Skin-to-skin contact is 
       SPECIALLY FOR PRETERMS

 The more premature a newborn is, the less resilience it has, the more it needs skin-to-skin contact. (But the more we separate ... )

All the scientific research on mammalian studies and on the “highly conserved neuro-endocrine behaviors of the brain”, relate to full term models and full term human babies. Despite their seeming helplessness, they do have considerable behavioural competencies, and RESILIENCE. This needs developing, and “positive stress” refers to short and brief stress that allows the infant to develop increasing resilience. Importantly, this requires the support of mother to help regulate in the face of a disturbance or perturbation. Tolerable stress refers to stress that would easily overwhelm systems and brain circuits, but there is “buffering protection of adult support” that helps the infant to adapt. “Toxic stress” is the same stress in the absence of “buffering protection of adult support. This disrupts brain architecture, and leads to stress management systems that responds at lower thresholds” … shifting the allostatic set-points and leading to short term distress and long term maladaptations.

This resilience can be overwhelmed, but full term infants  can cope with mild and moderate stress, or positive and tolerable stress. The worst form of stress for a full term is separation from parent, it defines toxic stress. The preterm and low birth weight infants however has less resilience, and therefore is less able to tolerate stress, and much less able to tolerate separation. Preterm infants are MORE DEPENDENT, not less, on buffering protection of adult support.

I argued that “separation tolerance” may be exceeded (LINK). In the last two years (2010 – 2011) increasing evidence has accumulated for adverse effects in a group of babies we call “LPI” (Late preterm infants) that are born between gestation age 34 to 36 weeks. They are preterm, but can cope quite well medically and clinically with our usual neonatal care. It was generally assumed they would be fine in their development. However, increasingly it is clear that by the time they start school, they have significant developmental delays and behavioural problems, as a group, compared to full term infants. The group has an average which is significantly lower in a variety of performance areas. (Within that group, there are some LPI’s who score higher than some full-terms).

In the last decade, such infants have been treated in neonatal care units with maternal infant separation as the unquestioned norm. Such infants, having lower resilience and higher sensitivity, are those who sooner will show the maladaptive effects I have described.  My hypothesis is that this originates in this early sensitive period. Preventing such problems should, start with a ZERO SEPARATION POLICY for such infants.

The step down from there is the smaller and younger preterm infants. During the last several decades, our technology and expertise has greatly improved the survival of preterm infants. The quality of that survival has not greatly increased. Preterm birth leads to greatly increased risk of cerebral palsy and mental retardation, lung disease and blindness; these are fairly gross measures of poor outcome. But with more subtle measures of emotional and social outcomes, long germ effects of prematurity are even greater. And so, again; I propose that these reflect the separation effects of maladaptations on multiple systems in the developing child during particularly critical periods of development.

Maternal-infant skin-to-skin contact is the essential developmental environment for the DNA and the brain, and both are exceptionally active in development before normal birth, in infants we call preterm. The more preterm, the more skin-to-skin contact is needed. And also: the more technology is needed to help immature organs. These should be added to skin-to-skin contact for optimal developmental outcome.

 

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