Family Nurture Intervention – NICU

When a baby is born prematurely and needs to be in the neonatal intensive care unit (NICU), the infant and family suffer emotional trauma from separation. The life-saving care these infants need causes mother-infant separation, just when the mother normally protects her baby against stress through ongoing, reciprocal calming interactions. Premature birth is known to put children at increased risk for many long-term challenges, including behavioral problems, learning difficulties, communication issues, and autism spectrum disorders. Many of these issues can be avoided when mother-infant nurture interactions are fostered in the first days of life.

Family Nurture Intervention (FNI) helps families re-establish emotional connection and autonomic co-regulation if they are interrupted. Results from a randomized control trial that compared Family Nurture Intervention with standard care in the NICU found that Family Nurture Intervention had significant short- and long-term benefits for both baby and mother.

The Intervention

During Family Nurture Intervention (FNI), a trained Nurture Specialist works with the family to help facilitate emotional connection. During the first randomized control trial, the intervention was provided for six hours a week, on average.

Each session facilitated by the Nurture Specialist is a calming session, with mother and baby being together physically and emotionally until both are calm. With practice, calming cycle interactions take less time for mother and infant to lower stress levels and calm each other.

Although many activities associated with FNI in the neonatal intensive care unit (NICU) are not novel (such as scent cloth exchange, kangaroo care, and talking to the baby), the larger goal of FNI is emotional communication between mother and infant. That is what makes FNI different from other interventions. The mother and baby are always thought of together, as a pair, and interventional activities deliberately create emotional connection between them.

Exciting Findings

The first clinical trial of Family Nurture Intervention (FNI) was conducted in the neonatal intensive care unit (NICU) of New York-Presbyterian’s Morgan Stanley Children’s Hospital between 2008 and 2014, with 150 preterm infants and their mothers randomly assigned to either FNI or standard care.

The findings revealed starkly different developmental tracks between these two groups:

At term age, infants who received FNI showed dramatically improved brain activity in the prefrontal cortex, which is the area of the brain most dysregulated by premature birth, compared to infants who received standard care.
At 18 months, infants who received FNI had improved cognition and language, fewer attention problems, and reduced risk for autism, compared to infants who received standard care.

Family Nurture Intervention also benefited the mothers:

While the babies were still in the NICU, the mothers who received FNI showed improved caregiving behaviors.
When the babies were four months old, mothers who received FNI reported lower levels of depression and anxiety, compared to mothers who received standard care.

Ongoing Research

Replication studies to confirm the findings from the initial randomized control trial are underway at two locations:

New York-Presbyterian’s Morgan Stanley Children’s Hospital, New York, NY. Principal Investigator: Martha G. Welch, MD, DFAPA
University of Texas Health Science Center at San Antonio, San Antonio, TX. Principal Investigator: Alice Gong, MD

An effectiveness trial is also underway to understand what training and support is needed for Family Nurture Intervention to be become integrated into standard care across the NICU at:

The Valley Hospital, Ridgewood, NJ. Principal Investigator: Christiana Farkouh, MD

Family Nurture Intervention – NICU

Contact Us: 212-342-4400 nurturescience@cumc.columbia.edu

Columbia University

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