title: Mothers seeing their VLBW infants within 3 h after birth are more likely to establish a secure attachment behavior: evidence of a sensitive period with preterm infants?
abstract: OBJECTIVE
  Close contact of mother and child in the first hours after birth is essential for the establishment of a secure attachment behavior in term infants. To date, studies investigating whether a 'sensitive period' also exists for very low birth weight (VLBW) preterm infants are lacking.
  
  
  METHODS
  Attachment patterns of 62 VLBW infants were assessed using the 'strange situation' setting and correlated with the time mothers saw their child for the first time. Furthermore, maternal and infant covariates possibly influencing the attachment behavior were analyzed. As maternal factors the mother's age, social status and pregnancy history were recorded and at three time points (time 1, 2 and 3 (t-1, t-2 and t-3)), a semi-structured interview, a depression and a social support questionnaire were performed. As infant factors neonatal basic data, ventilation time and length of hospital stay were recorded. Disease severity was scored using the clinical risk index for babies, score for neonatal acute physiology (SNAP), SNAP perinatal extension and nursery neurobiological risk score. At time points t-2 and t-3, the infants were examined using the second edition of Bayley scales of infant development.
  
  
  RESULTS
  In all, 53.2% of the children showed a secure, 33.9% an insecure-avoidant, 3.2% an insecure-ambivalent and 9.7% an insecure-disorganized attachment behavior. Preterm infants whose mothers had seen them within 3 h after birth had a higher rate of secure attachment than preterm infants with no early contact (76 versus 41%, P=0.009). Firstborns showed a significantly higher rate of insecure attachment behavior (93 versus 67%, P=0.01). No influence on attachment behavior was shown for any other maternal or infant factor.
  
  
  CONCLUSIONS
  Our results support the hypothesis that the first hours after birth are a 'sensitive period' for the development of attachment behavior in VLBW infants. When a mother is enabled to see her infant shortly after birth, the 'sensitive period' right after birth may be used to help forming an important basis for the secure attachment of the preterm infant.
authors.affiliation: Department of Neonatology, Children's Hospital, University of Cologne, Köln, Germany. katrin.mehler@uk-koeln.de
authors.forename: K
authors.initials: K
authors.lastname: Mehler
authors.forename: D
authors.initials: D
authors.lastname: Wendrich
authors.forename: R
authors.initials: R
authors.lastname: Kissgen
authors.forename: B
authors.initials: B
authors.lastname: Roth
authors.forename: A
authors.initials: A
authors.lastname: Oberthuer
authors.forename: F
authors.initials: F
authors.lastname: Pillekamp
authors.forename: A
authors.initials: A
authors.lastname: Kribs
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003423:Critical Period, Psychological; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D009034:Mother-Child Relations; D009769:Object Attachment; D019962:Reactive Attachment Disorder / Q000175:diagnosis / Q000523:psychology; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult