Integrated Mother-Premature Infant Intervention and Mother-Infant Interaction at 6-weeks Corrected Age Rosemary White-Traut, PhD, RN, FAAN Kathleen Norr, PhD Kristin Rankin, PhD Rohitkumar Vasa, MD University of Illinois at Chicago Mercy Hospital and Medical Center

Background Premature infants present subtle behavioral cues and their mothers experience stress and anxiety, often leading to difficulties in mother-infant interaction. Prior studies have reported positive associations between mother-infant interaction and infant development. No previous interventions have simultaneously addressed the needs of both mothers and infants in improving the quality of their interactions.

Purpose  To examine whether an integrated intervention for mother-premature infant dyads relates to more positive mother-infant interaction at 6-weeks corrected age (CA)

Design and Selection Criteria  Randomized clinical trial at 2 Level II NICU’s  Otherwise healthy infants born between weeks of age  Mothers with at least 2 risk factors: Minority status Less than high school education History of mental illness Household income < 150% poverty line More than 1 child under 24 months of age Four or more children in household Resides in a disadvantaged neighborhood

Intervention and Control Conditions  H-HOPE Intervention: Hospital-home transition – optimizing prematures’ environment 1.Mothers learn to read, interpret, and respond to premature infant cues and behavioral state 2.Mothers learn to perform the ATVV multi-sensory infant intervention –Auditory (infant directed talk) –Tactile (moderate touch massage) –Visual (eye to eye contact) –Vestibular (horizontal rocking)  Attention Control: Parent Education Program (PEP) –Infant Safety & Back To Sleep

Sample: Maternal & Infant Characteristics H-HOPE (n=66 ) Control (n=76) Maternal age at delivery, mean (SD)25.3 (6.6)26.4 (6.5) Maternal race (% Latina/Black)52 / 4949 / 51 Low Education for Age (%) First Time Mom (%) Infant Sex (% male)4758 Gestational Age at Birth, mean (SD)32.2 (1.7)32.5 (1.6) Infant Birth Weight, mean gms (SD)1816 (374)1868 (435) Infant Corrected Age at 6 week follow up, mean (SD) 13.6 (1.8)13.2 (1.9) No Significant Differences between groups

H-HOPE Intervention for Mother- Preterm Infant Dyads

Dependent Variables  DMC (Dyadic Mutuality Code) – Mother asked to play with infant for 5 minutes – Scored for contingent behaviors, 6-item scale (range: 6-12)  NCAST (Nursing Child Assessment Satellite Training – Feeding Scale) – Structured observation during feeding – Scored for maternal and infant behaviors on 76-item scale

Data Analysis The H-Hope and PEP dyads were compared using:  Chi-square tests to assess the proportion with high DMC scores  T-tests and multivariable linear regression to assess Overall NCAST, Maternal and Infant NCAST sub-scores

Percent of Dyads with High Responsiveness During Play (DMC)

Results: Mean Scores for NCAST Overall and Subscales *p < 0.10 (t-test) **p < 0.05 H-HOPE (n = 66) mean (SD) PEP (n = 76) mean (SD) Total NCAST Score * 64.3 (5.2)62.5 (7.0) Maternal Score 44.4 (4.3)43.4 (5.5) Sensitivity to Infant Cues Response to Distress Social-Emotional Growth Fostering* Cognitive Growth Fostering 14.2 (1.4) 9.9 (1.4) 12.4 (1.5) 7.9 (1.7) 14.3 (1.6) 9.8 (1.4) 11.8 (2.0) 7.5 (2.0) Infant Score** 19.9 (2.0)19.1 (2.5) Clarity of Cues ** Responsiveness to Caregiver 12.7 (1.1) 7.3 (1.4) 12.0 (1.5) 7.2 (1.6)

Results: Multivariable linear regression of Overall NCAST score ModelβSEp Intercept HHOPE vs. Control group High vs. Low Trait anxiety Infant morbidity score (POPRAS)

Results: Multivariable linear regression of NCAST Infant Sub-score ModelβSEp Intercept HHOPE vs. Control group Single vs. Multiple Adults in Household

Results: Multivariable linear regression of NCAST Maternal Sub-score ModelβSEp Intercept HHOPE vs. Control group Disadvantaged neighborhood Maternal age High vs. Low Trait Anxiety Gestational age Birth weight Infant morbidity

Conclusions Dyads receiving the H-HOPE intervention had marginally higher scores on overall mother-infant interaction during feeding (p =.06) Maternal social-emotional growth fostering subscale scores were marginally higher for the H-HOPE group (p =.09) The infant scale and the infant clarity of cues subscale scores were also marginally significant for the H-HHOPE group (p =.06)

Conclusions  H-Hope infants presented clearer behavioral cues and had higher mutual responsiveness with their mothers during play  Intervening with both mother and infant is a promising approach to help premature infants achieve the social interaction patterns essential for optimal development

Acknowledgements  Funded by the National Institute of Child Health and Development, the National Institute of Nursing Research (1 R01 HD A2) and the Harris Foundation  The authors wish to acknowledge the infants and their parents who participated in this research