Protocol for a prospective multicenter longitudinal randomized controlled trial (CALIN) of sensory-tonic stimulation to foster parent child interactions and social cognition in very premature infants

IntroductionPremature birth is associated with long-term somatic and neurological disorders, including cognitive, social and behavioral impairments. Moreover, the mothers of infants born preterm exhibit a higher prevalence of anxiety and depressive symptoms after birth. Early rehabilitation, developmental care, and parenting support have already been shown to have a positive impact on neurological outcome. However, no randomized controlled study has so far assessed the effects on parenting and long-term neurological outcomes of proprioceptive stimulation to trigger positive brain plasticity in very preterm babies. The CALIN project will therefore investigate the impact of sensory-tonic stimulation (STS) of extremely preterm infants by their parents on child parent interactions, infants' morphological and functional brain development and subsequent cognition (including social cognition), and parents' anxiety and depressive symptoms in the postpartum period.Methods and analysisInfants born between 25 and 32 weeks of gestation will be randomly assigned to the “STS + Kangaroo care” or “Kangaroo care” group. The primary endpoint, child and parent interactions, will be rated at 12 months corrected age using the Coding Interactive Behavior system. Secondary endpoints include: 1/functional and anatomical brain maturation sequentially assessed during neonatal hospitalization using electroencephalogram (EEG), amplitude-integrated EEG (aEEG), cranial ultrasound and MRI performed at term-corrected age, 2/social and cognitive outcomes assessed at 15 months, 2, 4 and 6 years, and 3/parents' anxiety and depressive symptoms assessed at 7 ± 1 weeks after birth, using dedicated questionnaires.Ethics and disseminationThis study was approved by the French Ethics Committee for the Protection of Persons on 18 October 2021. It is registered with the French National Agency for the Safety of Medicines and Health Products (ANSM; no. 2020-A00382–37). The registry number on ClinicalTrials.gov is NCT04380051

La dimension psychothérapique de la pédopsychiatrie

Les auteurs proposent – au-delà de la description des différentes techniques psychothérapiques utilisées en Pédopsychiatrie – d’insister sur la dimension psychothérapique centrale des soins pédopsychiatriques. Bien que non spécifique à cette spécialité, elle en constitue la référence thérapeutique la plus importante. En France, la pédopsychiatrie s’est formée dans la rencontre de plusieurs courants conceptuels mais son plein développement, à partir des années 1960, a été marqué par les apports de la psychanalyse. La psychanalyse propose une théorie de développement psychologique, une théorie du fonctionnement mental et un modèle de méthode thérapeutique, la cure psychanalytique. Son application à l’enfant a suscité de nombreuses questions. En fait, cette application nécessite des aménagements du cadre mais aussi des modes d’expression du patient. L’évolution de cette dimension a porté, dans un second temps, sur l’intérêt des consultations thérapeutiques et sur la diversité des médiations thérapeutiques. Les auteurs insistent également sur la contribution significative des concepts systémiques. Les relations entre professionnels et parents ont pu ainsi prendre une plus grande place de façon à permettre une réflexion partagée sur les difficultés de l’enfant au moyen de consultations parents-enfant. Le défi actuel est de maintenir cette dimension psychothérapique et, en même temps, d’intégrer à la pratique pédopsychiatrique les apports plus récents des sciences cognitives et des neurosciences

Prevalences and predictive factors of maternal trauma through 18 months after premature birth: A longitudinal, observational and descriptive study

International audiencePosttraumatic reactions are common among mothers of preterm infants and can have a negative influence on their quality of life and lead to interactional difficulties with their baby. Given the possible trajectories of posttraumatic reactions, we hypothesized that prevalences of postpartum posttraumatic reactions at given times underestimate the real amount of mothers experiencing these symptoms within 18 months following delivery. Additionally, we examined whether sociodemographic and clinical characteristics of dyads influence the expression of posttraumatic symptoms among these mothers. A sample of 100 dyads was included in this longitudinal study led by 3 french university hospitals. Preterm infants born before 32 weeks of gestation and their mothers were followed-up over 18 months and attended 5 visits assessing the infants’ health conditions and the mothers’ psychological state with validated scales. Fifty dyads were retained through the 18 months of the study. The period prevalence of posttraumatic reactions was calculated and a group comparison was conducted to determine their predictive factors. Thirty-six percent of the mothers currently suffered from posttraumatic symptoms 18 months after their preterm delivery. The 18 months period prevalence was 60.4% among all the mothers who participated until the end of the follow-up. There was a statistical link between posttraumatic symptoms and a shorter gestational age at delivery, C-section, and the mother’s psychological state of mind at every assessment time. Only a small proportion of mothers were receiving psychological support at 18 months. Preterm mothers are a population at risk of developing a long-lasting postpartum posttraumatic disorder, therefore immediate and delayed systematic screenings for posttraumatic symptoms are strongly recommended to guide at-risk mothers towards appropriate psychological support

Mother’s Emotional and Posttraumatic Reactions after a Preterm Birth: The Mother-Infant Interaction Is at Stake 12 Months after Birth

International audienc

Emotional reactions of mothers facing premature births: study of 100 mother-infant dyads 32 gestational weeks.

OBJECTIVES: This current study has been conducted to clarify the relationship between the mother's post-traumatic reaction triggered by premature birth and the mother-infant interactions. In this article, the precocious maternal feelings are described. METHODS: A multicenter prospective study was performed in three French hospitals. 100 dyads with 100 very premature infants and their mothers were recruited. Mothers completed, at two different times self-questionnaires of depression/anxiety, trauma and social support. The quality of interactions in the dyads was evaluated. RESULTS: Thirty-nine percent of the mothers obtained a score at HADS suggesting a high risk of depression at the first visit and approximately one-third at visit two. Seventy-five percent of the mothers were at risk of suffering from an anxiety disorder at visit one and half remained so at visit two. A "depressed" score at visits one and two correlated with a hospitalization for a threatened premature labor. We noted a high risk of trauma for 35% of the mothers and high interactional synchrony was observed for approximately two-thirds of the dyads. The mothers' psychological reactions such as depression and anxiety or postnatal depression correlate strongly with the presence of an initial trauma. At visit one and visit two, a high score of satisfaction concerning social support correlates negatively with presence of a trauma. A maternal risk of trauma is more frequent with a C-section delivery. CONCLUSIONS: Mothers' psychological reactions such as depression and anxiety correlate greatly with the presence of an initial trauma. The maternal traumatic reaction linked to premature birth does not correlate with the term at birth, but rather with the weight of the baby. Social support perceived by the mother is correlated with the absence of maternal trauma before returning home, and also seems to inhibit from depressive symptoms from the time of the infant's premature birth

Correlations between PIPE score at 12 months and mother’s and baby’s clinical characteristics.

<p>Correlations between PIPE score at 12 months and mother’s and baby’s clinical characteristics.</p

Correlations between PPQ score at 6 months and mother’s and baby’s clinical characteristics.

<p>Correlations between PPQ score at 6 months and mother’s and baby’s clinical characteristics.</p

Flowchart of the study.

<p>PRI: Perinatal Risk Inventory; V1: assessment at inclusion; V2: assessment at the hospital discharge; V3: assessment 6 months after birth; V4: assessment 12 months after birth.</p

Design of the two first visits of the study.

<p>Design of the two first visits of the study.</p

Mean scores of evaluation scales at visit 1 and visit 2.

a<p>N: Number of dyads.</p>b<p>m(sd): mean (standard deviation).</p>1<p>PRI: Perinatal Risk Inventory.</p>2<p>HADS: Hospital Anxiety and Depression Scale.</p>3<p>SSQ: Social Support Questionnaire of Sarason.</p>4<p>mPPQ: modified Perinatal PTSD (Post Traumatic Stress Disorder) Questionnaire.</p>5<p>EPDS: Edimburgh Postnatal Depression Scale.</p>6<p>DMC: Dyadic Mutuality Code.</p