Autonomic regulation of preterm infants is enhanced by Family Nurture Intervention

Dev Psychobiol. 2019 Sep;61(6):942-952. doi: 10.1002/dev.21841. Epub 2019 Mar 13.


Preterm infants have maturational delays in several neurobehavioral systems. This study assesses the impact of the Family Nurture Intervention (FNI) in the neonatal intensive care unit (NICU) on the maturation of autonomic regulation of preterm infants. Preterm infants born at 26-34 weeks postmenstrual age (PMA) were assigned to groups receiving either standard care (SC) or SC plus FNI, using a randomized controlled trial design. At two collection time points, approximately 35 weeks and 41 weeks PMA, electrocardiograms (ECG) were monitored for approximately 1 hour during sleep. Heart rate and respiratory sinus arrhythmia (RSA) were quantified from the ECG. Across the two time points, the FNI group exhibited greater increases in RSA (Cohen's d = 0.35) and slope between RSA and heart rate, as a measure of vagal efficiency (Cohen's d = 0.62). These results document that FNI resulted in enhanced autonomic regulation consistent with greater maturation of cardiac function. These and previous findings strongly suggest that facilitating early nurturing interactions and emotional connection between preterm infants and their mothers is a practicable and effective means of optimizing postnatal development in preterm infants. Interpretation of these autonomic function results also enriches our understanding of the potential long-term beneficial outcomes of FNI by drawing upon polyvagal theory, which explains how autonomic state provides a neurophysiological platform for optimal co-regulation between infant and caregiver, and by drawing upon calming cycle theory, which provides a model for understanding how repeated mother/infant calming interactions positively condition autonomic state and reinforce approach, prosocial behaviors.

Keywords: calming cycle theory; emotional connection; heart period; heart rate variability; polyvagal theory; respiratory sinus arrhythmia; vagal efficiency.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Twin Study

MeSH terms

  • Autonomic Nervous System / physiology*
  • Electrocardiography
  • Family Therapy*
  • Female
  • Heart Rate / physiology*
  • Humans
  • Infant, Newborn
  • Infant, Premature / physiology*
  • Male
  • Mother-Child Relations*
  • Outcome Assessment, Health Care
  • Respiratory Sinus Arrhythmia / physiology*
  • Vagus Nerve / physiology*