Focused attention and heart rate during exploratory play in healthy preterm and term-born infants

Infant attention is central to early development. Previous research has linked focused attention during infant exploratory play to preschool cognition. Importantly, focused attention and information processing have been related to sustained decreases in heart rate (HR), which show developmental changes in infancy. Few studies have examined the relationship between focused attention, heart rate and development in very preterm infants, who are vulnerable to cognitive and attention problems. Participants were 35 extremely low gestational age (ELGA; ≤28 weeks), 48 very low gestational age (VLGA; 29-32 weeks) and 46 healthy term-born infants seen at 8- months corrected age. Focused attention was timed and global focused attention was rated using a toy exploration paradigm. Heart rate was recorded continuously during attention testing. Mean HR and heart rate variability (HRV) were assessed during infant exploration. Additionally, change in mean HR for all focused episodes, and the mean and greatest HR change for the peak focus were calculated. Bayley Scales of Infant Development (BSID-II, Mental Development Index [MDI]) were administered. Term-born infants were rated higher on global focused attention than VLGA, and marginally higher than ELGA infants. For all infants, greater HRV suppression during exploration and magnitude ofHR deceleration during the peak focus were related to greater attentiveness. No group differences were seen in HRV suppression. However, ELGA infants showed greater HR deceleration during focused attention compared to VLGA and Term-born infants. Furthermore, after controlling for perinatal risk, infant peak focus and degree of HR deceleration predicted 8-month MDI for the ELGA (49% of the total variance), but not VLGA infants. This may reflect enhanced attentional effort to compensate for information processing deficits among the highest risk infants. These findings extend research on attention and heart rate during exploratory play to understanding the links between attention regulation, heart rate and cognitive development in very preterm infants. Further knowledge in this area will facilitate the development of effective methods to identify infants very early in life who are at-risk for attention and cognitive problems, and may lead to interventions that can improve developmental outcomes for vulnerable infants.Graduate and Postdoctoral StudiesGraduat

Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants

Procedural pain in the neonatal intensive care unit triggers a cascade of physiological, behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm, who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development. The aim of this study was to examine relationships between cumulative procedural pain (number of skin-breaking procedures from birth to term, adjusted for early illness severity and overall intravenous morphine exposure), and later cognitive, motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age (CCA), and further, to evaluate the extent to which parenting factors modulate these relationships over time. Participants were N = 211 infants (n = 137 born preterm ≤32 weeks gestational age [GA] and n = 74 full-term controls) followed prospectively since birth. Infants with significant neonatal brain injury (periventricular leucomalacia, grade 3 or 4 intraventricular hemorrhage) and/or major sensori-neural impairments, were excluded. Poorer cognition and motor function were associated with higher number of skin-breaking procedures, independent of early illness severity, overall intravenous morphine, and exposure to postnatal steroids. The number of skin-breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation. In general, greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months, but not at 18 months CCA, however, specific protocols for morphine administration were not evaluated. Lower parenting stress modulated effects of neonatal pain, only on cognitive outcome at 18 months