Person:

Nugent, J.K.

Background: Previous literature suggests an association between organochlorines and behavioral measures in childhood, including inattention. Objective: This study was designed to assess whether prenatal organochlorine exposure is associated with measures of attention in early infancy. Methods: We investigated an association between cord serum polychlorinated biphenyls (PCBs) and p,p′-dichlorodiphenyl dichloroethene (DDE) levels and measures of attention from the Neonatal Behavioral Assessment Scale (NBAS) in a cohort of 788 infants born 1993–1998 to mothers residing near a PCB-contaminated harbor and Superfund site in New Bedford, Massachusetts. Results: Medians (ranges) for the sum of four prevalent PCB congeners and DDE levels were 0.19 (0.01–4.41) and 0.30 (0–10.29) ng/g serum, respectively. For the 542 subjects with an NBAS exam at 2 weeks, we observed consistent inverse associations between cord serum PCB and DDE levels and NBAS measures of alertness, quality of alert responsiveness, cost of attention, and other potential attention-associated measures including self-quieting and motor maturity. For example, the decrement in quality of alert responsiveness score was −0.51 (95% confidence interval, −0.99 to −0.03) for the highest quartile of exposure to the sum of four prevalent PCB congeners compared with the lowest quartile. We found little evidence for an association with infant orientation, habituation, and regulation of state, assessed as summary cluster measures. Conclusions: Our findings provide evidence for an association between low-level prenatal PCB and DDE exposures and poor attention in early infancy. Further analyses will focus on whether organochlorine-associated decrements in attention and attention-related skills in infancy persist in later childhood.

Relationship-based interventions are an effective means for reducing postpartum depression (PPD), but few cost-effective tools that can be administered efficiently in medical and home settings are available or well-studied. This study examines the efficacy of the Newborn Behavioral Observations (NBO), an infant-centered relationship-based intervention, in reducing levels of postnatal maternal depression. These findings suggest that the NBO conducted in hospital and home settings may be an efficient, cost-effective, relationship-based method for reducing the likelihood of PPD symptoms.

The period covering the first 3 months of life consists of a series of pivotal, life-changing transitions for the infant, for the parents, and for the emerging parent-child relationship. The Newborn Behavioral Observations (NBO) system is a relationship-based tool that offers individualized information to parents about their baby's communication strategies and overall development, in order to strengthen the relationship between infants and parents. The content and uses of the NBO, the theoretical framework on which it is based, and the growing evidence for its effectiveness as form of support for parents and families will be discussed.

The purpose of this study is to compare two models of early intervention (EI) service delivery—a neurobehavioral intervention and usual care—on parents' perceived quality of EI service delivery. Families of newborns referred to EI were randomly assigned to a neurobehavioral intervention or usual care group and followed until the infant was 12 weeks corrected gestational age. The intervention group (n=25) received a weekly neurobehavioral intervention. The usual care group (n =13) received standard weekly home visits. Mothers completed the Home Visiting Index (HVI) measuring the quality of EI service delivery. Mixed linear regression was used to examine group differences in quality scores. The intervention group reported higher quality of care related to facilitating optimal parent–infant social interaction (mean difference= 2.17, 95% CI: 0.41, 3.92).A neurobehavioral model of service delivery can be successfully integrated into EI programming and appears to be associated with higher parent-reported perceived quality.

Study purpose: Early intervention (EI) can ameliorate neurobehavioural difficulties and parental psychosocial distress. Often, EI service providers are not trained to address the unique needs of the high risk parent–infant dyad. The purpose of this study was to describe provider confidence and knowledge following delivery of a neurobehavioural intervention for high-risk newborns. Methods: This feasibility study was a multi-site, randomised controlled trial of newborns referred to EI. The intervention group received weekly home visits by a service provider certified in the Newborn Behavioural Observation (NBO) – a neurobehavioural intervention. The control group received usual care. Eighteen EI providers completed the Index of Practitioner Knowledge and Skills (IPKS). Results: EI providers did not differ on socio-demographic characteristics, discipline, or experience between the intervention and usual care groups. In mixed linear regression models, the NBO group demonstrated higher confidence scores (mean difference = 2.2, 95% CI: 0.54, 3.87). Conclusion: Integrating a neurobehavioural intervention into EI service delivery may be associated with higher perceived confidence among service providers in their ability to work with high-risk newborns.