ASD; a vital step if underlying motor problems are to be considered a fundamental aspect of autism and allow a route of non-invasive preliminary diagnosis.

Temperament in the First 2 Years of Life in Infants at High-Risk for Autism Spectrum Disorders

The current study investigated early temperament in 54 infants at familial high-risk of ASD and 50 controls. Parental report of temperament was assessed around 7, 14 and 24 months of age and diagnostic assessment was conducted at 3 years. The high-risk group showed reduced Surgency at 7 and 14 months and reduced Effortful Control at 14 and 24 months, compared to controls. High-risk infants later diagnosed with ASD were distinguished from controls by a temperament profile marked by increased Perceptual Sensitivity from the first year of life, and increased Negative Affect and reduced Cuddliness in the second year of life. Temperament may be an important construct for understanding the early infant development of ASD.

Influenza Pandemics—Pregnancy, Pathogenesis, and Perinatal Outcomes

SINCE THE 1918 INFLUENZA PANDEMIC, IT HAS BEEN clear that pandemic influenza is associated with increased morbidity and mortality in pregnancy, and more recent studies have shown that nonpandemic seasonal influenza strains also lead to morbidity for pregnant women and their infants. In the 2009 worldwide pandemic of influenza A(H1N1)pdm09, pregnant women were at high risk for severe complications, including death and intensive care unit admission. The adverse effects of antenatal influenza infection on pregnant women and their infants suggest a biological effect of influenza infection in the mother that compromises the fetus. These effects are rarely associated with direct infection of the fetus with influenza virus, although fetal infection has been reported infrequently during epidemics, pandemics, and with the H5N1 influenza strain. Instead, it appears that the normal pregnancy-associated immunologic changes may inhibit the inflammatory response to influenza virus infection in pregnancy, leading to increased risks to mother and infant. Because of these observations, pregnant women have been listed among high-risk groups for seasonal influenza vaccine in the United States since 1997, and safety data suggest these vaccines are safe in pregnancy. Pregnant women were prioritized for immunization during the 2009 influenza A(H1N1)pdm09 pandemic, despite limited data on the safety of pandemic influenza vaccines in pregnancy. In this issue of JAMA, Pasternak and colleagues report the results of an observational cohort study on the safety in pregnancy of the monovalent inactivated ASO3adjuvanted split virion influenza A(H1N1)pdm09 vaccine. The authors linked several Danish national registries to examine outcomes in infants born during the 2009 influenza A(H1N1)pdm09 pandemic. From a cohort of 53 432 infants, 6989 received the influenza vaccine during pregnancy. The authors included 330 infants whose mothers received the influenza A(H1N1)pdm09 vaccine in the first trimester and 6642 infants whose mothers received the vaccine in the second or third trimesters in propensity score analyses matched 1:1 with infants whose mothers were unvaccinated. No statistically significant relationships were found between receipt of vaccine and several perinatal outcomes, including major birth defects, preterm birth, and fetal growth restriction. The authors had sufficient sample size to exclude these adverse outcomes after vaccination in the second or third trimesters, but could only exclude moderate to large risks after vaccination in the first trimester. In addition, these authors recently reported on the risk of fetal death (spontaneous abortion and stillbirth) in the same cohort and found no increased risk after vaccination in pregnancy. These results suggest that this monovalent adjuvanted pandemic vaccine is safe when given during pregnancy. The authors did not address the question of vaccine effectiveness and did not discuss the issue of narcolepsy, which was observed with use of this adjuvanted vaccine in Scandinavian countries. However, the researchers have the opportunity to follow up this cohort of children to determine long-term vaccine safety, ie, assessment of early infant development. Recently, Fell et al reported a similar analysis of the use of H1N1 pdm09 adjuvanted vaccine in a cohort in Ontario, Canada, of 55 570 pregnant women, of whom 23 340 received the vaccine. This study demonstrated that mothers who were immunized were less likely than mothers who were not to have an infant with small for gestational age (relative risk [RR], 0.90; 95% CI, 0.85-0.96), preterm birth at less than 32 weeks gestation (RR, 0.73; 95% CI, 0.530.91), and fetal death (RR, 0.66; 95% CI, 0.47-0.91). Reports of maternal vaccination during seasonal influenza have also shown a reduction in the proportion of small for gestational age births and an increase in mean birth weight associated with immunization of the pregnant woman, or a decrease in birth weight related to influenza infection. The pandemic vaccine used in Denmark was an adjuvanted vaccine. In the United States, a nonadjuvanted vaccine was used during the 2009 pandemic with identical H1N1 viral antigens, which were also included in the seasonal trivalent vaccines for 2009-2012. Data from the United States

Neural Tract Development of Infants Born to Methadone-Maintained Mothers

The early cerebral connective tract development of infants born to methadone-maintained mothers and comparison infants was examined using diffusion tensor imaging. Drawing on animal models, we hypothesized higher mean diffusivity in methadone-exposed infants, corresponding to the delayed or altered maturation of neural connective tracts. Thirteen methadone-exposed infants and seven comparison infants were scanned within 13-44 days after birth. Mean diffusivity was compared across groups voxelwise throughout a common white matter skeleton defined for the sample, and in probabilistically defined tracts of interest overlapping the skeleton, i.e., the superior and inferior longitudinal fasciculi. Higher mean diffusivity (P < 0.05) in methadone-exposed infants was evident in the superior longitudinal fasciculus regionally by voxelwise analysis and whole-tract analysis. These results are preliminary, given the small sample. However, all observed effects were in the hypothesized direction, with methadone-exposed infants exhibiting higher mean diffusivity, suggesting altered maturation of connective tracts. Such differences may underlie some of the increased risk for cognitive and behavioral difficulties in children born to mothers using opioids. These findings highlight the need for further assessments of the effects of prenatal methadone exposure on neural development.

Early Childhood Development of Late-Preterm Infants: A Systematic Review

Late-preterm infants (LPIs) born at 34 to 36 weeks' gestation are increasingly regarded as being at risk for adverse developmental outcomes. To date, the early childhood development of LPIs has not been systematically considered. To undertake a broad examination of literature relating to early childhood development at the ages of 1 to 7 years of LPIs born at 34 to 36 weeks' gestation. We conducted a systematic review of early childhood outcomes in LPIs by using 9 electronic databases (January 1980 to March 2010). Bibliographies were reviewed. After examination of abstracts, ineligible studies were excluded. A specifically designed data-extraction form was used. The methodologic quality of included studies was assessed by using well-documented quality-appraisal guidelines. Of 4581 studies, 10 (3 prospective and 7 retrospective cohort) were included. Studies were heterogeneous, and poorer outcomes were reported among LPIs in relation to neurodevelopmental disabilities, educational ability, early-intervention requirements, medical disabilities, and physical growth in comparison to term-born children. No identified study used healthy nonadmitted LPIs as a comparison group for admitted LPIs. Evidence suggests that LPIs are at increased risk of adverse developmental outcomes and academic difficulties up to 7 years of age in comparison to term infants. An infant control group matched for gestational age has not been used; thus, for LPIs, the effect of neonatal admission on longer-term outcomes has not been fully explored. Systematic measurement of early childhood outcomes is lacking, and focused long-term follow-up studies are needed to investigate early childhood development after late-preterm birth.

Estimating the impact of mandatory fortification of bread with iodine on pregnant and post-partum women

BackgroundIodine deficiency has re-emerged in Australia. Pregnant and breastfeeding women need higher iodine intakes (estimated average requirements: 160 μg/day and 190 μg/day) than non-pregnant women (100 μg/day) because iodine is...

Optical Brain Imaging Reveals General Auditory and Language-Specific Processing in Early Infant Development

This study uses near-infrared spectroscopy in young infants in order to elucidate the nature of functional cerebral processing for speech. Previous imaging studies of infants' speech perception revealed left-lateralized responses to native language. However, it is unclear if these activations were due to language per se rather than to some low-level acoustic correlate of spoken language. Here we compare native (L1) and non-native (L2) languages with 3 different nonspeech conditions including emotional voices, monkey calls, and phase scrambled sounds that provide more stringent controls. Hemodynamic responses to these stimuli were measured in the temporal areas of Japanese 4 month-olds. The results show clear left-lateralized responses to speech, prominently to L1, as opposed to various activation patterns in the nonspeech conditions. Furthermore, implementing a new analysis method designed for infants, we discovered a slower hemodynamic time course in awake infants. Our results are largely explained by signal-driven auditory processing. However, stronger activations to L1 than to L2 indicate a language-specific neural factor that modulates these responses. This study is the first to discover a significantly higher sensitivity to L1 in 4 month-olds and reveals a neural precursor of the functional specialization for the higher cognitive network.

Early Development of Epileptic Infants with Pre- or Perinatal Brain Injuries: Role of the Epileptic Disorder

To try to understand the causative role of epilepsy PER SE in the developmental deterioration of brain injured infants, twenty-eight infants affected with early acquired, pre- and perinatal brain injuries were enrolled and divided into three groups, a) those with West syndrome, b) those with other non-West epilepsies, and c) those without epilepsy. Developmental monitoring consisted of a full clinical assessment, including examination of visual function, Griffiths developmental scales, standard EEG, long-term monitoring when necessary, and MRI, from the seizure onset or the first observation to the end of follow-up. Patients with epilepsy showed at study onset abnormal clinical features (neurological and developmental) distinct from those of non-epileptic patients, partially due to the varying severity of their brain injuries. A definite differentiation between groups was observed in the clinical evolution that showed among the epileptic patients, mostly in West syndrome, a significant deterioration. Moreover, impaired visual function at seizure onset was possibly associated with a bad developmental evolution. A developmental deterioration, mostly in West syndrome, accounts for a causative role of the epileptic disorder PER SE, but in few cases it was also observed in infants with only a brain injury, suggesting other aetiopathogenic mechanisms. The predictive value of early visual function seems to be confirmed.