Clinical Research

Advances in family based-interventions in the neonatal ICU

Recent trials reviewed here find positive effects of a variety of family-related interventions focused on parental guidance. These interventions target prescribed physical activities with infants, parents’ stress, and the parents’ ability to recognize their positive and negative behaviors with their infants. Beneficial effects include reductions in parenting stress, maternal anxiety, and depression.

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Family Nurture Intervention in the Neonatal Intensive Care Unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial

Advances in prenatal and neonatal care have led to increased survival of preterm infants (Hack, Klein, & Taylor, 1995). However, infants born prematurely continue to be at risk for a broad range of adverse short- and long-term outcomes (Bhutta, Cleves, Casey, Cradock, & Anand, 2002; Moster, Lie, & Markestad, 2008).

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Family Nurture Intervention – Summary of Results Through April 15, 2015

The first RCT of FNI was conducted over a four-year period from 2008 to 2012, with randomization of infants between FNI and Standard Care (SC). One hundred fifteen (115) families and one hundred fifty (150) infants 26-34 wk GA were included. This trial was conducted in a level IV NICU at Morgan Stanley Children’s Hospital of New York at Columbia University Medical Center. FNI was delivered during the NICU stay and the cohort is being followed and assessed for a period of 5 years.

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Family Nurture Intervention Improves the Quality of Maternal Caregiving in the Neonatal Intensive Care Unit: Evidence from a Randomized Controlled Trial

This study assessed the impact of Family Nurture Intervention (FNI) on the quality of maternal caregiving behavior (MCB) while in the neonatal intensive care unit (NICU). FNI is a randomized controlled trial conducted in a high-acuity NICU to facilitate an emotional connection between mothers and their premature infants. FNI begins shortly after birth, continues until discharge, and involves mother/infant calming sessions that include scent cloth exchange, vocal soothing and emotion expression, eye contact, skin-to-skin and clothed holding, and family-based support sessions. Methods: Maternal caregiving behavior was coded during a single holding and feeding session (;30 min) in the NICU before discharge at approxi- mately 36 weeks gestational age (GA). Sixty-five mothers and their premature infants (34 male, 31 female; 26–34 wk GA) were included in these analyses (FNI, n 5 35; standard care [SC], n 5 30). Results: Relative to mothers in the SC condition, those in the FNI group showed significantly higher quality MCB, which remained significant when controlling for birth order, twin status, maternal depression, and maternal anxiety. Conclusion: This is the first study to demonstrate that in-unit MCB can be enhanced by a hospital-based intervention. FNI provides a new rationale for integrating nurture-based interventions into standard NICU care.

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Family Nurture Intervention in preterm infants alters frontal cortical functional connectivity assessed by EEG coherence

Family Nurture Intervention is a NICU-based intervention designed to establish emotional connection between mothers and preterm infants. Infants born at 26–34 weeks postmenstrual age (PMA) were divided into two groups, standard care (SC, N = 49) and FNI (FNI, N = 56). Infants had EEG recordings of ~one hour duration with 124 lead nets between 37 and 44 weeks PMA. Coherence was measured between all pairs of electrodes in ten frequency bands. Data were summarised both within and between 12 regions during two sleep states (active, quiet).

Coherence levels were negatively correlated with PMA age in both groups. As compared to SC infants, FNI infants showed significantly lower levels of EEG coherence (1–18 Hz) largely within and between frontal regions.

Coherence in FNI infants was decreased in regions where we previously found robust increases in EEG power. As coherence decreases with age, results suggest that FNI may accelerate brain maturation particularly in frontal brain regions, which have been shown in research by others to be involved in regulation of attention, cognition and emotion regulation; domains deficient in preterm infants.

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Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU

Preterm delivery can precipitate maternal psychological morbidities. Family Nurture Intervention (FNI) was designed to minimize these by facilitating the emotional connection between mother and infant, beginning early in the infant’s neonatal intensive care unit (NICU) stay. We examined depression and anxiety symptoms of mothers of preterm infants at 4 months infant corrected age (CA). One hundred fifteen mothers who delivered between 26 and 34 weeks gestational age were randomized to receive standard care (SC) or standard care plus FNI. Mothers’ self-reported depressive symptoms (Center for Epidemiologic Studies Depression Scale: CES-D) and state anxiety (Spielberger State-Trait Anx- iety Inventory: STAI) symptoms were assessed at enrollment, near to term age, and 4 months (CA). At 4 months CA, mean CES-D and STAI scores were significantly lower in FNI mothers compared to SC mothers. Effectiveness of FNI can only be evaluated as an integrated intervention strategy as it was not possible to control all aspects of FNI activities. Although there was considerable loss to follow-up, analyses suggest that resulting biases could have masked rather than inflated the measured effect size for depressive symptoms. FNI may be a feasible and practicable way to diminish the impact of premature delivery on maternal depressive and anxiety symptoms.

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Family Nurture Intervention in the Neonatal Intensive Care Unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial

Preterm infants are at high risk for adverse neurodevelopmental and behavioral outcomes. Family Nurture Intervention (FNI) in the Neonatal Intensive Care Unit (NICU) is designed to counteract adverse effects of separation of mothers and their preterm infants. Here, we evaluate effects of FNI on neurobehavioral outcomes.

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Electroencephalographic Activity of Preterm Infants is Increased by Family Nurture Intervention: A Randomized Controlled Trial in the NICU

The objective of the study was to assess the impact of Family Nurture Intervention (FNI) on electroencephalogram (EEG) activity in preterm infants (26–34 weeks gestation). Our results show that FNI leads to increased frontal brain activity during sleep, which other investigators find predictive of better neurobehavioral outcomes. FNI may be a practicable means of improving outcomes in preterm infants.

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Family Nurture Intervention: Methods and Treatment Protocol of a Randomized Controlled Trial in the NICU

The stress that results from preterm birth, requisite acute care and prolonged physical separation in the Neonatal Intensive Care Unit (NICU) can have adverse physiological/psychological effects on both the infant and the mother. In particular, the experience compromises the establishment and maintenance of optimal mother-infant relationship, the subsequent development of the infant, and the mother's emotional well-being. These findings highlight the importance of investigating early interventions that are designed to overcome or reduce the effects of these environmental insults and challenges. The Family Nurture Intervention (FNI) is designed to increase biologically important activities and behaviors that enhance maternally-mediated sensory experiences of preterm infants, as well as infant-mediated sensory experiences of the mother.

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Randomized Controlled Trial of Family Nurture Intervention in the NICU: Assessments of Length of Stay, Feasibility and Safety

While survival rates for preterm infants have increased, the risk for adverse long-term neurodevelopmental and behavioral outcomes remains very high. In response to the need for novel, evidence-based interventions that prevent such outcomes, we have assessed Family Nurture Intervention (FNI), a novel dual mother-infant intervention implemented while the infant is in the Neonatal Intensive Care Unit (NICU). Here, we report the first trial results, including the primary outcome measure, length of stay in the NICU and, the feasibility and safety of its implementation in a high acuity level IV NICU.

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