A simple form of skin-to-skin contact between mothers and premature babies right after birth enhances the babies' brain development until age 10, according to research conducted at Bar-Ilan University.
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The touch-based treatment, called "kangaroo care," was first developed in 1978 in Bogotá, Columbia, in the absence of costly incubators. The new study shows that kangaroo care has profound effects on the development of preemies in affluent societies as well.
Ruth Feldman, a professor of psychology and neuroscience at Bar-Ilan University, and her colleague Arthur Eidelman, a neonatologist at Shaare Zedek Medical Center and the Hebrew University of Jerusalem, began the study in 1996, before kangaroo care was a routine component of the care of premature babies. Feldman had suffered a personal tragedy with a baby of her own, and that experience impelled her to work with fragile premature infants.
“I spent nights and nights with parents and sick preemies,” in the Neonatal Intensive Care Unit of Shaare Zedek in Jerusalem, she says. “Some parents didn’t know if their children would make it to the morning.”
Her dedication to these families, which continued long after their children had left the NICU, has paid off. Her research has shown multiple early benefits of kangaroo care, including more-stable sleep and heart-rate patterns in the infants and less anxiety and closer bonding with the baby in the mothers.
In the study, 73 mothers of premature infants born at Schneider Children’s Medical Center in Petach Tikva spent one hour per day for 14 days snuggling their babies — who were born, on average, nine weeks before their due date — upright against their bare chest. The infant wore just a diaper and a cloth covering its back. A control group of 73 mother-preemie pairs at Shaare Zedek were given standard incubator care. By the time they left the hospital, the infants in the kangaroo care group were better able to regulate their heart rate in response to stress — and it was their mothers’ own heart rate that helped synchronize this rhythm, Feldman explains.
Over the course of ten years, Feldman and her team examined the children seven times at regular intervals. At 5 and 10 years old, the children in the kangaroo care group showed significant enhancement in executive function, a cognitive process controlled by the brain’s prefrontal cortex, which develops in the last trimester of pregnancy and in the first year-and-a-half of life. These children had better planning, problem-solving, and flexibility skills, all abilities governed by executive function.
Kangaroo care has positive effects on mothers, as well. Not only did they produce more breast-milk, but “a more involved mother [leads to] better interaction, the child learns to self-regulate more, and more regulated child elicits better mothering,” Feldman says. “This starts a cycle of better developmental trajectory.”
Others agree. “The findings of this research are the first to show permanent changes in how the infant’s central nervous system functions, child behavior, and how replacement of the lost tactile stimuli after birth influences the mother-child relationship and heart rate patterns, even at 10 years of age,” says Rosemary White-Traut, head of the Department of Women, Children and Family Health Science in the College of Nursing at University of Illinois, Chicago. The first “sense” that the fetus develops is tactile and they lose the constant tactile stimulation of the womb after birth, she explains. Kangaroo care can make up for some of this loss, especially since premature birth interrupts normal brain development. Feldman’s research, she says, confirms that kangaroo care “supports the continuing and optimal development of the central nervous system.”
Other aspects of NICU care can also have a profound effect on brain development of premature babies. In a study of 136 premature infants, Roberta Pineda and her colleagues at Washington University School of Medicine in St. Louis found that premature babies cared for in quiet private rooms had poorer motor and language skills at age 2 than babies cared for in open wards with eight to 12 beds. That finding is counter-intuitive, she says, since the infants in the communal wards were also exposed to the constant din of beeping machinery, bright lights and other babies’ cries.
“In the open ward, there is a constant flow of people coming through and there is the camaraderie of mothers being able to speak together, speak about their baby; the nurses can see and be right next to a baby who is crying and needs some interaction,” says Pineda, an assistant professor in occupational therapy and pediatrics. She found that babies in private rooms experienced three hours’ more silence in a 16 hour period than those in open wards. In the open room, a baby is exposed to more language even if it isn’t directed at them — for example from mothers or fathers talking or singing to babies in adjacent beds.
“Parenting in the NICU is extremely important,” says Pineda, herself a mother of a premature baby born at 29 weeks’ gestation. (“He is what makes me so passionate about this line of research,” she says.) “Once the baby is stable, close contact, holding, interacting, singing, verbalizing to the baby is likely to be really important to their development.”
Feldman, who continues to monitor the children in her study as they approach 18 years of age, agrees. “I’m very, very invested in these families,” she says. “Knowing that a lot of NICUs around the world introduced kangaroo care because of our studies is important for me.”