Family Nurture Intervention increases term age forebrain EEG activity: a multicenter replication trial

Emergence of a synergistic scaffold in the brains of human infants

The human brain is a complex organ comprising billions of interconnected neurons, which enables interaction with both physical and social environments. Neural dynamics of the whole brain go far beyond just the sum of its individual elements; a property known as "synergy". Previously it has been shown that synergy is crucial for many complex brain functions and cognition, however, it remains unknown how and when the large number of discrete neurons evolve into the unified system able to support synergistic interactions. Here we analyzed high-density electroencephalography data from the late fetal period to one month after term age. We found that the human brain transitions from a redundancy-dominated to a synergy-dominated system around birth. Frontal regions lead the emergence of a synergistic scaffold comprised of overlapping subsystems, while the integration of sensory areas developed gradually, from occipital to central regions. Strikingly, early developmental trajectories of brain synergy were modulated by environmental enrichment associated with enhanced mother-infant interactions, and the level of synergy near term equivalent age was associated with later neurocognitive development.

Neural dynamics underlying the cue validity effect in target conflict resolution

Cue validity significantly influences attention guidance, either facilitating or hindering the ability for conflict resolution. Previous studies have demonstrated that the validity effect and conflict resolution are associated with better/worse behavioral performance and specific neural activations; however, the underlying neural mechanism of their interaction remains unclear. We hypothesized that the effect of cue validity might sustain specific sequences of neural activities until target occurrence and throughout the subsequent conflict resolution. In this study, we recorded the scalp electroencephalography during the Attention Network Test paradigm to investigate their interactions in neural dynamics. Specifically, we performed a cluster-level channel-time-frequency analysis to explore significant time-frequency neural activity patterns associated with these interactions, in scalp regions of interest determined by a data-driven strategy. Our results revealed a string of significant neural dynamics in the frontal and parietal regions, including initial broad-band (especially the gamma-band) activations and subsequent complex cognitive processes evoked/effected by the invalid cue, that were firstly elicited. Finally, the resolution of conflict was completed by the frontal behavior-related theta-band power reduction. In summary, our findings advanced the understanding of the temporal and spectral sequences of neural dynamics, with the key regions involved in the resolution of conflict after invalid cueing.

Family Nurture Intervention and mother-preterm infant autonomic emotional connection in the neonatal intensive care unit: A review

AIM

We review methods and outcomes of a novel parenting intervention, Family Nurture Intervention (FNI), that promotes early mother-infant autonomic co-regulation and emotional connection in the neonatal intensive care unit (NICU).

METHODS

FNI involves individualised mother-infant calming sessions combined with maternal emotional expression. Two parallel group randomised controlled trials have evaluated FNI. The first, recruited 150 preterm newborns (26-34 weeks GA) and their mothers, randomised into two groups: FNI (n = 78) and Standard Care (SC) only (n = 72). Dyadic, infant and maternal outcomes were assessed at discharge, 18-months and 4-5 years corrected age. The second,recruited 135 infants from two level 4 NICUs (FNI n = 66, SC n = 69) with similar outcomes assessed at discharge/term equivalent.

RESULTS

Relative to SC, FNI infants showed improved development and relational health through 5 years. At term age, FNI infants had better autonomic regulation and more mature brain activity and cortical connectivity on EEG. FNI mothers also reported fewer anxiety and depression symptoms post-discharge. At 18-month, FNI infants obtained higher cognitive and language scores, and lower attention and social behaviour scores than SC infants.

CONCLUSIONS

FNI improves the early life development and relational health of high-risk preterm infants. Further research is important to assess its efficacy in other high-risk populations and contexts.

Six weeks that changed the preterm infant brain: lessons learned from the Family Nurture Intervention randomized controlled trials

Aim

We review extensive results from two randomized controlled trials conducted over 9 years, comparing standard care (SC) in level-4 neonatal intensive care units (NICUs) with SC plus Family Nurture Intervention (FNI).

Methods

FNI included ~six weeks of facilitated mother-infant interactions aimed at achieving mother-infant 'autonomic emotional connection', a novel construct that describes the emotional mother-baby relationship at the level of the autonomic nervous system.

Results and conclusion

Thus far, 18 peer-reviewed publications documented significant positive short-and long-term effects of FNI on infant neurobehavioral functioning, developmental trajectories and both mother and child autonomic health through five years. The observed profound effects of FNI on central and autonomic nervous system function following a relatively short intervention support a novel autonomic theory of emotions. We discuss the theoretical and clinical advances that grew out of the trials and speculate on how FNI changes the mother-infant relationship from 'dysregulation' to autonomic emotional co-regulation. We review new constructs and tools that can be used to view and measure the mother-infant autonomic emotional relationship. We present a simple blueprint to improve preterm birth outcomes. Finally, we discuss the significance of our findings and possible impact on the future of preterm infant care worldwide.

A Scoping Review of Multimodal, Dyadic Early Relational Health Interventions in NICUs in the United States

BACKGROUND

Early relational health (ERH) interventions can buffer toxic stress and improve the developmental trajectories of neonatal intensive care unit (NICU) infants.

PURPOSE

The purpose was to examine the current state of the science related to multimodal, dyadic ERH interventions implemented in the NICU setting in the United States and identify gaps in the current literature.

DATA SOURCES

PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo were searched in November 2022 and November 2023 for original studies and conference proceedings from 1970 to present in the English language. Gray literature searches were performed in February 2023 and December 2023.

STUDY SELECTION

English language, original research, with a focus on multimodal, dyadic ERH interventions that took place primarily in a NICU in the United States were included. Outcome measures could be related to implementation, relational health, or physical and/or mental health outcomes of parent and/or infant. Eighteen of 2021 reviewed articles met the inclusion criteria.

DATA EXTRACTION

Data were extracted for author, year, intervention, purpose, methods, sample, paternal inclusion, dyadic components, non-dyadic components, and major outcomes/results and distilled for study characteristics, multimodal, dyadic intervention characteristics, and outcome measures.

RESULTS

Several multimodal dyadic interventions exist to aid ERH in the NICU, providing evidence of improved outcomes for infants and families. More research is required using higher sample sizes and replication studies.

IMPLICATIONS FOR PRACTICE AND RESEARCH

ERH interventions show promise in improving neurodevelopmental, behavioral, and maternal mental health outcomes and should be considered for implementation into NICU services.

Preschool mother-child emotional preparation program leads to significant improvement in autonomic regulation: a randomized controlled trial

Introduction

Many studies have documented the profound impact that the mother-child relationship has on child sociality and behavior. However, the biological mechanisms that govern the relationship are poorly understood. We developed a mother-child emotional preparation program (MCEP), based on a novel autonomic nervous system learning mechanism. MCEP is hypothesized to condition the child's autonomic nervous system to better meet the preschool socioemotional classroom challenges.

Methods

We conducted a randomized controlled trial of MCEP, comparing a group of children receiving standard curriculum with children receiving standard curriculum plus MCEP. Previously, we reported that the MCEP mother-child dyads (vs controls) were more emotionally connected at six months post intervention and MCEP children (vs controls) displayed better socioemotional behavior at home and in the classroom. At six months post intervention, mothers and children underwent a stressful interaction-interruption paradigm, during which we acquired child ECG. We analyzed heart rate and several measures of child heart rate variability obtained during the 10-minute post-stress recovery period.

Results

We found that MCEP children showed better autonomic regulation following the stressor, as measured by lower heart rate (p = 0.017) and increased high frequency respiratory sinus arrhythmia (RSA) or vagal tone (p = 0.043). Surprisingly, despite a sample size limited by COVID (n = 12 and 12), the effect sizes were large (g's ranging from 0.89 to 1.09). In addition, we found significant correlations with large effect sizes between autonomic measures and scores on the Welch Emotional Connection Screen (WECS).

Discussion

These findings support the conclusion that MCEP had a significant positive impact on child autonomic regulation in response to stress, which correlates with behavioral assessments of emotional connection. We discuss theoretical considerations and the implications of our findings for preschool education programs in general. This trial was retrospectively registered (clinicaltrial.gov registry NCT02970565) three months after the start of the first recruitment on April 9, 2019.

Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review

BACKGROUND

Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts.

METHODS

We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field.

RESULTS

Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers.

CONCLUSIONS

We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.