Nils Bergman Science Behind New Standards UNICEF 2015

THE SCIENCE THE SCIENCE
BEHIND THE NEW BEHIND THE NEW

NEONATAL STANDARDS. NEONATAL STANDARDS.
Dr Nils Bergman
MB ChB, DCH, MPH, MD
(USA equiv: MD, MPH ,PhD)
Cape Town, RSA
www.skintoskincontact.com
The Neuroscience of Birth & Breastfeeding

The DNA The Brain Behaviour
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS
MICRO-
RNA
HISTONE
MODIFICATION
DNA
METHYLATION
The Neuroscience of Birth & Breastfeeding The Neuroscience of Birth & Breastfeeding
The DNA The Brain Behaviour The DNA The Brain Behaviour
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS
“Phenotype” – specimen
resulting from
gene – environment interaction
1
”Neurons that fire together wire BRAIN WIRING
together while those which don’t,won’t”
Hebb/Carla Shatz REM
NR1
NR2
NR3
NR4
ACQUISITION CONSOLIDATION MEMORY
FORMATION
poly-sensory input transfer information P waves
short-term memory “SNR” strong signals returns info
stored cortex amygdala / to neocortex:
hippocampus organized
Awake and REM NREM stage 4 REM
Stanley Graven 2006
SMELL
The secretion of Areolar
(Montgomery’s) Glands
modulates state organisation “In early ontogeny the

elicits emotional behaviours sleeping brain may thus
remain sentient of an
activates pre-feeding actions organism’s odor
anticipatory digestive physiology environment.”
regulates pace of ingestive behaviour
Schaal 2004 9 Doucet 2009 10
Joseph 2014 Infant: Mother-infant synchrony

Arch Dis Child Fetal Neonatal Ed. 2014 Sep 22. pii: fetalneonatal-2014-306104.
doi: 10.1136/archdischild-2014-306104. [Epub ahead of print] sleep cycles … at 12 weeks
Getting rhythm: how do babies do it? begin to block (circadian) Thomas 2014
on diurnal
rhythms
MELATONIN H3f3b gene START at 3 months
day-night rhythm detected
CORTISOL TEMPERATURE Can be “adult-like”
day-night day-night
rhythm rhythm at 6 months.
Birth ~ /~ 8w 9w 10w 11w
dates averaged  “between 6 and 18 weeks”
2
ONE SIZE
DOES NOT Infant sleep cycling
FIT ALL:  critical for brain
development,
BUT is also determined by brain requirements:
3 12 m
Equally *normal* TEMPERAMENT
at 6 months In child: PERSONALITY
to sleep 2hours will appear on its
as 6 hours own  3 – 12 m
OREXIN METABOLISM
“MORE SLEEP  MORE WIRING”
BRAIN WIRING
In adult: In child:
sleep pertains neurodevelopment
to memory (brain wiring)
1st 1000 days
Peirano 2003
Brain Architecture and Skills are Brain Architecture and Skills are
Built in a Hierarchical “Bottom-Up” Built in a Hierarchical “Bottom-Up”
Sequence Sequence
• Neural circuits that process basic information • Neural circuits that process basic information
are wired earlier than those that process more are wired earlier than those that process more
complex information. complex information.
• Higher circuits build on lower circuits, and
skill development at higher levels is more
difficult if lower level circuits are not wired
properly.
Slide by: Jack P. Shonkoff, M.D. Slide by: Jack P. Shonkoff, M.D.
3
The Neuroscience of Birth & Breastfeeding AT BIRTH,
the brain has
ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS TWO
CRITICAL
SENSORY
NEEDS:
SMELL & CONTACT
APPROACH RESPONSE
… learned prenatally, reinforced both during the birth process and SMELL vanilla / colostrum / water (control)
repeatedly throughout the postnatal period,
read NIRS activity FRONTAL LOBE
… supported by a unique neural framework … a system that ensures
rapid and robust maternal odor learning
APPROACH RESPONSE The first hours after birth are a

• This was confirmed by
demonstration of a statistically
significant negative correlation
CRITICAL PERIOD
between changes in [Hb O2] and
postnatal age (r 520.64, p 5 0.001
with 95% confidence interval) (Fig. Those babies In the 14 babies
4). Those babies showing the older than 24 h
showing the there was
greatest increase in [Hb O2] were
between 6 and 24 h old at testing greatest no significant
increase in difference
• In the 14 babies older than 24 h
[Hb O2] were between the
between 6 and changes in [Hb
there was no significant difference
24 h old at O2] during control
between the changes in [Hb O2]
and colostrum
during control and colostrum testing exposure
exposure
4
“For species such as Nothing an infant can or

primates, the mother cannot do makes sense,
IS the environment.”
Sarah Blaffer Hrdy, Mother Nature (1999) except in light of mother’s body
The Neuroscience of Birth & Breastfeeding Warming,

feeding and

protection
BIRTH TRANSITION behaviours are
“The newborn
may appear intricately, inseparably
helpless, but
raises its own temperature, linked to the right place.
has a higher blood glucose, (Alberts 1994)
metabolic adaptation faster.

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS REGULATION

BABY
BIRTH BONDING
The BOND
is made up of the
sensory inputs
from the parent
to the infant
Bowlby 1969, 1973, 1980
5
Through “hidden maternal regulators” ... Through “hidden maternal regulators” ...
a mother precisely controls every

element of her infant’s physiology,
warmth  activity level from its heart rate to its
milk  heart rate release of hormones
from its appetite to the
“ physiological set points “ intensity of its activity
internal working models (Gallagher 1992)
scripts – templates

REGULATION ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

BABY
BIRTH BONDING
The BOND
is made up of the AT BIRTH,
sensory inputs the brain has
Prefrontal cortex
Executive
AMYGDALA:
Emotional
TWO
from the parent CRITICAL
SENSORY
function Processing
Unit CPU
to the infant NEEDS: SOCIAL and

INTELLIGENCE
EMOTIONAL
SMELL & CONTACT

Bowlby 1969, 1973, 1980 connect direct to the amygdala
BABY BABY
BIRTH BONDING BIRTH BONDING In humans, oxytocin increases gaze to the
eye region of human faces and enhances
interpersonal trust and the ability to infer
the emotions of others from facial cues.
Simulation theory:
EMPATHY is generated
by inner imitation
Morphing emotion AMYGDALA  FUSIFORM
Smell
of actions of others
GYRUS
Skin contact
6
A primary
visual areas,
Fransson 2007
B somatosensory
motor cortex
C primary auditory
cortex
Smell D parietal cortex

& cerebellum
E m l anterior pre-
Skin contact frontal cortex
EMOTION OXYTOCIN
CONTROL
CENTRE A primary visual
B somatosensory
E prefrontal D parietal
& cerebellum
FACE
Smell RECOGNITION
CENTRE
28 days old, 30 w PMA

Skin contact C primary auditory


BABY SEPARATION
BIRTH BONDING Toxic stress
Garner 2011
7
©2012 by American Academy of Pediatrics

The basic EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
science of ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

pediatrics.
Shonkoff J P et al.
Pediatrics 2012;
129:e232-e246
Bad
Positive Stress
• Moderate, short-lived stress responses, such
as brief increases in heart rate or mild changes Good
in stress hormone levels.
Low High
Stress Stress
• An important and necessary
aspect of healthy development
that occurs in the context of
Slide by: Jack P. Shonkoff, M.D. stable and supportive relationships.

Tolerable Stress EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY

• Stress responses that could disrupt brain
BABY SEPARATION
architecture, but are buffered by supportive
relationships that facilitate adaptive coping.
• Generally occurs within a time-limited period, • Strong and prolonged activation of the body’s
which gives the brain an opportunity to recover stress management systems in the
from potentially damaging effects.
absence of the buffering
Slide by: Jack P. Shonkoff, M.D.
protection of adult support.
8
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY SEPARATION DYSREGULATES
ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS CORTISOL
BABY SEPARATION
•Disrupts brain architecture

and leads to stress management systems that
respond at relatively lower thresholds, thereby
increasing the risk of stress-
related physical and mental illness.
MICHAEL MEANEY epigenetics
CORTISOL CORTISOL
Unsafe environment activates HPA

axis (autonomic nervous system, ANS).
Psychobiology MOTHER MOTHER

and molecular HG - High Grooming Low Grooming LG
genetics of
resilience
Adriana Feder*, Eric HG BABY LG BABY

J. Nestler‡, and
Dennis S. Charney‡ Nat Rev Neurosci. 2009 June ; 10(6): 446–457. doi:10.1038/nrn2649
Healthy UNHEALTHY
adult adult
Makes MOTHER Makes MOTHER
HG – High Grooming Low Grooming - LG
HG BABY HG BABY
LOW Grooming care
CORTISOL UNHEALTHY
adult
Makes MOTHER
LOW Grooming LG
9
MOTHER MOTHER Earliest care
HG - High Grooming Low Grooming LG
at birth matters
HG BABY LG BABY
Same gene  switched
Healthy UNHEALTHY
adult adult
Makes MOTHER Makes MOTHER Makes MOTHER Makes MOTHER
HG – High Grooming Low Grooming - LG HG – High Grooming Low Grooming - LG
LG BABY LG BABY
Early stress alters gene expression, HIGH grooming care
with health impact across lifespan. HEALTHY OXYTOCIN

adult Makes MOTHER
HIGH Grooming HG
The Neuroscience of Birth & Breastfeeding Primate separation studies


BABY SEPARATION
Maternal Separation Paradigm

0w 1w 2w 3w 4w 5w 6w   12w
n 4 Mat MNS group reared no mother
OXYTOCIN CORTISOL n 4 Mat    MNS  group as above
n 4 Mat       (control)
Gene specific for the AMYGDALA

( GUYC1A3)
Separated at 1 week:
LOW gene expression

Repeated short
Increased self soothing separations:
 Anxiety
LOW gene expression
Decreased sociality
 Depression Correlate to human adult depression
10
2ND
KNOCK
DOHAD
Developmental Origins of
Health and Adult Disease
Adults with depression, suicides:
LOW gene expression
Early stress alters gene expression,
smalller hippocampal volume with health impact across lifespan.
reduced expression frontal lobe
… very early, once off, and forever.


BABY SEPARATION
THE PLACE MODEL

SKIN-TO-SKIN CONTACT
BREAST- VAGAL
MOTHER FEEDING (PSNS) GROWTH
OTHER PROTEST- STRESS SURVIVAL or

DESPAIR (SNS)
SEPARATION
11
Reference “100% SCRIP STABILIY”
RCT of skin-to-skin contact from birth S S C C M C

versus conventional incubator care
for physiological stabilisation
1200g to
2200 g
1 - 6h 56% 11%
in 1200- and 2199-gram newborns.
@ 6h 100% 46%
Bergman NJ, Linley LL, Fawcus SR.
Acta Paediatrica 2004
1200g to
1800g
1 - 6h 44% 0%
Vol 93(6); 779-785 @ 6h 100% 25%
Stabilization 1200g – 1800g INCUBATORS

DE-STABILISE
Stabilisation first 6 hours, average hourly SCRIP score
Skin-to-skin
6.1
6
NEWBORNS
5.9
5.8
Stabilisation first 6 hours, average hourly SCRIP score
5.7 KMC all
KMC
6.1
<1800
5.6
CMC6all
5.5
CMC <1800
5.9
Incubator
5.4
5.8
5.3 5.7 KMC all
KMC <1800
5.2 5.6
Hourly average of SCRIP score, 2nd to 6th hour

CMC all
5.1 5.5
CMC <1800
2nd 3rd 4th 5th 6th 5.4
5.3
5.2
5.1
2nd 3rd 4th 5th 6th
REGULATION vs STIMULATION
Premature babies are
Expected vs Unexpected
not in incubators because Ecologic salience vs Potential threat
they are unstable. Resource growth vs threat readiness
OXYTOCIN vs CORTISOL
Premature babies HOMEORHESIS vs HOMEOSTASIS
are unstable because MOTHER vs OTHER
they are in incubators.
12
Critical period concept :
“Windows of opportunity in early
ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS life when a child’s brain is
BABY MOTHER SEPARATION
exquisitely primed to receive
BIRTH BONDING Sensitization Toxic stress
sensory input in order to develop
more advanced neural systems.”
a mother’s brain …
SENSITIZATION
OXYTOCIN
Cingulate Maternal ferocity
Cingulate Suppressed  PROTECTION
Hypothalamus
Pituitary: Hypothalamus
Amygdala Pituitary:
PROLACTIN  Milk making
NUTRITION
Amygdala:
CHOLECYSTOKININ
 Emotion / satiety
REGULATION
OXYTOCIN
 Gaze increase:
 BONDING
SENSITIZATION
25
Dose of SCC first 24 hours correlates Dose of SCC first 24 hours correlates
Hours of SSC in Infants' First 24 Hours
Maternal behaviour Q Sort Maternal behaviour Q Sort

20
Predicts attachment security Predicts attachment security

15
25 25
20 20
15 15
10
10 10
5 5
0 0
-0.2 0 0.2 0.4 0.6 0.8 1 25 27 29 31 33 35 37 39 41 43 45
5 Maternal Behavior Q-Sort Maternal Behavior Subscale of the NCATS
Dose of SCC first 24 hours correlates

0 NCATS ( Nursing Child Assessment Teaching Scale )
Predicts cognitive outcome
-0.2 0 0.2 0.4 0.6 0.8 1
Maternal Behavior Q-Sort
SENSITIZATION SENSITIZATION
13
EPDS (depression) score DECREASED
significantly for first two visits.
JOGNN, 41, 369-382; 2012. DOI: 10.1111/j.1552-6909.2012.01350.x
Conclusion: Control
Mother/infant SSC benefits mothers by reducing
their depressive symptoms and physiological
stress in the postpartum period. SSC
JOGNN, 41, 369-382; 2012. DOI: 10.1111/j.1552-6909.2012.01350.x


BABY MOTHER SEPARATION OXYTOCIN
Well-adapted
SEPARATION
parenting
Toxic stress
BIRTH BONDING Sensitization Toxic stress … reward-related motivational mechanisms,
temporal organization, and affiliation hormones
Insensitive
parenting
Insensitive
… anxious parenting …
parenting mediated by stress-related mechanisms
and greater neural disorganization.
C/S
NVD
Brain differences
between VD
& CSD mothers …
may contribute to mental health risks &

NVD
RESILIENCY in the mother–infant dyad.
14
The Neuroscience of Birth & Breastfeeding PRATHIBA REEBYE
BIDIRECTIONAL !!
ENVIRONMENT
Affect regulation
ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS
BIRTH BONDING Sensitization Toxic stress BONDING Sensitization
Insensitive
parenting
“Human brains are RELATIONAL”
Secure Attuned
attachment parenting
There is a critical period for … co-creating touch
maternal neuroplasticity at birth. … signature unique to caregiver
BABY MOTHER BABY
BIRTH BONDING Sensitization BIRTH BONDING
BEYOND BREASTFEEDING
EMOTIONAL
Feed  Sleep Cycling Feed  Sleep Cycling
INTELLIGENCE
Secure Attuned Secure
attachment parenting attachment
SOCIAL
INTELLIGENCE
SENSATIONS THAT WIRE BRAIN a kind of invisible hothouse

SEES Ear HEARS
Mum’s eyes Mum’s voice
SMELLS
Mum’s milk MOVES
with Mum
BREAST - FEEDING
TASTES
Mum’s milk Back FEELS
=
BRAIN - WIRING
Mum’s arm
holding
Hand TOUCH
Mum’s skin
WARMED on
Skin-to-skin
Mum’s front
CONTACT
Slide from JILL BERGMAN
15
The Neuroscience of Birth & Breastfeeding John Bowlby
secure attachment
ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS “a safe base from which

BIRTH
BABY
BONDING
to explore the world”.
BEYOND BREASTFEEDING Safe Haven
Feed  Sleep Cycling Secure base
Secure Proximity
attachment
maintenance
Separation
distress


BEYOND BREASTFEEDING Insensitive

Feed  Sleep Cycling parenting
Secure Attuned Disordered

HEALTH DISEASE
SOCIAL REWARD SOCIAL REWARD

CONTROL CONTROL CONTROL CONTROL
CENTRE CENTRE CENTRE CENTRE
DOPAMINE DOPAMINE
OXYTOCIN OXYTOCIN
CORTISOL CORTISOL
FEAR EMOTION FEAR

CONTROL CONTROL CONTROL
CENTRE CENTRE CENTRE
16
RESILIENCE: OXYTOCIN DURING LABOUR
“capacity to maintain
healthy emotional CHANGES MOTHER’S
SOCIAL REWARD
Plasma CORTISOL response to STRESS (2y)
CONTROL CONTROL
functioning in the after- CENTRE CENTRE
math of stressful BRAIN !! OXYTOCIN

DOPAMINE
experiences”
Same brain circuits … CORTISOL
EMOTION FEAR
PR - Peer Reared as RESILIENCE, CONTROL
CENTRE
CONTROL
CENTRE
“highly conserved
neuro-endocrine behavior”
MR – Mother Reared
HEALTH MR PR DISEASE HEALTH DISEASE
RESILIENCE VULNERABILITY
OXYTOCIN DURING LABOUR OXYTOCIN DURING LABOUR
CHANGES MOTHER’S Orbitofrontal cortex –

SOCIAL REWARD
CONTROL CONTROL
CENTRE CENTRE
BRAIN !! OXYTOCIN
DOPAMINE activates approach
This brain responds to CORTISOL

Nucleus accumbens –
EMOTION FEAR
baby’s cry differently : CONTROL
CENTRE
CONTROL
CENTRE
Reward and pleasure
motivation- (dopamine)
Amygdala – Fusiform gyrus –

The emotional brain - to love her baby – (face coding unit of brain)
relationship - to focus on care for baby seeks her baby’s face
SOCIAL
OXYTOCIN DURING LABOUR
REWARD
CONTROL CONTROL
CENTRE CENTRE
DOPAMINE
OXYTOCIN
Cingulate - (inhibition)
switched off - makes EMOTION
CORTISOL
FEAR
ferocity for defence CONTROL
CENTRE
CONTROL
CENTRE
Thalamus -
… there is considerable overlap in the brain structures
activity coordinating
associated with these neural mechanisms … functional
centre of brain - to focus on care for baby interactions among the circuits.
Hypothalamus –
activates arousal response to respond
17
RESILIENCE
SOCIAL REWARD
CONTROL CONTROL
CENTRE CENTRE An overly responsive fear
(= STRESS RESISTANCE)
DOPAMINE
OXYTOCIN circuit … may negatively
CORTISOL
influence functioning of the
EMOTION reward system.
“capacity to maintain healthy
FEAR
CONTROL CONTROL
CENTRE CENTRE
emotional functioning in the after-

… a properly functioning reward
circuit may be necessary for … math of stressful experiences”
positive social behaviors.
Resilience Vulnerability Resilience Vulnerability
HEALTH DISEASE HEALTH DISEASE
SKIN-TO-SKIN
CONTACT OXYTOCIN
Feed  Sleep Cycling
Insensitive
parenting OPPOSITES
Resilience
HEALTH
Vulnerability
DISEASE
SEPARATION CORTISOL

CORTISOL ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS
OXYTOCIN BABY MOTHER SEPARATION Prog / Estr BABY MOTHER SEPARATION
BIRTH BONDING Sensitization Toxic stress BIRTH BONDING Sensitization Toxic stress
OXYTOCIN OXYTOCIN CORTISOL DOPAMINE VASOPRESSSIN
BEYOND BREASTFEEDING Insensitive BEYOND BREASTFEEDING Insensitive
Feed  Sleep Cycling parenting PROLACTIN
OXYTOCIN
CORTISOL
Secure Attuned Disordered Secure Attuned Disordered
attachment parenting attachment attachment parenting attachment
OXYTOCIN OXYTOCIN CORTISOL CCK DHEA
Resilience Vulnerability Resilience Vulnerability
OXYTOCIN
HEALTH OXYTOCIN CORTISOL DISEASE HEALTH DISEASE
18
intricately, inseparably intricately, inseparably

linked to the right place. linked to the right place.
(Alberts 1994) (Alberts 1994)
MOTHER
Protect my
ENVIRONMENT
OXYTOCIN!
ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS
is the key to
OXYTOCIN
neurodevelopment …
… because she is the -
-
birth hormone
breastfeeding hormone
RIGHT PLACE !!
- LOVE hormone
birthdoulasofpittsburgh.com
- FRIENDSHIP hormone

FATHER
AT BIRTH ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS
ZERO
BIRTH SEPARATION
COMPANION
“except in the light
Best  midwife + doula + father of mother’s body.”
cortisol oxytocin dopamine
19
“Absence of the
“needed neural buffering protection
processes” of adult support”
The Neuroscience of Birth & Breastfeeding “Non-pharmacological reduction of

Do not measure how much hypercortisolaemia in preterm infants”
(Modi & Glover 1998, Mooncey et al 1997)
skin-to-skin contact you are doing. Preterm infants experience prolonged severe stress
with tenfold increases in stress hormones.
Measure minutes of separation  Stress hormones at such levels are neurotoxic.
 Your dose of TOXIC STRESS
RCT on methods to reduce of stress (at one hour):
“Absence of the Cortisol Endorphin
CORTISOL
Massage slightly lower no change
buffering protection
Soft music no change no change
Skin-to-skin 66% lower 74% lower
of adult support”
SEPARATION
The Neuroscience of Birth & Breastfeeding THE SCIENCE

BEHIND THE NEW
ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS NEONATAL STANDARDS.

BABY MOTHER
BIRTH BONDING Sensitization
BREASTFEEDING
ZERO
SEPARATION
20
… more like POETRY than … moreNEURODEVELOPMENT
like POETRY than BIOLOGY
EPIGENETICS EVOLUTIONARY
Neuroscience ?? Neuroscience
ENVIRONMENT ADAPTATION EXPERIENCE
??
REPRODUCTIVE FITNESS
BEYOND BREASTFEEDING Insensitive

close and loving relationship close and loving relationship
Resilience Vulnerability
HEALTH DISEASE

• “NINO approach to Birth”
… a definition of current
EPIGENETICS
NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
• 1st 1000 seconds – Start skin-to-
Neuroscience
ENVIRONMENT ADAPTATION
!!!
EXPERIENCE REPRODUCTIVE FITNESS
skin contact on mum (later dad)
BIRTH BONDING Sensitization Toxic stress • 1st 1000 minutes first day/ night
Insensitive
parenting
• 1st 1000 hours- first 6 weeks
close and loving relationship
Secure Attuned Disordered • 1st 1000 days – (started at
conception … to end of year 2.)
Resilience Vulnerability
HEALTH DISEASE

The DNA
EPIGENETICS
The Brain
NEURODEVELOPMENT
Behaviour
EVOLUTIONARY BIOLOGY
ZERO SEPARATION
for first 1000 minutes
Insensitive
parenting
Support parents to have
There is a critical period for

maternal neuroplasticity at birth.
21
THE SCIENCE
ZERO SEPARATION BEHIND THE NEW
for first 1000 minutes
NEONATAL STANDARDS.
This science applies to

FULLTERM BABIES
Enable babies
Does it apply MORE or
LESS to PRETERMS ??
This science applies to

PRETERM BABIES … immunity, microbiota,
enteromammary cycle …
ZERO Enable babies to receive

SEPARATION
… developmentally ready ??
 no longer preterm !
(Evidence of harm !)
Promote cup-feeding !
22
THE SCIENCE
BEHIND THE NEW … actually, YOU are their
NEONATAL STANDARDS. partners in care …
The first hours after birth are a The Neuroscience of Birth & Breastfeeding
CRITICAL PERIOD

BABY MOTHER
BONDING Sensitization
“Human brains are RELATIONAL”

mutual Secure
attachment
Attuned
parenting
psycho-neuro-physiological … co-creating touch

caregivers … signature unique to caregiver
GC Anderson
BABY MOTHER BABY MOTHER
BIRTH BONDING Sensitization BIRTH BONDING Sensitization
BEYOND BREASTFEEDING BEYOND BREASTFEEDING

Feed  Sleep Cycling EMOTIONAL Feed  Sleep Cycling EMOTIONAL
INTELLIGENCE INTELLIGENCE
Secure Attuned Secure Attuned
attachment parenting attachment parenting
SOCIAL
INTELLIGENCE
23
Proposed areas of INNOVATION!
Skin-to-skin by parents … others ?

Role of father in continued BRF
Furniture to decrease separation dose

Garments to decrease separation dose
Feeding frequency for best output?

Synchronizing feeding and sleeping.
SEPARATION
VIOLATES
SEPARATION
BIRTH BONDING Sensitization Toxic stress Toxic stress
Insensitive
IT MATTERS
parenting
the innate agenda Disordered

attachment
of mother and baby Vulnerability
HOW WE ARE BORN DISEASE
A mother and baby

DYAD
BABY MOTHER BABY MOTHER SEPARATION
BIRTH BONDING Sensitization BIRTH BONDING Sensitization Toxic stress
BEYOND BREASTFEEDING BEYOND BREASTFEEDING Insensitive

are a
Feed  Sleep Cycling Feed  Sleep Cycling parenting
single
Secure Attuned Secure Attuned Disordered
attachment parenting attachment parenting attachment
Resilience psychoneurobiological Resilience Vulnerability
HEALTH organism HEALTH DISEASE
24
Nelson Mandela
… in describing the
measure of a nation,
he has argued that:
“There can be no keener

revelation of a society’s soul than
the way in which it treats its children.”
25

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THE SCIENCE THE SCIENCE

BEHIND THE NEW BEHIND THE NEW

Cape Town, RSA

The Neuroscience of Birth & Breastfeeding

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

modulates state organisation “In early ontogeny the

Joseph 2014 Infant: Mother-infant synchrony

SMELL & CONTACT

APPROACH RESPONSE The first hours after birth are a

“For species such as Nothing an infant can or

The Neuroscience of Birth & Breastfeeding Warming,

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

The Neuroscience of Birth & Breastfeeding

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS REGULATION

a mother precisely controls every

The Neuroscience of Birth & Breastfeeding

REGULATION ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

to the infant NEEDS: SOCIAL and

SMELL & CONTACT

Smell D parietal cortex

28 days old, 30 w PMA

The Neuroscience of Birth & Breastfeeding

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

The Neuroscience of Birth & Breastfeeding

science of ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

The Neuroscience of Birth & Breastfeeding

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

•Disrupts brain architecture

MICHAEL MEANEY epigenetics

Unsafe environment activates HPA

Psychobiology MOTHER MOTHER

Adriana Feder*, Eric HG BABY LG BABY

with health impact across lifespan. HEALTHY OXYTOCIN

The Neuroscience of Birth & Breastfeeding Primate separation studies

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

Maternal Separation Paradigm

Gene specific for the AMYGDALA

LOW gene expression

The Neuroscience of Birth & Breastfeeding

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

THE PLACE MODEL

OTHER PROTEST- STRESS SURVIVAL or

RCT of skin-to-skin contact from birth S S C C M C

Stabilization 1200g – 1800g INCUBATORS

Hourly average of SCRIP score, 2nd to 6th hour

Maternal behaviour Q Sort Maternal behaviour Q Sort

Predicts attachment security Predicts attachment security

Hours of SSC in Infants' First 24 Hours

5 Maternal Behavior Q-Sort Maternal Behavior Subscale of the NCATS

Dose of SCC first 24 hours correlates

Maternal Behavior Q-Sort

The Neuroscience of Birth & Breastfeeding

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS

may contribute to mental health risks &

RESILIENCY in the mother–infant dyad.

SENSATIONS THAT WIRE BRAIN a kind of invisible hothouse

ENVIRONMENT ADAPTATION EXPERIENCE REPRODUCTIVE FITNESS “a safe base from which

The Neuroscience of Birth & Breastfeeding