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The simple acts of care that could help premature babies develop
Yesterday, we introduced you to a long-term study aimed at improving the lives of some of the most vulnerable patients: premature babies. And it is using what seems, on the surface, to be the simplest of techniques.
We are back with William Brangham, who, along with producer Jason Kane, reports on the results of the study, and the more complex story of the woman behind it.
KATE ILIE, Mother:
Let's go to the park. Go ahead, hop in the stroller, Charlotte.
It's hard to believe, but, nearly 10 months ago, Kate and Tyler Ilie were afraid to even touch their youngest daughter, Caroline.
Kate's first pregnancy, with 3-year-old Charlotte, was textbook perfect. But not so with her second. Nearly five months in, her water broke, and Caroline was born eight chaotic weeks later. She was two pounds, five ounces, and over three months early.
Like most premature babies today, she was soon living inside this plastic isolette at Morgan Stanley Children's Hospital, and connected to the incredible medical technology that would save her life.
It took us months before I actually even saw her face, because she had so many tubes in. And when your baby is in that kind of situation, it's almost like you can't let your guard down to really bond with them. Because you're scared of losing them.
Despite the advances that keep younger and younger preterm babies alive, these kids are still at much higher risk for emotional, behavioral and developmental problems later in life.
But a long-term study here at Columbia University Medical Center and NewYork-Presbyterian is testing if the simplest of human interactions: being calmed by mom, taking in her smell, being soothed by her voice … whether these actions can somehow change the development of these children by strengthening their emotional connection.
The intervention is the brainchild of Dr. Martha Welch.
DR. MARTHA WELCH, Director, Columbia University’s Nurture Science Program:
The brain is developing at a very rapid rate, especially at the end of pregnancy, in the last trimester.
When the baby is born early, the baby doesn't have the same environment that promotes that growth. And, in fact, the baby has the opposite: isolation. The child is bombarded with sounds and light. It's antithetical to what the brain needs and the child needs for development.
So, what we're doing is trying to make up for that to the greatest extent possible.
For the past few months, we have been following the Ilie family and several others as they have gone through this study.
Elia Cardenas found it hard to feel like a mother in this clinical setting.
ELIA CARDENAS, Mother:
How are you supposed to bond with the baby that's behind a glass? You can only put your hand in there and touch them, but you can't hug them, you can't hold them.
But, in the study, Cardenas learned how to touch and connect with her sons.
Miguelina Tavarez was taught that a simple cloth, one that smelled like her and another that smelled like her still-hospitalized daughter, can calm both of them.
It's called the Family Nurture Intervention, and over 100 families have gone through it. During the baby's stay in the NICU, mothers learn very simple nurturing techniques, while researchers monitor their progress.
MICHAEL MYERS, Co-Director, Columbia University’s Nurture Science Program:
The intervention itself, I believe, has face validity. It just does make …
It feels right.
But Michael Myers' job is to measure if these interventions do more than just feel right. Do they make any substantive long-term difference to these children or their mothers?
I'm the challenger-in-chief of ideas, to constantly make sure that we don't accept what is intuitive always as being fact.
For the past five years, the team has analyzed video recordings of mothers and their children at various developmental stages — right after birth, four months, 12 months, 18 months, five years.
Their first randomized controlled trial, with 115 moms and 150 infants, indicates "statistically significant results." Among them: a 36 percent increase in brain activity in the frontal region.
Those brain waves, that difference, of about 40 percent, is really visible. It's something that you can really wrap your head around.
This activity is in an area associated with language, thinking and emotional regulation, and, at 18 months, babies in the intervention showed improvement in those areas.
Whether these changes last or even continue remains to be seen. Results for mothers were also significant: improved caregiving in the NICU, and, four months after giving birth, lower levels of anxiety and symptoms of depression.
But convincing some about these results may have less to do with data than with Martha Welch's past work. In the 1980s, Welch wrote a book called "Holding Time," which counseled parents to employ a very physical holding technique, like you see here. The hope was that it would increase communication and emotional connection between parent and child.
But some of Welch's ideas were then co-opted by other practitioners to promote increasingly physical and coercive techniques, similar to this one seen in a CBS News report.
CBS NEWS REPORT:
These earlier sessions were designed to force the rage out of him.
Another session resulted in the smothering death of a 10-year-old girl in 2000.
Welch says, even though her name is still associated with these techniques, she had nothing to do with them and that they have damaged her reputation.
DR. MARTHA WELCH:
I was devastated to be associated in the press with them. It was very, very, very hurtful to me, and that upset lasted about 10 years.
Welch was also criticized for claiming that her nurturing techniques can reduce the risk of autism, which is something premature babies are at greater risk of developing.
Back in the late 1980s, with just anecdotal evidence, she said her "Holding Time" techniques would reduce the risk. And now she says her NICU intervention has shown, by one scientific measure, to do the same.
About one out of four babies test positive for risk at 18 months. We have reduced that from one out of four to one out of 10. This is a big reduction.
But others aren't so sure.
THOMAS FRAZIER, Autism Speaks:
My initial reaction is, really, I think it's unlikely that it protects children from autism.
Thomas Frazier is chief science officer for Autism Speaks, the national advocacy group. He says there's persuasive evidence that, in many cases, autism emerges in utero or very early in life. And he's skeptical this intervention could change that.
Frazier also worries this study could inadvertently cause some parents of autistic children to blame themselves.
There's an early history within autism of saying that parents were sort of at fault, right? If they had just been more nurturing, if they had just done more, particularly moms, if they had just done more to attach to their children, that those children somehow wouldn't have had autism. We now know that that is just not true.
The fact that nurture is a remedy doesn't mean that lack of nurture was the cause. Parents cannot blame themselves for having autistic children. Almost every mother blames herself. This is wrong. But nurture is a remedy.
Meanwhile, some of Welch's scientific peers who were skeptical this study would yield any positive, lasting results have been surprised by the initial data. Among them, Dr. Richard Polin. He oversees the NICU where Welch conducted her trial.
DR. RICHARD POLIN, Morgan Stanley Children's Hospital of NewYork-Presbyterian/Columbia: I was skeptical that this kind of intervention involving kangaroo care, skin-to-skin care, and smell and other interventions would have any long-term benefit. I couldn't understand the biological basis. In fact, the biological basis is still a little uncertain to me.
But, clearly, those kinds of interactions and bonding episodes have a biological effect on the baby's brain. And we hope it's a long-term neurodevelopmental change.
Additional trials to see if these results can be replicated are now under way in New York and Texas, with two more in the works in New Jersey and Florida.
Caroline Ilie, who was born at just two-and-a-half pounds, is now a year-and-a-half old, and seems to be thriving. Back home, all these mothers say their families are better off.
While the science behind it remains a mystery to them, they think this intervention strengthened their relationships during a very fraught period, with impacts they hope will continue with time.
For the PBS NewsHour in New York, I'm William Brangham.
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William Brangham is a correspondent and producer for PBS NewsHour in Washington, D.C. He joined the flagship PBS program in 2015, after spending two years with PBS NewsHour Weekend in New York City.
Jason Kane is a PBS NewsHour producer, focusing on health care and national affairs.
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