Autonomic regulation of preterm infants is enhanced by Family Nurture Intervention

Abstract

Preterm infants have maturational delays in several neurobehavioral systems. This study assesses the impact of the Family Nurture Intervention (FNI) in the neonatal intensive care unit (NICU) on the maturation of autonomic regulation of preterm infants. Preterm infants born at 26–34 weeks postmenstrual age (PMA) were assigned to groups receiving either standard care (SC) or SC plus FNI, using a randomized controlled trial design. At two collection time points, approximately 35 weeks and 41 weeks PMA, electrocardiograms (ECG) were monitored for approximately 1 hour during sleep. Heart rate and respiratory sinus arrhythmia (RSA) were quantified from the ECG. Across the two time points, the FNI group exhibited greater increases in RSA (Cohen's d = 0.35) and slope between RSA and heart rate, as a measure of vagal efficiency (Cohen's d = 0.62). These results document that FNI resulted in enhanced autonomic regulation consistent with greater maturation of cardiac function. These and previous findings strongly suggest that facilitating early nurturing interactions and emotional connection between preterm infants and their mothers is a practicable and effective means of optimizing postnatal development in preterm infants. Interpretation of these autonomic function results also enriches our understanding of the potential long‐term beneficial outcomes of FNI by drawing upon polyvagal theory, which explains how autonomic state provides a neurophysiological platform for optimal co‐regulation between infant and caregiver, and by drawing upon calming cycle theory, which provides a model for understanding how repeated mother/infant calming interactions positively condition autonomic state and reinforce approach, prosocial behaviors.

Traumatic stress and the autonomic brain‐gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology

“…Children who receive this intervention also exhibit higher cardiac VVC regulation (measured by RSA), attenuated stress response, better cognitive control, and better organized sleep through the first 10 years of life (Feldman, Rosenthal, & Eidelman, ). The Family Nurture Intervention, a psychosocial intervention based on Calming Cycle Theory that promotes mother‐infant emotional connection through direct interpersonal communication of affect (Welch, ) has also shown promise in preterm infants, with benefits for VVC regulation, socioemotional function, and neurodevelopmental outcomes (Porges et al, in press; Welch et al, ). Interventions focused on parent–child interactions may also improve autonomic function in older children (e.g., Hastings et al, ).…”

Diverse Autonomic Nervous System Stress Response Patterns in Childhood Sensory Modulation

“…Integrating awareness of arousal regulation with sensorimotor-based treatments are necessary, including a promising trend towards decreasing EDA magnitude (e.g., Miller et al, 2007;Bodison and Parham, 2018;Foitzik and Brown, 2018). Sensorimotor-focused treatment strategies can impact a variety of distributed properties and benefit from being coupled with socio-emotional and play-based relational approaches (Greenspan et al, 1998;Bundy et al, 2008;Lillas et al, 2018;Pfeiffer et al, 2018;Roberts et al, 2018;Schaaf et al, 2018;Delahooke, 2019;Porges et al, 2019). This integrated, interdisciplinary lens better addresses sensorimotor over-and under-responsivity in tandem with the arousal and emotional dysregulation related to internal stress responses.…”

Nurturescience versus neuroscience: A case for rethinking perinatal mother–infant behaviors and relationship

“…Columbia is focused on the restorative nature of emotional connection. The Family Nurture Intervention (FNI) trials have shown dramatic and impressive benefits from an intervention that started an average of 7 days following preterm birth, despite protocol designed to begin FNI as soon as possible after birth (Porges et al, ; Welch et al, ; Welch et al, ; Welch & Myers, ). Columbia NSP is testing the hypothesis that it is not too late to reestablish the healing powers of emotional connection in children 0–5 years of age.…”

“…Calming cycle theory describes the process by which an emotional connection and autonomic coregulation can be reestablished between mother and infant utilizing the natural learning mechanism that makes it possible for the two to connect upon birth. Calming cycle theory extends polyvagal theory by providing a learning mechanism by which the vagus nerve controls heart rate and vagal tone (Ludwig & Welch, ; Porges et al, ). It proposes that an association is formed between the autonomic states of infant and mother during gestation via Pavlovian coconditioning (autonomic learning), which leads to a cardiac calming reflex and emotional connection following normal birth (Welch & Ludwig, ).…”