Visual habituation and dishabituation in preterm infants: a review and meta-analysis

Predictive coding and attention in developmental cognitive neuroscience and perspectives for neurodevelopmental disorders

Sensory prediction and repetition suppression are closely related cognitive mechanisms that allow the brain to form predictions about the environment, and guide perception in synergy with attention. Predictive coding is a theory of the fundamental role of predictive mechanisms in brain functions. Authors have proposed a central role of predictive impairments in autism and possibly other neurodevelopmental disorders. However, little is known about predictive mechanisms in typical development, and how they co-develop with attention. Here we review experimental support for predictive coding and its links with attention in healthy adults' brains, the first experimental works performed in typically developing children and infants, and theoretical accounts of neurodevelopmental disorders using a predictive coding framework. We propose future directions for predictive coding research in development. Finally, we describe the first predictive coding experiments in neonates and provide research perspectives for using this framework in searching for early markers of atypical neurodevelopment.

Attrition in a large-scale habituation task administered at home

Infant research often struggles with selective samples, especially when focusing on behavioural measures, such as those drawn from habituation tasks. However, selectivity may threaten the generalizability and interpretation of results, which is why the current study investigates attrition in a habituation task administered in a household setting in 7-month-old infants. We used a large-scale German dataset, focusing on the children's socioeconomic background, and investigated two aspects of attrition, namely, participation and task completion. The findings suggest significant effects of the children's socioeconomic background on attrition: Maternal education, parental occupation, household income and household language (German vs. other) were positively related to participation and task completion. The analyses indicate that multiple barriers may prevent parents from lower socioeconomic backgrounds from letting their children participate. The study concludes with a critical discussion of possible mechanisms of selectivity in behavioural measures as well as the household setting, in which the data were collected.

Olfactive short-term habituation in children and young people with profound intellectual and multiple disabilities

BACKGROUND

Despite its importance for learning, the existence of the habituation process and its characteristics in people with profound intellectual and multiple disabilities (PIMD) remains understudied. Habituation is, however, considered the simplest form of learning, and a significant neuroadaptive mechanism. Even though habituation occurs in all sensory modalities, the olfactory system is where it manifests itself very visibly.

AIM

This study explores the olfactory short-term habituation abilities of children and young people with PIMD.

METHOD

Twenty children and young people with PIMD (7-18 years) were presented six times successively with a 30-second habituating olfactory stimulus. The interstimulus interval was 15 s. A new odour was presented on the seventh trial. The scenario was carried out two times with two pairs of stimuli. The participants' head alignment duration on the odour was measured.

RESULTS

Seventeen participants out of 20 manifested a decline in response, which reached about 50 % between the first and sixth presentation of the habituation odour. All habituators also showed a distinctive response when exposed to a novel odour. The participants who did not habituate showed a strong, non-fluctuating response to the stimulus throughout the presentations. Three participants only habituated to one of the two habituation stimuli.

CONCLUSION AND IMPLICATIONS

The results raise theoretical, scientific, and practical issues. They question the factors explaining olfactory habituation mechanisms, namely the stimulus properties and the severity of impairment, reveal the need for points of comparison for interpreting this population's responses, and point to the consequences of stimuli repetition and or variety in therapeutic or educational settings for these individuals' learning and cognitive functioning.

NOS1 mutations cause hypogonadotropic hypogonadism with sensory and cognitive deficits that can be reversed in infantile mice

The nitric oxide (NO) signaling pathway in hypothalamic neurons plays a key role in the regulation of the secretion of gonadotropin-releasing hormone (GnRH), which is crucial for reproduction. We hypothesized that a disruption of neuronal NO synthase (NOS1) activity underlies some forms of hypogonadotropic hypogonadism. Whole-exome sequencing was performed on a cohort of 341 probands with congenital hypogonadotropic hypogonadism to identify ultrarare variants in NOS1. The activity of the identified NOS1 mutant proteins was assessed by their ability to promote nitrite and cGMP production in vitro. In addition, physiological and pharmacological characterization was carried out in a Nos1-deficient mouse model. We identified five heterozygous NOS1 loss-of-function mutations in six probands with congenital hypogonadotropic hypogonadism (2%), who displayed additional phenotypes including anosmia, hearing loss, and intellectual disability. NOS1 was found to be transiently expressed by GnRH neurons in the nose of both humans and mice, and Nos1 deficiency in mice resulted in dose-dependent defects in sexual maturation as well as in olfaction, hearing, and cognition. The pharmacological inhibition of NO production in postnatal mice revealed a critical time window during which Nos1 activity shaped minipuberty and sexual maturation. Inhaled NO treatment at minipuberty rescued both reproductive and behavioral phenotypes in Nos1-deficient mice. In summary, lack of NOS1 activity led to GnRH deficiency associated with sensory and intellectual comorbidities in humans and mice. NO treatment during minipuberty reversed deficits in sexual maturation, olfaction, and cognition in Nos1 mutant mice, suggesting a potential therapy for humans with NO deficiency.

Genetics, molecular control and clinical relevance of habituation learning

Habituation is the most fundamental form of learning. As a firewall that protects our brain from sensory overload, it is indispensable for cognitive processes. Studies in humans and animal models provide increasing evidence that habituation is affected in autism and related monogenic neurodevelopmental disorders (NDDs). An integrated application of habituation assessment in NDDs and their animal models has unexploited potential for neuroscience and medical care. With the aim to gain mechanistic insights, we systematically retrieved genes that have been demonstrated in the literature to underlie habituation. We identified 258 evolutionarily conserved genes across species, describe the biological processes they converge on, and highlight regulatory pathways and drugs that may alleviate habituation deficits. We also summarize current habituation paradigms and extract the most decisive arguments that support the crucial role of habituation for cognition in health and disease. We conclude that habituation is a conserved, quantitative, cognition- and disease-relevant process that can connect preclinical and clinical work, and hence is a powerful tool to advance research, diagnostics, and treatment of NDDs.

A review of the characteristics, mechanisms and clinical significance of habituation in foetuses and newborn infants

Habituation has been a topic of interest since the early 20th century. We summarise the characteristics of habituation, the proposed habituation mechanisms, the associated cortical responses and the link between habituation and cognitive development. Behavioural and neuroimaging studies have highlighted the early sensory abilities of foetuses and newborn infants, with preterm newborn infants exhibiting decreased habituation and dishabituation capabilities that increase their environmental vulnerability. Habituation provides a foundation for the learning and cognition on which higher functions are constructed. It has been suggested that it is efficient for predicting cognitive developmental outcomes in term and preterm newborn infants.

Additive and multiplicative probabilistic models of infant looking times

Additive and multiplicative regression models of habituation were compared regarding the fit to looking times from a habituation experiment with infants aged between 3 and 11 months. In contrast to earlier studies, the current study considered multiple probability distributions, namely Weibull, gamma, lognormal and normal distribution. In the habituation experiment the type of contrast between the habituation and the test trial was varied (luminance, color or orientation contrast), crossed with the number of habituation trials (1, 3, 5, or 7 habituation trials) and crossed with three age cohorts (4, 7, 10 months). The initial mean LT to dark stimuli (around 3.7 s) was considerably shorter than the mean LT to green and gray stimuli (around 5 s). Infants showed the strongest dishabituation to changes from dark to bright (luminance contrast) and weak-to-no dishabituation to a 90-degrees rotation of the gray stimuli (orientation contrast). The dishabituation was stronger after five and seven habituation trials, but the result was not statistically robust. The gamma distribution showed the best fit in terms of log-likelihood and mean absolute error and the best predictive performance. Furthermore, the gamma distribution showed small correlations between parameters relative to other models. The normal additive model showed an inferior fit and medium correlations between the parameters. In particular, the positive correlation between the initial looking time (LT) and the habituation rate was likely responsible for a different interpretation relative to the multiplicative models of the main effect of age on the habituation rate. Otherwise, the additive and multiplicative models provided similar statistical conclusions. The performance of the model versions without pooling and with partial pooling across participants (also called random-effects, multi-level or hierarchical models) were compared. The latter type of models showed worse data fit but more precise predictions and reduced correlations between the parameters. The performance of model variants with auto-regressive time structures were explored but showed considerably worse fit. The performance of quadratic models that allowed non-monotonic changes in LTs were investigated as well. However, when fitted with LT data, these models did not produce non-monotonic change in LTs. The study underscores the utility of partial-pooling models in terms of providing more accurate predictions. Further, it agrees with previous research in that a multiplicative LT model is preferable. Nevertheless, the current results suggest that the impact of the choice of an additive model on the statistical inference is less dramatic then previously assumed.

Preterm Birth and the Development of Visual Attention During the First 2 Years of Life: A Systematic Review and Meta-analysis

Importance

Preterm birth is associated with an increased risk for long-lasting attention deficits. Early-life markers of attention abnormalities have not been established to date but could provide insights into the pathogenesis of attention abnormalities and could help identify susceptible individuals.

Objective

To examine whether preterm birth is associated with visual attention impairments in early life, and if so, in which attention functions and at which developmental period during the first 2 years of life.

Data Sources

PubMed and PsycINFO were searched on November 17, 2019, to identify studies involving visual attention outcomes in infants born preterm vs full term.

Study Selection

Peer-reviewed studies from the past 50 years met the eligibility criteria if they directly assessed visual attention outcomes until the age of 2 years in generally healthy infants born preterm or full term. The selection process was conducted by 2 independent reviewers.

Data Extraction and Synthesis

The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Random-effects models were used to determine standardized mean differences. The risk of bias was assessed both within and between studies.

Main Outcomes and Measures

Five nascent indices of visual attention were analyzed, including very basic functions-namely, the abilities to follow and fixate on visual targets-and more complex functions, such as visual processing (ie, habituation), recognition memory (ie, novelty preference), and the ability to effortfully focus attention for learning.

Results

A total of 53 studies were included, with 69 effect sizes and assessing a total of 3998 infants (2047 born preterm and 1951 born full term; of the 3376 for whom sex was reported, 1693 [50.1%] were girls). Preterm birth was associated with impairments in various attention indices, including visual-following in infancy (Cohen d, -0.77; 95% CI, -1.23 to -0.31), latency to fixate (Cohen d, -0.18; 95% CI, -0.33 to -0.02), novelty preference (Cohen d, -0.20; 95% CI, -0.32 to -0.08), and focused attention (Cohen d, -0.28; 95% CI, -0.45 to -0.11). In the neonatal period, preterm birth was associated with superior visual-following (Cohen d, 0.22; 95% CI, 0.03 to 0.40), possibly owing to the additional extrauterine exposure to sensory stimulation. However, this early association waned rapidly in infancy (Cohen d, -0.77; 95% CI, -1.23 to -0.31).

Conclusions and Relevance

The findings suggest that preterm birth is associated with impingements to visual attention development in early life, as manifested in basic and then complex forms of attention. Advancements in neonatal care may underlie improvements found in the current era and accentuate several early protective factors.

Influence of swaddling on tactile manual learning in preterm infants

BACKGROUND AND AIM

Swaddling is a well-known technique in developmental care programs as there is some evidence that swaddling is an appropriate stress-reducing method for preterm infants in the NICU. However, no experimental study has investigated the influence of swaddling in a learning context. This study aimed to assess the impact of swaddling on tactile manual abilities in preterm infants.

METHODS

Two phases were introduced for all infants: habituation (successive presentation of the same object, prism or cylinder in the left hand), followed by discrimination (presentation of a new-shaped object). The infants were assigned to one of the two conditions (swaddled; non-swaddled).

RESULTS

Forty preterm infants were included (between 28 and 35 weeks' postconceptional age). First, swaddled and non-swaddled infants exhibited similar tactile habituation abilities. However, all infants needed more time and more trials to habituate to the cylinder than to the prism. Second, they all exhibited an effective discrimination, but the importance of the increase in holding time for the new-shaped object varied according to the habituated-shape and the condition. Moreover, stress intensity was higher in non-swaddled infants during tactile exploration. Finally, infants with greater previous swaddling experience during the week preceding the test took more time and more trials to habituate to the object, regardless of the condition.

CONCLUSION

Swaddling preterm infants during sensory learning did not influence the tactile memorization process but would improve the use of their attentional resources. Swaddling seems to provide favorable conditions for sensory learning by improving attention to tactile stimuli.

CLINICAL TRIAL REGISTRATION

This trial, EMMASENS, has been registered at www.clinicaltrials.gov (identifier NCT04315428).

Habituation Alteration in Infants with Periventricular Echogenicity as an Indicator of Neurocognitive Impairment

Habituation difficulties may suggest neurocognitive impairment. Periventricular echogenicity (PVE) potentially causes subtle damage that poses neuropsychological risk. Habituation was evaluated through heart rate and behavioral states in infants at 36-37 weeks of corrected age between control and PVE groups. PVE infants showed early alertness and abrupt changes in behavioral states. However, the comparison group could better regulate their states. Heart rate was significantly high and remained unchanged in the PVE group but decreased in the control group. Alterations during the habituation paradigm in PVE infants could be early indicators of neuropsychological risk impairment. Scope of early habituation assessment is discussed.

Reduced Sensory Habituation in Autism and Its Correlation with Behavioral Measures

Autism is strongly associated with sensory processing difficulties. We investigate sensory habituation, given its relevance for understanding important phenotypic traits like hyper- and hypo-sensitivities. We collected electroencephalography data from 22 neuro-typical(NT) and 13 autistic(ASD) children during the presentation of visual and auditory sequences of repeated stimuli. Our data show that the ASD children have significantly reduced habituation relative to the NT children for both auditory and visual stimuli. These results point to impaired habituation as a modality-general phenomenon in ASD. Additionally, the rates of habituation are correlated with several clinical scores associated with competence along diverse phenotypic dimensions. These data suggest that the sensory difficulties in autism are likely to be associated with reduced habituation and are related to clinical symptomology.

Foundations of attention sharing: Orienting and responding to attention in term and preterm 5-month-old infants

Attention is the gateway to perceptual, cognitive, and socioemotional development in humans. We observed 104 5-month-old term and preterm infants and their mothers in social interactions to address three questions about the role of maturation in orienting and responding to attention. We used a fine-grained coding system to allow parallel comparisons across infant and maternal orienting, and sequential analysis to evaluate infant and maternal responding to attention. Orienting and responding to attention differed for attention to people versus objects, as did the relations between maturity and attention. We conclude that maturity contributes to orienting and responding to attention and that orienting and responding to attention are specific rather than homogenous. We discuss the implications of these conclusions for future studies of how attention influences cognitive and communicative development.

Preterm infants with peri/intraventricular hemorrhage have poorer habituation responses to external stimuli

OBJECTIVE

To evaluate the association between intra-ventricular hemorrhage and habituation responses to external stimuli in preterm infants at 36-38 weeks post-conceptual age.

METHODS

Cross-sectional study of infants with gestational age <32 weeks. Intra-ventricular hemorrhage was identified by cranial ultrasonography and classified according to Papile et al. (1978). The luminous (flashlight), sound (rattle, bell), and tactile stimuli were presented, and the responses were scored according to Lester and Tronik (2004). Habituation response scores were compared between groups by Student's t-test. The association between IVH and habituation scores was evaluated by linear regression adjusted for GA, clinical severity score, post-conceptual age at habituation assessment, sepsis, and bronchopulmonary dysplasia.

RESULTS

Sixty-five infants were studied, 20 with intra-ventricular hemorrhage (16 grades I/II; four grades III/IV) and 45 without intra-ventricular hemorrhage. Infants with intra-ventricular hemorrhage had lower gestational age (28.2±2.2 vs. 29.7±1.7 weeks) and birth weight (990±305 vs. 1275±360g). Infants with intra-ventricular hemorrhage at 36-38 weeks post-conceptual age had lower habituation scores to light (4.21±2.23 vs. 6.09±2.44), rattle (3.84±2.12 vs. 6.18±2.27), and bell (3.58±1.74 vs. 5.20±2.47) after controlling for confounders. No differences were found for tactile stimulus.

CONCLUSION

Infants with gestational age <32 weeks and intra-ventricular hemorrhage had poorer habituation responses to external stimuli than those without intra-ventricular hemorrhage at 36-38 weeks post-conceptual age.

Changes in event-related brain responses and habituation during child development - A systematic literature review

OBJECTIVE

This systematic review highlights the influence of developmental changes of the central nervous system on habituation assessment during child development. Therefore, studies on age dependant changes in event-related brain responses as well as studies on behavioural and neurophysiological habituation during child development are compiled and discussed.

METHODS

Two PubMed searches with terms "(development evoked brain response (fetus OR neonate OR children) (electroencephalography OR magnetoencephalography))" and with terms "(psychology habituation (fetal OR neonate OR children) (human brain))" were performed to identify studies on developmental changes in event-related brain responses as well as habituation studies during child development.

RESULTS

Both search results showed a wide diversity of subjects' ages, stimulation protocols and examined behaviour or components of event-related brain responses as well as a demand for more longitudinal study designs.

CONCLUSIONS

A conclusive statement about clear developmental trends in event-related brain responses or in neurophysiological habituation studies is difficult to draw. Future studies should implement longitudinal designs, combination of behavioural and neurophysiological habituation measurement and more complex habituation paradigms to assess several habituation criteria.

SIGNIFICANCE

This review emphasizes that event-related brain responses underlie certain changes during child development which should be more considered in the context of neurophysiological habituation studies.

The Efficiency of Infants' Exploratory Play Is Related to Longer-Term Cognitive Development

In this longitudinal study we examined the stability of exploratory play in infancy and its relation to cognitive development in early childhood. We assessed infants' (N = 130, mean age at enrollment = 12.02 months, SD = 3.5 months; range: 5-19 months) exploratory play four times over 9 months. Exploratory play was indexed by infants' attention to novelty, inductive generalizations, efficiency of exploration, face preferences, and imitative learning. We assessed cognitive development at the fourth visit for the full sample, and again at age three for a subset of the sample (n = 38). The only measure that was stable over infancy was the efficiency of exploration. Additionally, infants' efficiency score predicted vocabulary size and distinguished at-risk infants recruited from early intervention sites from those not at risk. Follow-up analyses at age three provided additional evidence for the importance of the efficiency measure: more efficient exploration was correlated with higher IQ scores. These results suggest that the efficiency of infants' exploratory play can be informative about longer-term cognitive development.

Maturation constrains the effect of exposure in linking language and thought: evidence from healthy preterm infants

The power of human language rests upon its intricate links to human cognition. By 3 months of age, listening to language supports infants' ability to form object categories, a building block of cognition. Moreover, infants display a systematic shift between 3 and 4 months - a shift from familiarity to novelty preferences - in their expression of this link between language and core cognitive processes. Here, we capitalize on this tightly-timed developmental shift in fullterm infants to assess (a) whether it also appears in preterm infants and (b) whether it reflects infants' maturational status or the duration of their postnatal experience. Healthy late preterm infants (N = 22) participated in an object categorization task while listening to language. Their performance, coupled with that of fullterm infants, reveals that this developmental shift is evident in preterm infants and unfolds on the same maturational timetable as in their fullterm counterparts.

Habituation as Parameter for Prediction of Mental Development in Healthy Preterm Infants: An Electrophysiological Pilot Study

The aim of this prospective pilot study was to evaluate the predictive value of discrimination and habituation, which was measured by mismatch negativity in 17 healthy very preterm (mean gestational age 27.4 weeks; range 25.0-31.3) and 16 term (mean gestational age 40.3 weeks; range 37.9-41.7) born infants at term equivalent age. Developmental outcome was measured by Bayley Scales of Infant Development-I in 13 preterm and 13 term-born children at a mean age of 21.7 months (±2.18) and 18.5 months (±1.9), respectively. No differences in amplitude and latency of the mismatch negativity were found between both groups at term equivalent age. Within the preterm group habituation capacity was positively correlated with the Mental Developmental Index (r = .654, P = .008) and Performance Developmental Index (r = .482, P = .048) at 21 months. Early learning capability, as measured by habituation, may be associated with a better prognosis for early mental development in healthy preterm infants.

Prenatal DHA supplementation and infant attention

BACKGROUND

Results of randomized trials on the effects of prenatal docosahexaenoic acid (DHA) on infant cognition are mixed, but most trials have used global standardized outcomes, which may not be sensitive to effects of DHA on specific cognitive domains.

METHODS

Women were randomized to 600 mg/d DHA or a placebo for the last two trimesters of pregnancy. Infants of these mothers were then followed on tests of visual habituation at 4, 6, and 9 mo of age.

RESULTS

DHA supplementation did not affect look duration or habituation parameters but infants of supplemented mothers maintained high levels of sustained attention (SA) across the first year; SA declined for the placebo group. The supplemented group also showed significantly reduced attrition on habituation tasks, especially at 6 and 9 mo.

CONCLUSION

The findings support with the suggestion that prenatal DHA may positively affect infants' attention and regulation of state.

Predictive role of early milestones-related psychomotor profiles and long-term neurodevelopmental pitfalls in preterm infants

BACKGROUND

Developmental milestones are useful signposts developed to assess the pace and the trajectory of maturation occurring during specific time-windows called critical periods. The predictive role of their clinical assessment in premature infants is challenging, however, it actually represents an easy and reliable tool at follow-up.

AIM AND STUDY DESIGN

Relying on a milestone-based neurological examination, we aimed to detect the interdependence between time of achievement of each milestone with long-term neuropsychological and neurodevelopmental outcomes. The influence of pre-perinatal events was also considered.

PATIENTS & METHODS

Two-hundred-eighty patients (53.2% M) were serially assessed by classic neurological examination during the first 18months and subsequently evaluated by Griffiths Developmental Mental Scale. Children were sorted by ranges of gestational age and compared according to their different profiles.

RESULTS

The Extremely PreTerms appeared to have a globally delayed development with subsequent attentional and behavioral troubles. Differently, the older peers, from Moderately to Full Term ones, although did not show significant differences in achievement of gross motor skills, had a stable delay of visual and social skills across the age ranges. This gap was not evidenced at the long-term evaluation, except for the Extremely PreTerm children. Pre-perinatal factors played a significant role on short and long term neurodevelopmental outcome.

CONCLUSIONS

Early assessed classic neurological examination might address neurodevelopmental trajectories in PreTerm children in which visual and social skills appear to be the mostly affected. It remains the easiest and most reliable tool of evaluation throughout the follow-up programs.

Preterm Cognitive Function Into Adulthood

BACKGROUND

Very preterm (VP; gestational age <32 weeks) and very low birth weight (VLBW; <1500 g) births are related to impaired cognitive function across the life span. It is not known how stable cognitive functions are from childhood to adulthood for VP/VLBW compared with term-born individuals and how early adult cognitive function can be predicted.

METHODS

The Bavarian Longitudinal Study is a prospective geographically defined cohort study that followed 260 VP/VLBW and 229 term-born individuals from birth to adulthood. Data on cognitive function were assessed with developmental and IQ tests at 5 and 20 months and at 4, 6, 8, and 26 years of age.

RESULTS

Across all assessments, VP/VLBW individuals had significantly lower IQ scores than term-born controls, even when individuals with severe cognitive impairment (n = 69) were excluded. IQ scores were found to be more stable over time for VP/VLBW than term-born individuals, yet differences in stability disappeared when individuals with cognitive impairment were excluded. Adult IQ could be predicted with fair certainty (r > 0.50) from age 20 months onward for the whole VP/VLBW sample (n = 260) and from 6 years onward for term-born individuals (n = 229).

CONCLUSIONS

VP/VLBW individuals more often suffer from cognitive problems across childhood into adulthood and these problems are relatively stable from early childhood onward. VP/VLBW children's risk for cognitive problems can be reliably diagnosed at the age of 20 months. These findings provide strong support for the timing of cognitive follow-up at age 2 years to plan special support services for children with cognitive problems.

Looking in the eyes to discriminate

Studies showed that individual differences in encoding speed as well as looking behaviour during the encoding of facial stimuli can relate to differences in subsequent face discrimination. Nevertheless, a direct linkage between encoding speed and looking behaviour during the encoding of facial stimuli and the role of these encoding characteristics for subsequent discrimination has not been investigated yet. In the present habituation study, an eye-tracker was used to investigate how individual differences in encoding speed (number of habituation trials) relate to individual differences in looking behaviour on faces and the internal facial features (eyes, nose, and mouth) during encoding as well as discrimination. Forty infants habituated to a photograph of a female face. In a subsequent dishabituation phase, a new face was followed by the familiar one. As expected, the results showed that most of the infants were able to habituate to the face and that they managed to discriminate between the new and the familiar face. Furthermore, correlations and analyses of variance showed that individual differences in encoding during habituation related to differences in looking behaviour during habituation as well as dishabituation. Slower-habituating infants could better discriminate between the new and the familiar face and showed a higher interest in the eyes during habituation as well as dishabituation than faster-habituating infants. These data underline that individual differences in encoding speed relate to individual differences in looking behaviour and that increased looking behaviour to important social cues might help subsequent discrimination.

Habituation responses to external stimuli: is the habituation of preterm infants at a postconceptual age of 40 weeks equal to that of term infants?

OBJECTIVE

Compare the habituation responses to external stimuli between preterm infants at the postconceptual age of 40 weeks and term infants in the first days of life, and evaluate the habituation responses of the preterm infants until the age of 40 postconceptual weeks.

METHODS

Prospective cohort study of preterm infants aged <32 weeks. The habituation responses to light, rattle, bell and tactile stimuli of preterm infants were assessed at 32, 34, 36 and 38-40 postconceptual weeks. External stimuli were presented and responses were scored according to Lester and Tronik (2004). Habituation scores were compared between preterm and term infants, matched by sex, using t test. Repeated measures ANOVA was used to compare the responses between the different postconceptual gestational ages. Contrast models were used to verify the differences between the habituation responses according to the type of stimulus and the postconceptual ages.

RESULTS

51 preterm infants were studied (gestational age 29.4±2.4w; birth weight 1230±323 g). The scores for the habituation responses to the four stimuli progressively increased with advancing postconceptual age. At the age of 40 postconceptual weeks, the preterm infants were habituated to external stimuli similarly to the 51 studied term infants. The preterm infants showed higher habituation response scores for the rattle and bell stimuli than for the light and tactile stimuli.

CONCLUSIONS

Preterm infants improve their habituation responses to external stimuli as their postconceptual age increases, and, at 40 weeks of corrected age, they have similar responses to those exhibited by full-term infants in the first days of life.

The effect of postnatal age on the early tactile manual abilities of preterm infants

BACKGROUND

Although preterm infants possess early tactile manual abilities, the influence of the postnatal experience has not yet been systematically examined.

AIMS

To investigate whether early tactile manual habituation, discrimination and recognition (following interference) of shape in preterm infants are modified by postnatal age.

STUDY DESIGN

Prospective study.

SUBJECTS

Forty preterm infants were assessed from the post-conceptional age (PCA) of 34 weeks. Two groups were made up according to postnatal age (PNA): low PNA (PNA≤10 days of life) and high PNA (PNA≥12 days of life).

OUTCOME MEASURES

An object (prism or cylinder) was presented repeatedly in the left hand, and holding times of the object were recorded during each trial.

RESULTS

Holding time was shorter for all preterm infants following successive presentation of the same object irrespective of postnatal age range. In the discrimination phase, the mean holding time for the novel object was longer than holding times in the last two habituation trials, in both PNA groups. Finally, the mean holding time of the familiar object presented in the recognition phase was shorter than the holding time of the novel object presented previously, but only in the low PNA group.

CONCLUSIONS

Tactile manual habituation and discrimination of shape information is present in preterm infants at a post-conceptional age of 34 weeks, independently of postnatal age. However, tactile manual recognition of familiar shapes following interference is affected by length of postnatal experience. The significance of this last result is discussed in detail.

Preterm and term infants’ perception of temporally coordinated syllable–object pairings: implications for lexical development

PURPOSE

This experimental study examined term infants (n = 34) and low-risk near-term preterm infants (gestational age 32–36 weeks) at 2 months chronological age (n = 34) and corrected age (n =16). The study investigated whether the preterm infants presented with a delay in their sensitivity to synchronous syllable–object pairings when compared with term infants.

METHOD

First, infants were habituated to a single syllable, [tah] or [gah], spoken in synchrony with the motions of 1 of 4 toy objects, a crab, a porcupine, a star, or a lamb chop. Next, the infants received 2 syllable- and 2 object-change test trials, counterbalanced for order.

RESULTS

After factoring out differential looking time during habituation, the study found that preterm infants showed attenuated looks to the change in the object and the change in the syllable relative to term infants.

CONCLUSIONS

These findings suggest that even near-term preterm infants present with a delay in their sensitivity to synchrony in syllable–object pairings relative to term infants. Given the important role that synchrony plays in word mapping at 6–9 months, this early delay in sensitivity to synchrony might be an indicator of word mapping delays found in older preterm infants.

Preterm birth: neuropsychological profiles and atypical developmental pathways

Preterm birth is characterized by multiple interacting atypical constraints affecting different aspects of neuropsychological development. In the first years of life, perceptual, motor, and communicative-linguistic abilities, as well as attention, processing speed, and memory are affected by preterm birth resulting in cascading effects on later development. From school age to adolescence, a catch-up of simpler competencies (i.e., receptive lexicon) along with a more selective effect on more complex competencies (i.e., complex linguistic functions, math, motor, and executive functions) are observed, as well as a relevant incidence of behavioral outcomes. A wide heterogeneity in preterm children's neuropsychological profiles is described depending on the interaction among the degree of neonatal immaturity, medical complications, neurological damages/alterations, environmental and social factors. Severe neuromotor and sensory damages are not frequent, while low severity impairments are common among preterm children. It is argued that developmental pathways of preterm children are atypical, and not merely delayed, and are characterized by different developmental patterns and relationships among competencies.

Systems and cascades in cognitive development and academic achievement

A large-scale (N = 552) controlled multivariate prospective 14-year longitudinal study of a developmental cascade embedded in a developmental system showed that information-processing efficiency in infancy (4 months), general mental development in toddlerhood (18 months), behavior difficulties in early childhood (36 months), psychometric intelligence in middle childhood (8 years), and maternal education either directly or indirectly (or both) contribute to academic achievement in adolescence (14 years).

The comparator model of infant visual habituation and dishabituation: recent insights

Current knowledge of the perceptual and cognitive abilities in infancy is largely based on the visual habituation-dishabituation method. According to the comparator model [e.g., Sokolov (1963a) Perception and the conditioned reflex. Oxford: Pergamon Press], habituation refers to stimulus encoding and dishabituation refers to discriminatory memory performance. The review also describes the dual-process theory and the attention disengagement approach. The dual-process theory points to the impact of natural stimulus preferences on habituation-dishabituation processes. The attention disengagement approach emphasizes the contribution of the ability to shift the attention away from a stimulus. Moreover, arguments for the cognitive interpretation of visual habituation and dishabituations are discussed. These arguments are provided by physiological studies and by research on interindividual differences. Overall, the review shows that current research supports the comparator model. It emphasizes that the investigation of habituation and dishabituation expands our understanding of visual attention processes in infants.

Mother's depression at childbirth does not contribute to the effects of antenatal depression on neonate's behavioral development

BACKGROUND

Maternal depression is a worldwide phenomenon that has been linked to adverse developmental outcomes in neonates.

AIMS

To study the effect of antenatal depression (during the third trimester of pregnancy) on neonate behavior, preference, and habituation to both the mother and a stranger's face/voice. To analyze mother's depression at childbirth as a potential mediator or moderator of the relationship between antenatal depression and neonate behavioral development.

METHOD

A sample of 110 pregnant women was divided in 2 groups according to their scores on the Edinburgh Postnatal Depression Scale during pregnancy (EPDS; ≥ 10, depressed; <10, non-depressed). In the first 5 days after birth, neonatal performance on the Neonatal Behavioral Assessment Scale (NBAS) and in the 'Preference and habituation to the mother's face/voice versus stranger' paradigm was assessed; each mother filled out an EPDS.

RESULTS

Neonates of depressed pregnant women, achieved lower scores on the NBASs (regulation of state, range of state, and habituation); did not show a visual/auditory preference for the mother's face/voice; required more trials to become habituated to the mother's face/voice; and showed a higher visual/auditory preference for the stranger's face/voice after habituation compared to neonates of non-depressed pregnant women. Depression at childbirth does not contribute to the effect of antenatal depression on neonatal behavioral development.

CONCLUSION

Depression even before childbirth compromises the neonatal behavioral development. Depression is a relevant issue and should be addressed as a routine part of prenatal health care.

Motor learning and working memory in children born preterm: a systematic review

Children born preterm have a higher risk for developing motor, cognitive, and behavioral problems. Motor problems can occur in combination with working memory problems, and working memory is important for explicit learning of motor skills. The relation between motor learning and working memory has never been reviewed. The goal of this review was to provide an overview of motor learning, visual working memory and the role of working memory on motor learning in preterm children. A systematic review conducted in four databases identified 38 relevant articles, which were evaluated for methodological quality. Only 4 of 38 articles discussed motor learning in preterm children. Thirty-four studies reported on visual working memory; preterm birth affected performance on visual working memory tests. Information regarding motor learning and the role of working memory on the different components of motor learning was not available. Future research should address this issue. Insight in the relation between motor learning and visual working memory may contribute to the development of evidence based intervention programs for children born preterm.

Zebrafish embryos and larvae: a new generation of disease models and drug screens

Technological innovation has helped the zebrafish embryo gain ground as a disease model and an assay system for drug screening. Here, we review the use of zebrafish embryos and early larvae in applied biomedical research, using selected cases. We look at the use of zebrafish embryos as disease models, taking fetal alcohol syndrome and tuberculosis as examples. We discuss advances in imaging, in culture techniques (including microfluidics), and in drug delivery (including new techniques for the robotic injection of compounds into the egg). The use of zebrafish embryos in early stages of drug safety-screening is discussed. So too are the new behavioral assays that are being adapted from rodent research for use in zebrafish embryos, and which may become relevant in validating the effects of neuroactive compounds such as anxiolytics and antidepressants. Readouts, such as morphological screening and cardiac function, are examined. There are several drawbacks in the zebrafish model. One is its very rapid development, which means that screening with zebrafish is analogous to "screening on a run-away train." Therefore, we argue that zebrafish embryos need to be precisely staged when used in acute assays, so as to ensure a consistent window of developmental exposure. We believe that zebrafish embryo screens can be used in the pre-regulatory phases of drug development, although more validation studies are needed to overcome industry scepticism. Finally, the zebrafish poses no challenge to the position of rodent models: it is complementary to them, especially in early stages of drug research.

Visual perception in preterm children: what are we currently measuring?

Over the past two decades, cerebral visual impairment has been recognized as a principal deficit in preterm children, and in particular those with cerebral palsy. We review the current knowledge of visual processing deficits in these children, and provide an overview of the tools for assessing cerebral visual impairment. Commercially available instruments are usually directed at evaluating visuospatial skills rather than detecting object recognition difficulties. Particularly in children aged 3 years or younger and in children with multiple handicaps, cerebral visual impairment is difficult to diagnose. This difficulty may be attributable to limitations specific to the instrument, such as a test that is inappropriate for age, or to child-specific limitations such as motor impairment or speech delay. We therefore include an overview of relevant neuroimaging findings reported in these children, focusing on the most recent imaging modalities. Novel techniques such as diffusion tensor imaging may provide sensitive markers of cerebral visual impairment in situations where clinical diagnosis is difficult, and such approaches may allow for early intervention.