title: Development of attachment in infants born preterm
title: The development of attachment in infants born preterm
titleType: AlternativeTitle
Creators: name: Jiménez Sánchez, Lorena
Publisher: name: The University of Edinburgh
Year: 2024
Subjects: attachment in infants born preterm
infants born preterm
Preterm birth
neurodevelopmental outcomes in childhood
secure attachment relationships
attachment relationships in term infants
socioemotional development

description: Preterm birth (birth before 37 weeks of gestation) is associated with atypical neurodevelopmental outcomes in childhood, including socioemotional difficulties and attention problems. Positive infant attachment relationships might attenuate some of these challenges. Early interactions between infants and their caregivers build infants’ attachment relationships and shape infants’ attachment styles. Securely-attached infants use caregivers as a secure base to explore from and return to. Under a threat, insecurely-attached infants either avoid their caregiver (avoidant), fail to respond independently (resistant) or show contradictory behaviours i.e. attachment disorganisation. Meta-analyses show that securely-attached infants are better able to regulate their emotions, more often using cognitive and social support coping strategies, show fewer attention problems, and appear to have more language competence in childhood. Specifically, preterm children in secure attachment relationships show better cognitive development. Thus, understanding what factors contribute to secure attachment after preterm birth may help inform the design of interventions that foster infant resilience and family wellbeing. This work investigated the development of attachment in preterm infants in the context of a well-characterised and controlled cohort, incorporating both clinical antecedents and neural correlates. Preterm and term infants were recruited to a longitudinal study, and followed up during childhood. Nutritional information in the Neonatal Intensive Care Unit (NICU) was collected for preterm infants. Structural and diffusion magnetic resonance imaging (MRI) data were collected for all infants at term equivalent age. A sample of 82 preterm (born at &lt; 33 weeks’ gestation) and 75 term infants were exposed to a socioemotional stressor, the Still-Face Paradigm, at nine months of age (corrected age for the preterm group). Video recordings were behaviourally coded for attachment behaviours, and attachment styles were derived for each infant. Caregivers completed developmental questionnaires about their infants’ development at two years of age. Since secure attachment relationships could be affected in preterm infants early exposed to extrauterine life, I firstly investigated attachment differences between preterm and term infants. I found preterm infants exhibited less fretful responses when re-engaging with caregivers after a socioemotional stressor. These differences were small, and may reflect a different emotional reactivity under social stressors, rather than a disrupted attachment relationship, in the developing preterm infant. I did not find associations between infant fretfulness and concurrent adaptive functioning, and executive function or adaptive functioning in early childhood. These results suggest that attachment differences may be of little clinical relevance for the developing preterm child. I also explored neonatal factors that may predict attachment in infancy. Higher breast milk intake in the NICU has shown to be positive for structural brain development, emotion regulation and cognitive outcomes in the preterm infant, but it did not associate with attachment outcomes in this cohort. This result may relieve some pressure for parents who struggle to provide breast milk for babies being cared for in the NICU and beyond. Environmental factors only partially explain attachment in infants, and intrinsic correlates of stress and emotion regulation may play a role in how infants build relationships with caregivers. I investigated the influence of the amygdala and hippocampal structure and structural connectivity at birth on attachment behaviours at nine months of age. MRI variables were selected to enable inference about neurite density and organisation of amygdalae and hippocampi, and their connections to the whole brain. Data did not support that neonatal differences in the structure and structural connectivity of these nuclei, already known to be important for stress and emotion regulation, contribute to individual differences in attachment behaviours in infancy. Finally, I investigated whether infant attachment predicted executive and adaptive functioning in preterm children, and found some evidence for a positive association between infant secure attachment and executive function in early childhood. These findings suggest that the development of attachment relationships in preterm and term infants is similar, and may be more influenced by the postnatal environment after discharge than by neonatal factors. Preterm infants still benefit from secure relationships with their caregivers, so interventions that focus on the postnatal environment to support caregiver-infant interactions may be more effective at fostering the socioemotional development of preterm infants.