Although evidence is available about preterm newborns’ spontaneous behavioral repertoire during the first weeks of life in the neonatal intensive care unit (NICU), studies on infant behavioral responses to external social stimuli are scarce. The main aim of this study was to analyze preterm infant behaviors in response to the maternal voice, speaking or singing, in the NICU, compared with a control condition when the mother was not present. We hypothesized that the infants’ self-touch, eye-opening, and oral behaviors would increase in the singing and speaking conditions. The neonates’ behavior was video recorded and then coded by using the System for Coding Perinatal Behavior. Preterm newborns showed increased self-touch and eye-opening behaviors during maternal-directed speech and songs in the NICU. Oral movements were modulated differently by the singing and speaking conditions: the singing condition was specifically associated with infants’ rhythmical sucking behaviors and smiles, whereas maternal speech was associated with non-rhythmical mouth movements. In both speaking and singing conditions, yawning occurred more frequently than in the control condition. The findings of this pilot study suggest that preterm newborns from 32 weeks’ postmenstrual age respond to social and contingent stimuli with a general activation of self-touch and eye-opening behaviors. However, they respond to live maternal speech versus songs by showing different oral behaviors. The differential responses and clinical implications of the findings are discussed.
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Odds ratio (OR) is a measure of association between exposure and an outcome. The OR represents the odds that an outcome will occur (a specific event such as a hand-to-head movement) given a particular exposure (such as a speaking or singing condition), compared with the odds of the outcome occurring in the absence of that exposure (without mother) or with exposure to another condition (singing versus speaking).
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A brief summary of the behavioral items included in the System for Coding Perinatal Behavior (SCPB; Dondi et al. in prep). Descriptions of these items as well as the Action Units (AUs) involved are available in Oster H., Baby FACS: Facial Action Coding System for infants and young children, Monograph and Coding manual (2015, Revised Edition in preparation).
The rooting reflex is displayed when a corner of the mouth or the lower portion of the cheeks of a fetus or neonate are touched or brushed. This stimulation elicits an ipsilateral rotation of the head, typically accompanied by further facial actions including tongue expulsion, cheek raising, nose wrinkling and mouth opening.
B2. Occipito-Frontalis Reflex
When the head of a fetus or neonate, after falling forward, is raised through the contraction of the muscles of the neck, a rapid and simultaneous contraction of the forehead muscles is often observed, raising both the inner and the outer parts of the eyebrows. Eyes are usually open—sometimes wide open—and the forehead muscles can remain contracted for a few seconds.
B3. Chin Tremble
This pattern involves short, rapid and spasmodic vibratory movements of the chin. In some cases, a rhythmic vertical movement of the jaw can also be observed. It often occurs in the newborn during a crying episode or as a result of a spontaneous or provoked startle.
This behavior consists in a rapid and involuntary alternation of contraction and relaxation involving various muscle areas. It is often associated with anserine skin (goosebumps). When this usually episodic activity appears persistently, affecting the whole body and taking the form of generalized tremors, it must be reported during coding.
Yawning is a stereotyped behavior characterized by a slow mouth opening with deep inspiration, followed by a brief apnea and a short expiration and mouth closing, typically accompanied by limb stretching. The expansion of the pharynx can quadruple its diameter, while the larynx opens up with maximal abduction of the vocal cords. Yawn usually emerges from a relaxed face, involving initially mouth opening and eyes closing, followed by head tilting back, eye drooping, flattened tongue on the bottom of the mouth and swallowing.
Startle represents a complex motor pattern consisting in sudden movements involving extension of the limbs together with trunk and neck flexion, and eyeblink. This pattern can be observed as a spontaneous behavior, relatively frequent during quiet or non-REM sleep in fetuses, neonates and infants, as well as following a sudden and intense stimulus (e.g., a sharp sound or a bright light). Spontaneous and reflex startles must be coded separately.
It is a behavior caused by the irritation of the mucous membranes of the nose and throat consisting in an uncontrolled, strong and sudden gust of air passing through the nose and mouth. Often the sneeze can be preceded by an inspiratory phase and/or a brief apneic period. It often starts with a slow lifting of the head, followed by a rapid movement of the head forward and down which coincides with the air expulsion.
Hiccups is a stereotyped activity consisting in a repeated and involuntary contraction of the diaphragm. It can last for several minutes and is sometimes followed by isolated movements of the arms and legs. In utero, repetitive diaphragm contractions can be so strong that they passively move the fetus into the amniotic cavity. It is not necessary to codify with precision every single contraction, but rather to identify the periods where the contractions tend to repeat with a certain rhythmicity.
This behavior facilitates the shove of food from mouth through pharynx and esophagus; it can begin with some sucking movements together with mouth opening, but it can also occur in absence of mouth movements. In utero it is often followed by low frequency tongue movements that seem to have the function to push the fluid cud through the ipopharynx.
This category indicates the emission of saliva, that leaks outside of the inner part of the lips. When the saliva is very abundant, and gets to the chin, it must be reported during coding.
B11. Hand Movements
These movements involve hands and arms and ends with the contact of hand or fingers with the head, face or mouth region. It is possible to distinguish between four different behavioral patterns, although in the analysis phase their scores can be aggregated. They are: 11A. Hand To Head Movements; 11B. Hand To Mouth Movements; 11C. Hand To Face Movements; 11D. Finger-Sucking.
B12. Head Movements
This category includes the widest movements involving the neck and head. It is possible to distinguish between three different behavioral patterns, although in the analysis phase their scores can be aggregated. They are: 12A. Head Retroflexion; 12B. Head Rotation; 12C. Head Anteflexion.
B13. Eyes Movements
They involve the eye and periocular muscles, resulting in the opening and closing of the eyes, or in saccadic movements below the eyelids. They are: 13A. Eyes Open. 13B. Eyes Closed; 13C. Eye Blinking; 13D. Rapid Eye Movements (REM).
B14. Mouth Movements
These category includes movements involving the mouth or the tongue. It is possible to distinguish between three different behavioral patterns, although their scores can be aggregated. 14A. Sucking.
This action consists of tongue protrusion and rhythmic movements involving the mandible and the tongue, characterized by constant frequency and duration. 14B. Non – rhythmical mouthing movements. Within this category fall non-rhythmical and non-stereotypical mouth movements, sometimes involving the tongue and the mandible. The facial actions that make up this activity are numerous and can involve the entire musculature of the lower part of the face. 14C. Tongue expulsion. This behavior is coded when the tongue protrudes from its resting position beyond the inner margin of the red part of the lips.
The main feature of smile is the action of the zygomaticus major muscle, whose contraction pulls the lip corners obliquely upward toward the cheek bones. When a strong contraction of the zygomaticus is present, the infraorbital triangle is raised, the nasolabial furrow is deepened and eyes aperture results narrowed by the upward lifting of the cheeks and skin below the lower lid. In case of unilateral smiles, the coder can report what side of the face is affected by the contraction.
This facial configuration can be identified when the contraction of the procerus or depressor glabellae muscle is observed. The contraction of these muscles pushes down the inner corners of the eyebrows and knots the portion of skin between the eyebrows just above the nose root. This configuration is frequently associated with the contraction of the corrugator supercilii, that pulls together and lowers the internal end of the eyebrow by corrugating the eyebrow itself. The facial configuration of distress is often accompanied by closing of the eyes, cheeks raising, mouth opening and horizontal lip stretching.
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Filippa, M., Menin, D., Panebianco, R. et al. Live Maternal Speech and Singing Increase Self-Touch and Eye-Opening in Preterm Newborns: A Preliminary Study. J Nonverbal Behav (2020). https://doi.org/10.1007/s10919-020-00336-0
- Preterm infant-directed speech
- Preterm infant-directed songs
- Preterm infant’s behaviors
- Early vocal contact
- Neonatal intensive care unit