Nurturing the preterm infant brain: leveraging neuroplasticity to improve neurobehavioral outcomes

Abstract

An intrinsic feature of the developing brain is high susceptibility to environmental influence-known as plasticity. Research indicates cascading disruption to neurological development following preterm (PT) birth; yet, the interactive effects of PT birth and plasticity remain unclear. It is possible that, with regard to neuropsychological outcomes in the PT population, plasticity is a doubleedged sword. On one side, high plasticity of rapidly developing neural tissue makes the PT brain more vulnerable to injury resulting from events, including inflammation, hypoxia, and ischemia. On the other side, plasticity may be a mechanism through which positive experience can normalize neurological development for PT children. Much of the available literature on PT neurological development is clinically weighted and focused on diagnostic utility for predicting long-term outcomes. Although diagnostic utility is valuable, research establishing neuroprotective factors is equally beneficial. This review will: (1) detail specific mechanisms through which plasticity is adaptive or maladaptive depending on the experience; (2) integrate research from neuroimaging, intervention, and clinical science fields in a summary of findings suggesting inherent plasticity of the PT brain as a mechanism to improve child outcomes; and (3) summarize how responsive caregiving experiences situate parents as agents of change in normalizing PT infant brain development.

Spatial Thinking in Term and Preterm-Born Preschoolers: Relations to Parent–Child Speech and Gesture

“…According to the differential susceptibility hypothesis, PTB may be more susceptible not only to the consequences of negative environmental exposures but also to the benefits of positive ones (Shah et al, 2013;Gueron-Sela et al, 2015). Some posit that neuronal plasticity may partially account for PTB's susceptibility to both negative and positive exposures (DeMaster et al, 2019). However, little is known about whether this theory can be extended to specific parent-child interactions that predict PTB children's cognitive outcomes.…”

“…Given the paucity of research on both spatial skill across the full spectrum of gestational age and also on specific aspects of input, we do not have strong predictions regarding differences between TB and PTB children and their parents. Per differential susceptibility hypothesis and given prior work suggesting that PTB children might be more open to environmental effects (Gueron-Sela et al, 2015;DeMaster et al, 2019), we expect that parental input will more strongly predict spatial skills in PTB children than TB. Based on work on typically developing children's language (Pruden et al, 2011), we expect a mediation model where parental language and gesture input will predict children's spatial skill via children's own language and gesture use.…”

A guided participation nursing intervention to theraupeutic positioning and care (GP_Posit) for mothers of preterm infants: protocol of a pilot randomized controlled trial

“…While in the neonatal intensive care unit (NICU), the preterm infant's brain requires nurturing, that being responsive and sensitive caregiving, in order to develop optimally [1]. Maternal sensitivity is the primary predictor of long-term mother-infant attachment [2] and less secure attachment has been found in 1 to 3 years of age children born preterm compared to children born at term [3].…”

Development and Design of a Nursing Intervention Following a Theory and Evidence-Based Approach to Promote Maternal Sensitivity and Preterm Infant Neurodevelopment in the NICU

“…Moreover, considering that early maternal sensitivity has a positive impact upon the preterm infant development, interventions promoting maternal sensitivity during Neonatal Intensive Care Unit (NICU) hospitalization seem necessary. In fact, evidence shows that early interventions implemented during NICU hospitalization enhancing parenting in mothers of preterm infants may act as a leverage for plasticity of the preterm infant's brain to enhance neurodevelopmental outcomes (22).…”