The Newborn Infant, capable and vulnerable : An interactional perspective

Sammanfattning: The overall aim of this work was to increase our knowledge of newborn infants and their mothers, gain a better understanding of attachment and the infants' development and identify infants at risk for poorer emotional, social and cognitive development. An interdisciplinary approach was used. Six studies are included in the thesis. Non-nutritive sucking (NNS) and its relation to neurobehavioural status and developmental maturity have for many decades attracted interest. The main obstacle has been the lack of a reliable and easily administered method. The purpose of Study I was to construct an easily administered method of measuring NNS. The study was a collaborative project between physicians, psychologists and computer engineers. The purpose of Study II was, by using this instrument, to explore possible differences between healthy full-term infants and preterm infants at term conceptional age and whether the NNS pattern in the newborn period is related to the use of a pacifier. A highly automatised method of assessing NNS patterns was developed. The studies demonstrated differences in NNS pattern between groups of infants which might be ascribed to age, experience, sex, maturity and level of tension. The Neonatal Behavioral Assessment Scale, NBAS, appears to be the most comprehensive assessment instrument for assessing newborn infants. Despite many studies with the NBAS, complete standardisation data are not available. The purpose of Study III was to explore if the NBAS distinguishes differences among medically, very healthy infants assessed by strict criteria for optimal health. The study is a joint project with a neonatologist. The results indicated behavioural variability among healthy neonates and gender differences, girls showing higher levels of functioning than boys. As the NBAS is an extensive and time-consuming instrument, a screening technique for identifying infants at risk for disturbances in early mother-infant interactions has long been desirable. The purpose of Study IV was to construct such an instrument, on the basis of the NBAS. The study was a joint project with a statistician. The study demonstrated a possibility of constructing a hierarchical conditional global scale for assessing the level of self-regulation by using seven items of the NBAS. This scale is suggested to constitute a screening instrument and to be further evaluated by follow-up studies and be applied to other groups of infants. The purpose of Study V was to test the hypothesis that the level of self-regulation in the newborn baby predicts emotional, social and cognitive development at two years of age. The infants were assessed by Griffths' Mental Developmental Scales and the parents were interviewed about the infants' sleeping habits, autonomic behaviours and duration of breast-feeding. The hypothesis was confirmed. It is now widely recognised that advances in medicine unintentionally alter the initiation of the mother-infant relationship and may cause emotional disturbances in the mother-infant interaction. The aim of Study IV was to explore possible differences between mothers of healthy full-term infants and mothers of preterm infants, when discharged from the hospital, with regard to their emotional status and their perception of the infants. The results revealed obvious differences between the groups immediately postpartum but when leaving the hospital the differences were eliminated. However, there were mothers in both groups who may be at risk for disturbances in the attachment process. The studies showed that there are still many questions to be answered about infant development. This work may contribute to further development of intervention routines in neonatal and maternity wards and prompt further studies in this field.

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