Mother-infant Bonding During COVID-19
Mother-infant Bonding During COVID-19
The purpose of this study is to compare the mother-infant emotional connection formed during
 the pandemic in standard care (SC) versus Family Nurture Intervention (FNI) pairs, an
 evidence-based intervention designed to counteract the adverse effects of maternal-infant
 disconnection. In prior research on preterm infants in the neonatal intensive care unit
 (NICU), FNI participants demonstrated increased quality of maternal caregiving behaviors and
 significant improvements in premature infants' neurodevelopment across multiple domains,
 including social-relatedness and attention problems. Goals of FNI include assisting mothers
 in providing appropriate types of stimulation for their babies that are important for social,
 emotional, and neurobehavioral development as well as reducing stress physiology in both
 mother and infant. Data gathered in this study will help the investigators learn more about
 the underlying mechanisms that take place during mother-infant interactions and examine how
 these play a role in setting the infant up for the best neurodevelopmental trajectory.
 Intervention will be conducted electronically both in the Well Baby Nursery (WBN) and at home
 over the following 4 months. Assessments will consist of videos of mother-infant interactions
 at the time of each intervention session, and pediatrician-led follow-up surveys conducted in
 the linked Institutional Review Board-approved study.
Mother-infant interactions, which are well-established to strongly influence long-term
 neurodevelopmental outcomes, are at particular risk during the pandemic, both due to maternal
 stress, as well as to changes in health care policies leading to decreased interaction with
 healthcare providers during the immediate postpartum period. In order to minimize risk of
 severe acute respiratory syndrome (SARS)-CoV-2 transmission, nurses and physicians in the WBN
 have minimized entry and exit into patient rooms, and new moms are discharged on average one
 day early. In addition to psychological stress, there are also currently unknown risks to the
 neonates born to mothers with SARS-CoV-2 infections at various points in their pregnancy.
 Although viral transmission itself seems unlikely, it is currently completely unknown if
 secondary effects will be observed. In the case of maternal HIV infection, it is now well
 established that even when vertical transmission does not occur, there are negative
 consequences to neurodevelopmental outcomes of these exposed children. It is therefore
 imperative to develop preventative strategies that protect newborns and set them on the path
 of optimal neurodevelopment. As mother-infant nurturing interactions are known to be the most
 crucial ingredient in optimal neurodevelopmental trajectories, the goal of the investigators
 is to test the hypothesis that an intervention focused on promoting mother-infant emotional
 connection in the neonatal period will lead to long-term benefit and prevention of
 deleterious effects of the COVID-19 pandemic. The investigators will use FNI, an intervention
 specifically developed to enhance mother-infant emotional connection through facilitated
 mother-infant interactions, emotional exchanges and mutual calming sessions. Some of the
 facilitated interactions include: interactive touch with deep emotional expression and vocal
 soothing, sustained reciprocal olfactory exposure, family practice in comforting, and
 skin-to-skin holding. Previously at CUIMC, an RCT investigated the effects of FNI in NICU
 infants. Infants who received FNI showed significant increases in electroencephalogram (EEG)
 power, a measure of brain activity, near term age compared with those who receive Standard
 Care (SC). Increased EEG power has previously been shown to be associated with improved
 cognitive development, as measured by the Bayley Scales of Infant and Toddler Development
 (BSID-III). Within the group of children who scored above 85 on the Bayley-III (1 standard
 deviation below the mean or higher), FNI infants scored significantly higher on the BSID-III
 Cognitive and Language scales compared to SC infants. Additionally, FNI infants had lower
 risk for autism spectrum disorder (ASD) as measured by the Modified Checklist of Autism for
 Toddlers (M-CHAT), an early ASD screening questionnaire. FNI infants also displayed
 significantly lower levels of EEG coherence (1-18 Hz) largely within and between frontal
 regions. This finding suggests that FNI may accelerate brain maturation particularly in
 frontal brain regions, which are involved in regulation of attention, cognition, and emotion.
 Taken together, the first RCT of FNI is strongly suggestive of neurodevelopmental benefit.

 Purpose/aims: The COVID-19 pandemic has made precautions necessary in the Well Baby Nursery
 that result in maternal stress which is known to impair mother-infant bonding, which is
 well-established to be critical for positive long-term neurodevelopmental and behavioral
 outcomes. The investigators will be conducting a randomized controlled trial (RCT) of Family
 Nurture Intervention (FNI) in the Morgan Stanley Children's Hospital (MSCH) Well Baby Nursery
 (WBN) at Columbia University Irving Medical Center (CUIMC). The RCT will compare
 neurodevelopmental and socio-emotional outcomes of the current standard of care (SC) during
 the COVID-19 pandemic with Family Nurture Intervention (FNI) conducted via telemedicine.
Inclusion Criteria:

 -  Mother agrees to participate in a linked study involving additional surveys and
 assessments

 -  Newborn born between 37 weeks and 40 weeks and 6 days gestational age

 -  Newborn is a singleton

 -  Mother can speak English or Spanish

 Exclusion Criteria:

 -  Newborn born at less than 37 weeks and 0 days gestational age

 -  Newborn born at more than 40 weeks and 6 days gestational age

 -  Infant's attending physician does not recommend enrollment in the study based on
 newborn health concerns or diagnoses, or based on concern regarding maternal history
 of maternal substance abuse, severe psychiatric illness or psychosis

 -  Congenital, cardiac, or chromosomal anomalies requiring special infant care beyond
 routine testing based on prenatal concerns (e.g. postnatal ultrasound necessary for
 prenatal ultrasound findings of hydronephrosis would not exclude newborn, but newborn
 with known Trisomy 21 would)

 -  Mother and/or infant has a medical condition that precludes intervention components

 -  Newborn is a twin or other multiple at birth

 -  Mother is unwilling to place wearable electrophysiological recording devices on
 herself or her newborn

 -  Mother is unwilling to be video recorded or to give consent for videos/photographs
 (video stills)/audio (from the videos) to be used in educational materials, scientific
 publications or professional meeting presentations