Discussion
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SECONDARY
This protocol-based secondary analysis of a multicenter randomized clinical trial investigated the effect of immediate SSC with a parent after birth on interaction between very preterm infants and their mother. Our findings support the existence of an early sensitive period for very preterm infants after birth. Infant expressions of positive affect, communication, and social skills were most favorable in the mother-infant dyads allocated to immediate SSC. The dyadic interaction was more optimal in the SSC group after adjustment for observation setting. Maternal contributions to interaction quality did not differ between groups. Although SSC initiated at birth was also associated with longer SSC duration during the first week after birth, no effects of accumulated SSC after the first 6 hours on mother-infant interaction were observed.Sensitive periods have been defined as opportunities that exist in early environments. These opportunities are biobehavioral experiences between parents and infants that trigger specific neuroendocrine systems influencing gene expression, brain development, and parent-infant attachment.In this study, enhanced interaction quality in the SSC group was observed for infant PCERA subscale 3, which describes positive affect and communicative and social skills. Furthermore, after adjustment for observation setting, a between-group difference was observed for dyadic PCERA subscale 5, which describes emotional tone, reciprocity and regulation between mother and infant. Thus, immediate SSC seems to be especially beneficial for interactive behaviors of very preterm infants, and it may also benefit the dyadic aspects of interaction. One possible interpretation is that infants exposed to SSC at birth became more mature social partners, making it easier for their mother to respond to and interact with them. As reported previously, preterm infants have an increased risk of less synchronous interactions due to their immature nervous system and diffuse behavioral cues.Interestingly, in our study, fathers provided the most SSC at birth. This finding reflected the clinical situation, with mothers often unavailable for SSC during the first hours after a cesarean birth, for example. The beneficial effect of SSC on interaction was assessed in the mother-infant dyad 4 months later. Our findings showed that the higher-quality mother-infant interaction in the SSC group was driven by the infants’ enhanced social skills. Thus, an important conclusion of the present data might be that from a developmental perspective, time spent in SSC after birth is valuable and may be provided by either parent. This finding highlights the role of fathers in supporting the development of their very preterm infant immediately from birth when the mother is not available,