Live Maternal Speech and Singing Increase Self-Touch and Eye-Opening in Preterm Newborns: A Preliminary Study

Abstract

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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Notes

  1. 1.

    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).

References

  1. Almli, C. R., Ball, R. H., & Wheeler, M. E. (2001). Human fetal and neonatal movement patterns: Gender differences and fetal-to-neonatal continuity. Developmental Psychobiology,38(4), 252–273.

    PubMed  Article  Google Scholar 

  2. Als, H., Butler, S., Kosta, S., & McAnulty, G. (2005). The assessment of preterm infants’ behavior (APIB): Furthering the understanding and measurement of neurodevelopmental competence in preterm and full-term infants. Mental Retardation and Developmental Disabilities Research Reviews,11(1), 94–102.

    PubMed  PubMed Central  Article  Google Scholar 

  3. Als, H., Lester, B. M., Tronick, E. Z., & Brazelton, T. B. (1982a). Manual for the assessment of preterm infants’ behavior (APIB). In H. E. Fitzgerald, B. M. Lester, & M. W. Yogman (Eds.), Theory and research in behavioral pediatrics (65–132).

  4. Als, H., Lester, B. M., Tronick, E. Z., & Brazelton, T. B. (1982b). Toward a research instrument for the assessment of preterm infants’ behavior (APIB). In H. E. Fitzgerald, B. M. Lester, & M. W. Yogman (Eds.), Theory and research in behavioral pediatrics (pp. 35–132). Berlin: Springer.

    Google Scholar 

  5. Anand, K., & Scalzo, F. M. (2000). Can adverse neonatal experiences alter brain development and subsequent behavior? Neonatology,77(2), 69–82.

    Article  Google Scholar 

  6. Arnon, S., Diamant, C., Bauer, S., Regev, R., Sirota, G., & Litmanovitz, I. (2014). Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety. Acta Paediatrica,103(10), 1039–1044.

    PubMed  Article  Google Scholar 

  7. Berardi, N., Pizzorusso, T., & Maffei, L. (2000). Critical periods during sensory development. Current Opinion in Neurobiology,10(1), 138–145.

    PubMed  Article  Google Scholar 

  8. Brazelton, T. B., Tronick, E., Adamson, L., Als, H., & Wise, S. (1975). Early mother-infant reciprocity. Parent-Infant Interaction,33(137–154), 122.

    Google Scholar 

  9. Butler, S. C., O’Sullivan, L. P., Shah, B. L., & Berthier, N. E. (2014). Preference for infant-directed speech in preterm infants. Infant Behavioral Development,37(4), 505–511. https://doi.org/10.1016/j.infbeh.2014.06.007.

    Article  Google Scholar 

  10. Carvalho, M. E. S., Justo, J. M., Gratier, M., Tomé, T., Pereira, E., & Rodrigues, H. (2019). Vocal responsiveness of preterm infants to maternal infant-directed speaking and singing during skin-to-skin contact (Kangaroo Care) in the NICU. Infant Behavior and Development,57, 101332.

    PubMed  Article  Google Scholar 

  11. Caskey, M., Stephens, B., Tucker, R., & Vohr, B. (2011). Importance of parent talk on the development of preterm infant vocalizations. Pediatrics,128(5), 910–916. https://doi.org/10.1542/peds.2011-0609.

    Article  PubMed  Google Scholar 

  12. Caskey, M., Stephens, B., Tucker, R., & Vohr, B. (2014). Adult talk in the NICU with preterm infants and developmental outcomes. Pediatrics,133(3), e578–e584. https://doi.org/10.1542/peds.2013-0104.

    Article  PubMed  Google Scholar 

  13. Castiello, U., Becchio, C., Zoia, S., Nelini, C., Sartori, L., Blason, L., et al. (2010). Wired to be social: the ontogeny of human interaction. PLoS ONE,5(10), e13199. https://doi.org/10.1371/journal.pone.0013199.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cooper, L., Gooding, J., Gallagher, J., Sternesky, L., Ledsky, R., & Berns, S. (2007). Impact of a family-centered care initiative on NICU care, staff and families. Journal of Perinatology,27(S2), S32.

    PubMed  Article  Google Scholar 

  15. Daquin, G., Micallef, J., & Blin, O. (2001). Yawning. Sleep Medicine Reviews,5(4), 299–312. https://doi.org/10.1053/smrv.2001.0175.

    Article  PubMed  Google Scholar 

  16. de l’Etoile, S. K. (2015). Self-regulation and infant-directed singing in infants with down syndrome. The Journal of Music Therapy,52(2), 195–220.

    Article  Google Scholar 

  17. De Vries, J. I., Visser, G. H., & Prechtl, H. F. (1982). The emergence of fetal behaviour. I. Qualitative aspects. Early Human Development,7(4), 301–322.

    PubMed  Article  Google Scholar 

  18. De Vries, J. I., Visser, G. H. A., & Prechtl, H. F. (1985). The emergence of fetal behaviour. II. Quantitative aspects. Early Human Development,12(2), 99–120.

    PubMed  Article  Google Scholar 

  19. DeCasper, A. J., Lecanuet, J.-P., Busnel, M.-C., Granier-Deferre, C., & Maugeais, R. (1994). Fetal reactions to recurrent maternal speech. Infant Behavior and Development,17(2), 159–164.

    Article  Google Scholar 

  20. D’elia, A., Pighetti, M., Moccia, G., & Santangelo, N. (2001). Spontaneous motor activity in normal fetuses. Early Human Development,65(2), 139–147.

    PubMed  Article  Google Scholar 

  21. DiPietro, J. A., Costigan, K. A., & Voegtline, K. M. (2015). Studies in fetal behavior: Revisited, renewed, and reimagined. Monographs of the Society for Research in Child Development,80(3), 1–94. https://doi.org/10.1111/mono.v80.3.

    Article  Google Scholar 

  22. Dondi, M., Menin, D., & Oster, H. (in preparation). A System for Coding Perinatal Behavior (SCPB), Supplement to Oster H. Baby FACS: Facial Action Coding System for infants and young children (Monograph and Coding manual, 2015, Revised Edition in preparation).

  23. Dondi, M., Messinger, D., Colle, M., Tabasso, A., Simion, F., Dalla, B. B., et al. (2007). A new perspective on neonatal smiling: Differences between the judgments of expert coders and naïve observers. Infancy,12, 235–255. https://doi.org/10.1111/j.1532-7078.2007.tb00242.x.

    Article  Google Scholar 

  24. Durier, V., Henry, S., Martin, E., Dollion, N., Hausberger, M., & Sizun, J. (2015). Unexpected behavioural consequences of preterm newborns’ clothing. Scientific Reports,5, 9177.

    PubMed  PubMed Central  Article  Google Scholar 

  25. Eckerman, C. O., & Oehler, J. M. (1992). Very low birthweight newborns and parents as early social partners. In S. L. Friedman & M. D. Sigman (Eds.), The psychological development of low birthweight children. Norwood: Ablex.

    Google Scholar 

  26. Eckerman, C. O., Oehler, J. M., Medvin, M. B., & Hannan, T. E. (1994). Premature newborns as social partners before term age. Infant Behavior and Development,17(1), 55–70.

    Article  Google Scholar 

  27. Ekman, P., Friesen, W., & Hager, J. C. (2002). New version of the Facial Action Coding System. Salt Lake City, UT: Research Nexus division of Network Information Research Corporation.

    Google Scholar 

  28. Emde, R. N., & Koenig, K. (1969). Neonatal smiling and rapid eye movement states. Journal of the American Academy of Child Psychiatry,8, 57–67.

    PubMed  Article  Google Scholar 

  29. Emde, R. N., McCartney, R. D., & Harmon, R. J. (1971). Neonatal smiling in REM states: IV. Premature study. Child Development,42, 1657–1661.

    PubMed  Article  Google Scholar 

  30. Feldman, R., Weller, A., Sirota, L., & Eidelman, A. I. (2002). Skin-to-skin contact (kangaroo care) promotes self-regulation in premature infants: Sleep-wake cyclicity, arousal modulation, and sustained exploration. Developmental Psychology,38(2), 194.

    PubMed  Article  Google Scholar 

  31. Ferrari, G. A., Nicolini, Y., Demuru, E., Tosato, C., Hussain, M., Scesa, E., et al. (2016). Ultrasonographic investigation of human fetus responses to maternal communicative and non-communicative stimuli. Frontiers in Psychology,7, 354. https://doi.org/10.3389/fpsyg.2016.00354.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Filippa, M., Devouche, E., Arioni, C., Imberty, M., & Gratier, M. (2013). Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Acta Paediatrica,102(10), 1017–1020. https://doi.org/10.1111/apa.12356.

    Article  PubMed  Google Scholar 

  33. Filippa, M., Gratier, M., Devouche, E., & Grandjean, D. (2018). Changes in infant-directed speech and song are related to preterm infant facial expression in the neonatal intensive care unit. Interaction Studies,19(3), 427–444. https://doi.org/10.1075/is.16019.fil.

    Article  Google Scholar 

  34. Filippa, M., Kuhn, P., & Westrup, B. (2017a). Early vocal contact and preterm infant brain development. Berlin: Springer.

    Google Scholar 

  35. Filippa, M., Monaci, M. G., & Grandjean, D. (2019). Emotion attribution in nonverbal vocal communication directed to preterm infants. Journal of Nonverbal Behavior,43(1), 91–104.

    Article  Google Scholar 

  36. Filippa, M., Panza, C., Ferrari, F., Frassoldati, R., Kuhn, P., Balduzzi, S., et al. (2017b). Systematic review of maternal voice interventions demonstrates increased stability in preterm infants. Acta Paediatrica, International Journal of Paediatrics,106(8), 1220–1229. https://doi.org/10.1111/apa.13832.

    Article  Google Scholar 

  37. Flacking, R., Lehtonen, L., Thomson, G., Axelin, A., Ahlqvist, S., Moran, V. H., et al. (2012). Closeness and separation in neonatal intensive care. Acta Paediatrica,101(10), 1032–1037.

    PubMed  Article  Google Scholar 

  38. Fogel, A. (1980). The effect of brief separations on 2-month-old infants. Infant Behavior and Development,3, 315–330.

    Article  Google Scholar 

  39. Gallup, A. C., & Gallup, G. G. (2008). Yawning and thermoregulation. Physiology & l Behavior,95(1–2), 10–16. https://doi.org/10.1016/j.physbeh.2008.05.003.

    Article  Google Scholar 

  40. Gibbins, S., Stevens, B., Beyene, J., Chan, P. C., Bagg, M., & Asztalos, E. (2008). Pain behaviors in extremely low gestational age infants. Early Human Development,84(7), 451–458. https://doi.org/10.1016/j.earlhumdev.2007.12.007.

    Article  PubMed  Google Scholar 

  41. Giganti, F., Hayes, M. J., Cioni, G., & Salzarulo, P. (2007). Yawning frequency and distribution in preterm and near term infants assessed throughout 24-h recordings. Infant Behavior and Development,30(4), 641–647.

    PubMed  Article  Google Scholar 

  42. Granier-Deferre, C., Ribeiro, A., Jacquet, A. Y., & Bassereau, S. (2011). Near-term fetuses process temporal features of speech. Developmental Science,14(2), 336–352.

    PubMed  Article  Google Scholar 

  43. Grieser, D. L., & Kuhl, P. K. (1988). Maternal speech to infants in a tonal language: Support for universal prosodic features in motherese. Developmental Psychology,24(1), 14.

    Article  Google Scholar 

  44. Grunau, R. E., Whitfield, M. F., Petrie-Thomas, J., Synnes, A. R., Cepeda, I. L., Keidar, A., et al. (2009). Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants. Pain,143(1–2), 138–146.

    PubMed  PubMed Central  Article  Google Scholar 

  45. Guggisberg, A. G., Mathis, J., & Hess, C. W. (2010). Interplay between yawning and vigilance: A review of the experimental evidence. Frontiers of Neurology and Neuroscience,28, 47–54. https://doi.org/10.1159/000307079.

    Article  PubMed  Google Scholar 

  46. Harmon, R. J., & Emde, R. N. (1972). Endogenous and exogenous smiling systems in early infancy. Journal of the American Academy of Child Psychiatry,11, 77–100.

    Google Scholar 

  47. Haslbeck, F., & Hugoson, P. (2017). Sounding together: Family-centered music therapy as facilitator for parental singing during skin-to-skin contact. In M. Filippa, P. Kuhn, & B. Westrup (Eds.), Early vocal contact and preterm infant brain development (pp. 217–238). Cham: Springer.

    Google Scholar 

  48. Hepper, P. G., Scott, D., & Shahidullah, S. (1993). Newborn and fetal response to maternal voice. Journal of Reproductive and Infant Psychology,11(3), 147–153.

    Article  Google Scholar 

  49. Hofer, M. A. (2003). The emerging neurobiology of attachment and separation: How parents shape their infant’s brain and behavior. Relational Perspectives Book Series,23, 191–210.

    Google Scholar 

  50. Jaffe, J., Beebe, B., Feldstein, S., Crown, C. L., Jasnow, M. D., Rochat, P., & Stern, D. N. (2001). Rhythms of dialogue in infancy: Coordinated timing in development. Monographs of the society for research in child development, 1–149.

  51. Jardri, R., Houfflin-Debarge, V., Delion, P., Pruvo, J. P., Thomas, P., & Pins, D. (2012). Assessing fetal response to maternal speech using a noninvasive functional brain imaging technique. International Journal of Developmental Neuroscience,30(2), 159–161. https://doi.org/10.1016/j.ijdevneu.2011.11.002.

    Article  PubMed  Google Scholar 

  52. Kanagasabai, P. S., Mohan, D., Lewis, L. E., & Rao, B. K. (2016). Behavioral responses to multisensory stimulation in preterm infants. Journal of Nepal Paediatric Society,36(2), 110–114.

    Article  Google Scholar 

  53. Korner, A. F. (1972). State as variable, as obstacle, and as mediator of stimulation in infant research. Merrill-Palmer Quarterly of Behavior and Development,18(2), 77–94.

    Google Scholar 

  54. Kugiumutzakis, G. (2017). Intersubjective vocal imitation in early mother-infant interaction. In J. Nadel & L. Camaioni (Eds.), New perspectives in early communicative development (pp. 23–47). London: Routledge.

    Google Scholar 

  55. Kurjak, A. B., Predojević, M., Stanojević, M., Talić, A., Honemeyer, U. G., & Kadić, A. H. (2011). The use of 4D imaging in the behavioral assessment of high-risk fetuses. Imaging in Medicine,3(5), 557–569.

    Article  Google Scholar 

  56. Lecanuet, J.-P., Granier-Deferre, C., Jacquet, A.-Y., & Busnel, M.-C. (1992). Decelerative cardiac responsiveness to acoustical stimulation in the near term fetus. Quarterly Journal of Experimental Psychology: Section B,44(3–4), 279–303.

    Google Scholar 

  57. Lenke, M. C. (2003). Motor outcomes in premature infants. Newborn and Infant Nursing Reviews,3(3), 104–109.

    Article  Google Scholar 

  58. Lickliter, R. (2000). Atypical perinatal sensory stimulation and early perceptual development: Insights from developmental psychobiology. Journal of Perinatology,20(S1), S45.

    PubMed  Article  Google Scholar 

  59. Matthiesen, A. S., Ransjö-Arvidson, A. B., Nissen, E., & Uvnäs-Moberg, K. (2001). Postpartum maternal oxytocin release by newborns: Effects of infant hand massage and sucking. Birth,28(1), 13–19. https://doi.org/10.1046/j.1523-536x.2001.00013.x.

    Article  PubMed  Google Scholar 

  60. Medoff-Cooper, B., & Gennaro, S. (1996). The correlation of sucking behaviors and Bayley Scales of Infant Development at six months of age in VLBW infants. Nursing Research,45(5), 291–296.

    PubMed  Article  Google Scholar 

  61. Meltzoff, A. N., & Moore, M. K. (1977). Imitation of facial and manual gestures by human neonates. Science,198(4312), 75–78. https://doi.org/10.1126/science.198.4312.75.

    Article  PubMed  Google Scholar 

  62. Meltzoff, A. N., Murray, L., Simpson, E., Heimann, M., Nagy, E., Nadel, J., et al. (2019). Eliciting imitation in early infancy. Developmental Science,22(2), e12738. https://doi.org/10.1111/desc.12738.

    Article  PubMed  Google Scholar 

  63. Messinger, D., & Fogel, A. (2007). The interactive development of social smiling. Advances in Child Development and Behavior,35, 327–366.

    PubMed  Article  Google Scholar 

  64. Moore, E. R., Bergman, N., Anderson, G. C., & Medley, N. (2016). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews, 11, 1–121.

  65. Nakata, T., & Trehub, S. E. (2004). Infants’ responsiveness to maternal speech and singing. Infant Behavior and Development,27(4), 455–464.

    Article  Google Scholar 

  66. Oehler, J. M., Eckerman, C. O., & Wilson, W. H. (1988). Social stimulation and the regulation of premature infants’ state prior to term age. Infant Behavior and Development,11(3), 333–351.

    Article  Google Scholar 

  67. Oller, D. K., Caskey, M., Yoo, H., Bene, E. R., Jhang, Y., Lee, C. C., et al. (2019). Preterm and full term infant vocalization and the origin of language. Scientific Reports,9(1), 1–10.

    Article  Google Scholar 

  68. Örtenstrand, A., Westrup, B., Broström, E. B., Sarman, I., Åkerström, S., Brune, T., et al. (2010). The Stockholm Neonatal Family Centered Care Study: Effects on length of stay and infant morbidity. Pediatrics,125(2), e278–e285.

    PubMed  Article  Google Scholar 

  69. Oster, H. (2015). Baby FACS: Facial Action Coding System for infants and young children. Unpublished monograph and coding manual.

  70. Petrikovsky, B., Kaplan, G., & Holsten, N. (1999). Fetal yawning activity in normal and high-risk fetuses: a preliminary observation. Ultrasound Obstetrics and Gynecology,13(2), 127–130.

    Article  Google Scholar 

  71. Philbin, M. K., & Klaas, P. (2000). Evaluating studies of the behavioral effects of sound on newborns. Journal of Perinatology,20(1), S61–S67.

    PubMed  Article  Google Scholar 

  72. Sai, F. (2005). The role of the mother’s voice in developing mother’s face preference: Evidence for intermodal perception at birth. Infant and Child Development,14(1), 29–50.

    Article  Google Scholar 

  73. Saliba, S., Esseily, R., Filippa, M., Kuhn, P., & Gratier, M. (2018). Exposure to human voices has beneficial effects on preterm infants in the neonatal intensive care unit. Acta Paediatrica, International Journal of Paediatrics,107(7), 1122–1130. https://doi.org/10.1111/apa.14170.

    Article  Google Scholar 

  74. Shoemark, H. (2017). Empowering parents in singing to hospitalized infants: The role of the music therapist. In M. Filippa, P. Kuhn, & B. Westrup (Eds.), Early vocal contact and preterm infant brain development (pp. 205–215). Cham: Springer.

    Google Scholar 

  75. Simpson, E. A., Murray, L., Paukner, A., & Ferrari, P. F. (2014). The mirror neuron system as revealed through neonatal imitation: Presence from birth, predictive power and evidence of plasticity. Philosophical Transactions of the Royal Society B: Biological Sciences,369(1644), 20130289.

    Article  Google Scholar 

  76. Stefana, A., Lavelli, M., Rossi, G., & Beebe, B. (2019). Interactive sequences between fathers and preterm infants in the neonatal intensive care unit. Early Human Development,140, 104888.

    PubMed  Article  Google Scholar 

  77. Stroup, W. W. (2016). Generalized linear mixed models: Modern concepts, methods and applications. Boca Raton: CRC Press.

    Google Scholar 

  78. Thoyre, S., Shaker, C., & Pridham, K. (2005). The early feeding skills assessment for preterm infants. Neonatal Network,24(3), 7–16.

    PubMed  Article  Google Scholar 

  79. Van Sleuwen, B. E., Engelberts, A. C., Boere-Boonekamp, M. M., Kuis, W., Schulpen, T. W., & L’Hoir, M. P. (2007). Swaddling: A systematic review. Pediatrics,120(4), e1097–e1106.

    PubMed  Article  Google Scholar 

  80. Voegtline, K. M., Costigan, K. A., Pater, H. A., & DiPietro, J. A. (2013). Near-term fetal response to maternal spoken voice. Infant Behavioral Development,36(4), 526–533. https://doi.org/10.1016/j.infbeh.2013.05.002.

    Article  Google Scholar 

  81. Volpe, J. J., Inder, T. E., Darras, B. T., de Vries, L. S., du Plessis, A. J., Neil, J., et al. (2017). Volpe’s neurology of the newborn e-book. Philadelphia: Elsevier.

    Google Scholar 

  82. Westrup, B. (2014). Family-centered developmentally supportive care. NeoReviews,15(8), e325–e335.

    Article  Google Scholar 

  83. Wolff, P. H. (1987). The development of behavioral states and the expression of emotions in early infancy: New proposals for investigation. University of Chicago Press.

  84. Wolf, M. J., Koldewijn, K., Beelen, A., Smit, B., Hedlund, R., & De Groot, I. J. M. (2002). Neurobehavioral and developmental profile of very low birthweight preterm infants in early infancy. Acta Paediatrica,91(8), 930–938.

    PubMed  Article  Google Scholar 

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Appendices

Appendix A

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).

B1. Rooting

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.

B4. Shiver

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.

B5. Yawning

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.

B6. Startle

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.

B7. Sneezing

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.

B8. Hiccup

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.

B9. Swallow

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.

B10. Drooling

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. Nonrhythmical 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.

B15. Smile

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.

B16. Distress

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.

Appendix B

Time Frames Frequencies

Tables 3 and 4: time frames frequencies in the three conditions.

Table 3 General behaviors
Table 4 Detailed behaviors

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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

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Keywords

  • Preterm infant-directed speech
  • Preterm infant-directed songs
  • Preterm infant’s behaviors
  • Early vocal contact
  • Neonatal intensive care unit