1. C.J. Nicolais

2. 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

3. Kangaroo Care
C.J. Nicolais

4. Methods
C.J. Nicolais

5. Methods
C.J. Nicolais

6. 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

7. 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

8. 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

9. H1-H3 Results
C.J. Nicolais

10. 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

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

12. 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