A Randomized Controlled Trial Comparing Early Maternal Holding Styles on Maternal-Infant Interaction at 6 Months Infant Age

Objective: High quality maternal-infant interaction is associated with positive infant development and attachment, but may be compromised by premature birth. Kangaroo holding may assist the dyad to develop optimal interactional strategies, but research is needed to compare the support that mothers receive when encouraged to do kangaroo holding with that received for blanket holding. The purpose of this study was to compare co-regulated interactive responses during a Still Face observation of mother infant dyads who experienced kangaroo holding daily for 8 weeks to dyads who experienced blanket holding and a control group. We hypothesized that during a standard Still-Face observation dyads in the kangaroo group would display more co-regulated responses than dyads in the blanket or control groups.

Design: Randomized trial

Setting: Dyads were recruited in the NICU. The intervention and assessment were conducted in the hospital and in the homes of the participants.

Patients/Participants: Sixty-six mother-infant dyads participated in an 8-week home intervention encouraging holding. Dyads were assessed when infants were 6 months of age. Infants were born at 32 to 35 weeks gestational age and were 2 to 4 weeks of age at recruitment.

Methods: Dyads were randomly assigned to: a) kangaroo holding at least 1 hour a day; b) traditional blanket holding at least 1 hour a day; or c) control with no restrictions on holding. Kangaroo and blanket holding groups received 60-minute weekly visits from an RN who encouraged holding and discussed infant development. The control group received 15 minute social visits. During the Still Face observation at 6 months, infants sat across from the mother in an infant seat. The two-minute observational periods were: a) mother and infant played; b) mother assumed a neutral expression; c) mother and infant played. The neutral expression period is typically stressful for the infant. Observations were videotaped and scored by four coders blind to group assignment.  In the Fogel scoring method symmetrical interaction, when both mother and infant are contributing, is the most optimal form of co-regulation.

Results: MANOVA analysis indicated no difference in percentage of time spent in co-regulated interaction before the neutral expression period. After the stress of the neutral expression period, dyads in the kangaroo group interacted more symmetrically than dyads in the blanket and control groups (p = .022).

Conclusion/Implications for nursing practice: Kangaroo holding positively influenced mother-infant interaction after stress when the amount of support and attention to the mother was controlled.

 Keywords: prematurity, NICU, still face, mother/infant, holding, intervention