ABSTRACT
OBJECTIVE: The purpose of this article was to systematically compare the developmental trajectory of neurobehavior over the first postnatal month for infants with prenatal exposure to pharmacologically untreated maternal depression, selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors (collectively: SSRIs), SSRIs with concomitant benzodiazepines (SSRI plus benzodiazepine), and no maternal depression or drug treatment (no exposure). METHOD: Women (N=184) were assessed at two prenatal time points to determine psychiatric diagnoses, symptom severity, and prenatal medication usage. Infants were examined with a structured neurobehavioral assessment (Neonatal Intensive Care Unit Network Neurobehavioral Scale) at multiple time points across the first postnatal month. SSRI exposure was confirmed in a subset of participants with plasma SSRI levels. General linear-mixed models were used to examine group differences in neurobehavioral scores over time with adjustment for demographic variables and depression severity. RESULTS: Infants in the SSRI and SSRI plus benzodiazepine groups had lower motor scores and more CNS stress signs across the first postnatal month, as well as lower self-regulation and higher arousal at day 14. Infants in the depression group had low arousal throughout the newborn period. Infants in all three clinical groups had a widening gap in scores from the no-exposure group at day 30 in their response to visual and auditory stimuli while asleep and awake. Infants in the SSRI plus benzodiazepine group had the least favorable scores on the Neonatal Intensive Care Unit Network Neurobehavioral Scale. CONCLUSIONS: Neonatal adaptation syndrome was not limited to the first 2 weeks postbirth. The profile of neurobehavioral development was different for SSRI exposure than depression alone. Concomitant benzodiazepine use may exacerbate adverse behavioral effects.
Subject(s)
Anxiety Disorders/drug therapy , Benzodiazepines/therapeutic use , Child Development , Depressive Disorder, Major/drug therapy , Infant Behavior , Pregnancy Complications/drug therapy , Prenatal Exposure Delayed Effects , Selective Serotonin Reuptake Inhibitors/therapeutic use , Adult , Anxiety Disorders/psychology , Arousal , Case-Control Studies , Depressive Disorder/drug therapy , Depressive Disorder/psychology , Depressive Disorder, Major/psychology , Female , Habituation, Psychophysiologic , Humans , Infant, Newborn , Male , Muscle Hypotonia , Pregnancy , Pregnancy Complications/psychology , Severity of Illness Index , Transcription Factors , Young AdultABSTRACT
This study examined attachment in association with preschoolers' emotional functioning among 54 predominantly low-income families living in Appalachia. Attachment was assessed at age 4 years using the Strange Situation (Ainsworth, Blehar, Waters, & Wall, 1978) and classified with the PAA (Crittenden, 2004). Emotional competence was measured via an interview about children's memories for six emotions, rated in terms of both emotion understanding and regulation. Parent-, teacher-, and self-reports of children's internalizing and externalizing symptoms were also completed. Questionnaires and interviews assessed socioeconomic risk and parental symptoms and negative childhood experiences. Children's PAA strategies were significantly associated with risks, emotion regulation and understanding, and symptoms. Children using highly coercive strategies showed the greatest difficulties. Emotion regulation and understanding also were associated with parent- and teacher-report of symptoms. These findings suggest that intervention efforts with at-risk youngsters should target not only attachment security, but also emotional competence skills.
Subject(s)
Adaptation, Psychological , Child Behavior Disorders/psychology , Emotions , Object Attachment , Personality Assessment , Poverty Areas , Reactive Attachment Disorder/psychology , Appalachian Region , Child Behavior Disorders/classification , Child Behavior Disorders/diagnosis , Child Behavior Disorders/therapy , Child, Preschool , Coercion , Defense Mechanisms , Father-Child Relations , Female , Humans , Internal-External Control , Life Change Events , Male , Mental Recall , Models, Psychological , Mother-Child Relations , Parenting/psychology , Reactive Attachment Disorder/classification , Reactive Attachment Disorder/diagnosis , Reactive Attachment Disorder/therapy , Risk FactorsABSTRACT
BACKGROUND: Children who were born prematurely are at higher risk for sleep-disordered breathing (SDB) compared to their same-age peers who were born fullterm. OBJECTIVE: The objective of the present study was to assess the frequency of SDB symptoms and effects on growth among preterm infants while they are still infants, with a goal of identifying risk factors to facilitate prevention and early intervention. METHODS: The Louisville pediatric SDB risk survey was administered to the primary caretakers of prematurely born infants attending the Neonatal Follow-Up Clinic at West Virginia University Children's Hospital. RESULTS: Participation was 100% among 173 consecutive patients invited to participate in the study. At 9.13 months corrected age, 8.1% of infants born at a mean of 31.6 weeks gestation were reported to snore > or = 3 days/week, a rate consistent with diagnosis of sleep-disordered breathing among older children. A composite of nine parent-reported symptoms was created based on factor analysis. Birth weight and size for gestational age at birth did not differ between snoring groups or correlate with the composite score. But a significant negative correlation between the composite risk for SDB score and current weight for adjusted age percentile score indicate that infants with higher SDB symptom profiles have lower weight for age (r=-.18, p=.028). CONCLUSIONS: SDB symptoms are detectable among infants born preterm, while they are still infants. Because of their preferential risk for SDB and its somatic consequences, a primary research goal should be description of the natural history of SDB and identification of modifiable risk factors and treatment options.
