- Safety and Practicability of Intervention [ Time Frame: up to 5 years ]
To confirm implementation of the intervention is safe and practicable within the Neonatal Intensive Care Unit (NICU)throughout the study duration.
- Psychological Assessments: Mothers in both groups are given a wide-range of psychological questionnaires. These include indices of anxiety, depression, temperament, personality, attachment, stress, and social support. [ Time Frame: Up to 24 months of Age ]
Mothers are administered questionnaires at several time periods to assess levels of anxiety (Speilberger State-Trait Anxiety Inventory), and depressive symptoms (Center for Epidemiological Studies Depression Scale). After group assignment, symptoms of post-partum depression (Postpartum Depression Screening Scale), depressive experiences (Depressive Experiences Questionnaire), qualities of attachments (Adult Attachment Interview) are assessed. Status of inhibitory vs. approach systems (Behavioral Inhibition System-Behavioral Approach System), and Mom's Support Circle are assessed.
- Neurobehavioral Assessments of Infants: The use of the NICU Network Neurobehavioral Scale (NNNS) to assess infant's neurodevelopmental status [ Time Frame: Up to 40 weeks Gestational Age ]
The test measures neurological reflexes, body tone and motor maturity at 36 weeks (+/- 1 week) and 40 weeks (+/- 1 week) post-conceptional age. It also measures the infant's orientation to and engagement with social and non-social stimuli, the lability of the infant's activity and states, and the infant's consolability. The stress/abstinence scale, originally formulated for prenatally drug-exposed infants, includes physiological, autonomic, skin, central nervous system (CNS), visual and gastrointestinal markers.
- Neurobehavioral Assessments of Infants: Mothers provide a wide range of information about infant's development through questionnaires [ Time Frame: Up to 24 months corrected age ]
Infant temperament is obtained using the Early Infancy Temperament Questionnaire and the Infant Behavior Questionnaire. Social-emotional problems of the infants are assessed by the Brief Infant-Toddler Social and Emotional Assessment at 4, 12, 18 and 24 months corrected age, and at 12, 18, 24 months CA by the Child Behavior Checklist. The mother also provides information about possible developmental delays by filling out the Ages and Stages Questionnaire, at 4, 12, 18 and 24 months corrected age.
- Neurobehavioral Assessments of Infants- Bayley Scales of Infant and Toddler Development, Bayley III [ Time Frame: Up to 24 months corrected age ]
At 18 and 24 months corrected age, infants are administered the Bayley Scales of Infant and Toddler Development, Bayley III consisting of four subscales: Cognitive, Language (receptive/expressive), Motor (fine/gross) and Social-Emotional. These filmed assessments, made by research staff 'blind' to infant group assignment, provide information about the neurobehavioral status of the child and whether there are significant delays in key domains of motor, language, and cognitive development.
- Physiological Assessments: A one hour recording of high density electroencephalogram (EEG) (128 leads), electrocardiogram (ECG), and respiration during sleep. [ Time Frame: Up to 42 weeks post-conceptional age ]
EEG and ECG are collected at 1000 samples/sec and respiration at 50 samples/sec at 34, 36, and 39-42 weeks post-conceptional age. Throughout recording, research assistants assign sleep state codes (quiet sleep, active sleep, indeterminate, awake, cry) once each minute, based on behavioral criteria as well as provide estimates of heart rate and heart rate for each sleep state. EEG data is processed to obtain spatially-dependent measures of wave amplitude (power) at specific frequencies for each spatial location and measures of functional connectivity (coherence) between electrode locations.
- Physiological Assessments- Cortisol Levels, breast milk, saliva, infant blood samples, and infant stool collection [ Time Frame: Up to 24 months corrected age ]
As a component of the mother-infant interaction assessments conducted at 4 and 12 months corrected age, salivary cortisol levels are measured at four times during each session. These measures provide physiological indices of how the infants respond to a social interaction stressor. In addition, breast milk, saliva (mother and infant), infant stool, and infant blood for peptides are collected.
- Mother-Infant Interactions Assessments: Evaluating the qualities of the mother's interaction with her infant during diaper change [ Time Frame: Up to 4 months corrected age ]
Videos of infant's diaper change are obtained and coded by research team members unfamiliar with the dyads' group assignment at 36 weeks post-conceptional age and 4 months corrected age. The mother is instructed to undress her infant, remove the diaper, wipe clean, and re-dress her infant. These familiar caregiving procedures represent a mild, ecologically valid stressor. Maternal behavior is coded, using a 9-point Likert scale for: (a) Acceptance vs. Rejection; (b) Soothing capability; (c) Consideration vs. Intrusiveness; (d) Quality of Physical Contact; and (e) Quality of Vocal Contact.
- Mother-Infant Interaction Assessments: Mother-infant face-to-face communicative competence, sensitivity of maternal caregiving and mother and infant physiological capacity to cope with a stressor [ Time Frame: Up to 24 months corrected age ]
A split-screen filming session is conducted following protocols and analyzed by team members 'blind' to the dyads' group assignments at 4, 12, and 24 months corrected age. The videotapes consist of: (1) mother-infant play; (2) stranger-infant play (3) diaper change; (4) the Still Face protocol in which mothers assume an expressionless face for two minutes. Primary measures are: infant gaze aversion, mother-infant gaze coordination, infant distress, maternal interaction style (affectionate vs. intrusive), and responses of mothers and infants to gaze aversion.
- Mother-Infant Interaction Assessments- Yale Inventory of Parental Thoughts and Actions (YIPTA) [ Time Frame: up to 24 months corrected age ]
Twice during each infant's stay in the NICU, and again at term, 4, 12, 18 and 24 months corrected age following discharge, the Yale Inventory of Parental Thoughts and Actions, YIPTA is administered. This inventory quantifies maternal ratings of her thoughts about her infant. To evaluate the mother-to-child attachment processes subscales include: frequency of thoughts/worries about the infant, the distress caused by these thoughts, how she manages her distress, frequency of checking the infant, affiliative interactions, measures of attachment, frequency of care taking behavior.
- Assessments of Neonatal Intensive Care Unit Activities: Ascertainment of attendance and the frequency and/or time spent engaged in key aspects of the Family Nurture Intervention using maternal self-report forms. [ Time Frame: Participants will be followed for the duration of NICU stay, an expected average of 7 weeks ]
These forms are filled out after each visit to NICU. The mother is asked to enter information about the start and stop times of each of her visits to the NICU and to estimate the amount of time or number of times she engaged in various types of interactions with her infant. A similar schedule of questionnaires is given to the Standard Care group mothers, but without questions that pertain only to the Family Nurture Intervention group (i.e., odor cloth exchange, Calming Cycle).