C.J. Nicolais

Background Early maternal contact associated with bio-behavioral processes that support development and impact infant stress management and social functioning The brain develops after birth and mothering behaviors affect that development (especially the HPA axis, autonomic nervous system, and sleep- wake cycle) These functions are especially important for premature infants Early and persistent maternal separation Disruptions to brain development Combined effects of development (especially processes sensitive to mothering) No one has looked at the long-term effects of maternal contact on these processes. C.J. Nicolais

Kangaroo Care C.J. Nicolais

Methods C.J. Nicolais

Methods C.J. Nicolais

Physiologic Functioning H1) Infants receiving KC would show more optimal physiologic functioning in contact- sensitive systems, including autonomic functioning, sleep organization, and HPA reactivity AT TERM: KC > baseline RSA & more organized sleep-wake cycle Sicker neonates less organized sleep and autonomic functioning 10 YEARS: KC > autonomic functioning and sleep efficiency No differences in cortisol at baseline KC < cortisol at reactivity assessment KC marginally quicker cortisol recovery Milder cortisol stress reactivity & autonomic reactivity to stress C.J. Nicolais

Mother-child Interactions H2) Mother–child interactions would be more optimal following KC PARENTAL MENTAL HEALTH KC < maternal anxiety at term, 3 months, and 6 months KC < mother parenting stress No group differences maternal depression father parenting stress maternal anxiety/depression at 10 years MOTHER-CHILD RELATIONSHIP KC > attachment behavior across postpartum period KC > mother-child reciprocity at 10 years C.J. Nicolais

Cognitive Skills KC > Mental Development score at 6, 12, 24 months H3) Children who received KC would show improved cognitive skills across childhood, particularly EF that require cognitive flexibility and mental shifting KC > Mental Development score at 6, 12, 24 months IQ not sig. different between groups at 5 & 10 yrs Lower medical risk > IQ KC > EF Lower medical risk > EF C.J. Nicolais

H1-H3 Results C.J. Nicolais

Individual Stability Neonatal/10yr stability: RSA (r = .33, p = .001) H4) Individual stability will be observed in each domain (e.g., child physiology, mother– child relationship) over time. Additionally, cross-domain correlations would be found, expressed in both concurrent correlations and long-term associations between early parenting and later child physiology and vice versa.  Neonatal/10yr stability: RSA (r = .33, p = .001) Maternal attachment/mother-child reciprocity 10 yr (r = .32, p = .001) Maternal anxiety (r = .28, p = .008) Depression (r = .32, p = .001) Many cross-domain same-period correlations as well! C.J. Nicolais

Predicting 10yr Outcomes Models predicting cortisol and sleep efficiency not significant. C.J. Nicolais

Conclusions Let’s Discuss! KC has long-term benefits for child development Stable functioning in each domain across 10 years what happens in infancy sets the stage for the long-term Improvements in child physiological organization and maternal behavior may reinforce each-other over time sustained improvements Highly accessible intervention Let’s Discuss! How do we use this information clinically? Methods? What about fathers? How would we expect these findings to translate to full-term infants? The authors found an effect of increased breast milk production with KC. Does this impact our interpretation of these findings? 14 days of KC neonatal, but does which 14 days matter? C.J. Nicolais