Gravens By Design: Six Weeks that Changed the Preterm Infant Brain: Insights from the Family Nurture Intervention (FNI) Randomized Controlled Trials

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Martha G Welch, MD, Robert J Ludwig, BA, Amie A. Hane, PhD, Michael M Myers. PhD

Abstract:

Our group conducted two randomized controlled trials over 12 years between 2008 and 2020 (total n=261) comparing neonatal intensive care unit (NICU) standard care (SC) with SC plus Family Nurture Intervention (FNI) of infants 26 to 34 weeks GA. The intervention included ~6 hours per week (24 to 36 hours total) of facilitated mother-infant calming sessions aimed at dyadic ‘emotional connection”’ during the NICU stay. At approximately 35 weeks and 41 weeks postmenstrual age, we collected electroencephalographic (EEG) activity on the brains of all subjects using 128-lead nets. Analyses at near-term age showed dramatic changes in brain function on multiple measures in FNI vs. SC infants. Importantly, we found similar increased prefrontal cortical activity in a multisite replication trial of FNI-NICU. We have documented in 18 publications that FNI group infants had significantly better short and long-term neurobehavioral functioning, autonomic health, and developmental trajectories. FNI dyads had significantly better autonomic regulation than SC dyads through five years. In this article, we discuss the key features of FNI that led to our results and the theoretical and clinical advances that grew out of the trials. We discuss how these insights can help improve preterm infant outcomes. We introduce new terminology and constructs that describe behavior and physiology and a new assessment tool that correlates with physiology to measure the mother/infant emotional relationship (Welch Emotional Connection Screen). Finally, we discuss the significance of our findings and how our insights might be incorporated into other NICU interventions and widespread standard NICU care.

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Disclosure: The authora have no stated conflicts of interest

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