30 • 2023 • Developmental Observer A lthough neonatology is a technolog- ically sophisticated medical field, its insights are too frequently slighted by parents, medical staff, and psychosocial support personnel. Even today, neona- tology lacks any kind of psychological specialisation, which has, for example, been a core component of paediatric oncology for many years. Developing new modes of sensitive, individualized, attachment-based nursing, helping par- ents to bond with their baby born very preterm, implementing kangarooing for mothers AND fathers, and 24/7 visiting hours should lead to a specialisation on psychological and trauma-related issues. Furthermore, the medical and nursing staff should receive regular supervision as part of psychohygiene in order to foster sensitivity for the infants’ and parents’ needs, and to facilitate an attachment-based friendly atmosphere in the NICU. All this should focus on fostering secure infant-parent attachment development, despite the difficulties resulting from preterm delivery, complex newborn in- tensive care, and familial complications. Our Ulm study, which started about 20 years ago,1 was one of the first inter- vention studies, in which we focused on enhancing the development of attach- ment security in the preterm infant by supporting the parents through individ- ual support, parent groups, and support during the transition from hospital to home. One aim was to mitigate previous unresolved issues of loss and trauma, as many parents had already experienced a stillbirth before they had to cope with a preterm delivery. We found that if the trauma of a previous loss has not been resolved, preterm birth triggers several trauma-related symptoms like avoidance of the baby, overanxiety, inability to Psycho-Neonatology: Working with Parents, Preterm Infants, and Staff. The Outcome of Former Preterm Infants 20 Years Later DOI: 10.14434/DO.V16I1.35783 Karl Heinz Brisch1, Carmen Walter2 1Specialist in child and adolescent psychiatry, Private Medical School Paracelsus Salzburg, Institute for Early Life Care, Salzburg, Austria, and Children’s Hospital Dr von Hauner, Department Paediatric Psychosomatic Medicine and Psychotherapy, University of Munich, Germany, 2Specialist in education, formerly research assistant at the Children’s Hospital Dr von Hauner, Department Paediatric Psychosomatic Medicine and Psychotherapy, University of Munich, Germany. Carmen is a co-researcher with Karl Heinz Brisch. Karl Heinz Brisch Reflection An important facilitator of bringing developmental care to the spotlight, was the publication of a report in March this year of the Belgian Health Care Knowledge Center (KCE)* on infant- and family-centred developmental care (IFCDC) for preterm newborns. In the comprehensive report, the authors suggested recommendations for the implementation of IFCDC-princi- ples to the FPS, the Minister and hospital boards. A group of experts (neonatologists and specialized nursing staff in neo- natology) underlined the importance of these proposals. This collaboration between experts from the working field together with evidence from the literature, convinced policy makers of the necessity to establish a course of action and to continue the support of developmental care in neonatal settings. The opening ceremony of the NIDCAP Training Center in UZ Leuven, was the perfect opportunity to invite our Ministers to the NICU to meet the parents of our vulnerable babies as well as the nursing staff personally, and to discuss why IFCDC is so important to sustain. The combination of the scientific report on IFCDC and the opening of the Training Center created momentum for current policy makers to finalize decisions that will result in the consolidation of both projects. We hope this will build a strong foundation on which to build, and to enhance chances for a better future of preterm born babies in Belgium. References * Detollenaere J, Benahmed N, Costa E, Christiaens W, Devos C, Van den Heede K. Infant- and family-centred developmental care for preterm newborns in neonatal care. Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2022. KCE Reports 350. D/2022/10.273/09. This document is available on the website of the Belgian Health Care Knowledge Centre. https://kce.fgov.be/en M E E T T H E P R E S E N T E R S — N I D C A P T R A I N E R S M E E T I N G 2 0 2 3 2023 • Developmental Observer • 31 M E E T T H E P R E S E N T E R S — N I D C A P T R A I N E R S M E E T I N G 2 0 2 3 separate from the baby, and leaving the infant in the incubator for an extended period of time. Unprocessed mourning of a previous stillbirth impeded the parental bonding process with the preterm baby. We further found out that in the control group – without any attachment-based intervention – healthy preterm infants had a greater chance of developing a secure attachment to their mothers, while neurologically impaired infants were more likely to develop insecure attachment. On the other hand, in the intervention group, infants had eight times (OR 7.8) higher chance to develop a secure attachment to their mothers, even when they had neurological problems, which implies that their health status no longer predicted their attachment development. We followed this sample of very low-weight preterm infants (all <1,500 g birthweight; the infant with the lowest birthweight at that time in our sample that survived weighed only 320 g!) for 20 years and have collected data at several age points during their lives. The latest data sampling point for these formerly preterm infants occurred at about 20 years and included their mothers. To the best of our knowledge, ours is the first to investigate into late adolescence the long- term attachment development of teenagers born very preterm. We conducted a semi-structured interview that focused on attachment development with respect to their family and to their peers. In adolescence, peers are very important for emotional security and for the separation process from the core family. The most striking result was that the attachment status of 56% of former very preterm adolescents changed over time. More precisely, a shift was found from attachment security in early childhood (assessed 14 months postpartum, corrected for prematurity) toward insecurity, resulting in a high proportion of insecure-avoidant (36.9%) and to some extent disorganised attachment classifications (21.5%).2,3 However, attachment was unrelated to neonatal parameters, neurobiological risk, or intelligence. Furthermore, in late adolescence, there was an association between psychological distress and behavioural problems in teenagers born very preterm, especially according to those symptoms classified as "preterm behavioural pheno- type". These subjects had to be referred to psychotherapy.4 In summary, our results reveal that psychological burdens in late adolescence do not primarily arise from the physiolog- ical consequences of preterm delivery per se, but rather from feelings of loneliness and isolation, resulting, for example, from having people around, missing close friends, or non-par- ticipation in age-appropriate peer groups. Our findings stress the urgent need to integrate psychoso- cial attachment-based support for the babies, parents, and staff as a baseline requirement from the very beginning. Promoting attachment security by internalising representations of trust, reliable emotional support in times of need, and dampening the adverse effects of parenting on psychosocial outcome, should be taken into account. References: 1. Brisch, Karl Heinz, Bechinger, Doris, Betzler, Suzanne, & Heinemann, Hilde. (2003). Early preventive attachment-oriented psychotherapeutic intervention program with parents of a very low birthweight premature infant: Results of attachment and neurological development. Attachment and Human Development, 5(2), 120-135. doi: 10.1080/1461673031000108504. 2. Walter, C. (2021a). Bindung, Bindungsbeziehungen und psychosoziale Entwicklung von ehemals sehr kleinen Frühgeborenen (< 1500g) in der späten Adoleszenz — eine prospektive Längsschnittuntersuchung. (Dissertation zum Erwerb des Doktorgrades der Humanbiologie). Medizinische Fakultät der Ludwig-Maximilian-Universität München. 3. Walter, C. (2021b). Bindung, Frühgeburt und deren langfristige Auswirkungen auf die psychische Entwicklung bis zur Spätadoleszenz. In K. H. Brisch (Ed.), Bindung und psychische Störungen. Ursachen, Behandlung und Prävention. Stuttgart: Klett-Cotta. 4. Walter, C., Beese, J., Bembenek, S., Sieber, S., Geis, L., & Brisch, K. H. (2018). Self- Reported Mental Health Problems Among Late Adolescents Previously Born Extremely or Very Preterm (EP/VP) And Maternal Attachment Representation: An Attachment-Based Longitudinal Study From 320g in Incubator to Early Majority. Paper presented at the WAIMH 2018, Rome. Note: This paper was to be presented at the 33rd NIDCAP Trainers Meeting. Unfortunately Professor Brisch was unable to present his paper. 5. Riddell RRP, Racine NM, Gennis HG, Turcotte K, Uman LS, Horton RE, Kohut SA, Stuart JH, Stevens B, Lisi DM. (2015) Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews, doi. org/10.1002/14651858.CD006275.pub3 6. Axelin A, Salantera S, Lehtonen L. (2006) ‘Facilitated tucking by parents’ in pain management of preterm infants— a randomized crossover trial. Early Human Development, 82(4):241–247. doi.org/10.1016/ 7. Alinejad-Naeini M, Mohagheghi P, Peyrovi H. (2014) The effect of facilitated tucking during endotracheal suctioning on procedural pain in preterm neonates: A randomized controlled crossover study. Global Journal of Health Sciences, 6(4):278-284. doi: 10.5539/ gjhs.v6n4p278 8. Obeidat H, Kahalaf I, Callister LC, et al. (2009) Use of facilitated tucking for nonpharmacological pain management in preterm infants: A systematic review. The Journal of Perinatal and Neonatal Nursing, 23(4):372–377. doi: 10.1097/ JPN.0b013e3181bdcf7 9. Shah PS, Herbozo C, Aliwalas LL, Shah VS. (2012) Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database of Systematic Reviews, 12: CD004950. 10. Vu-Ngoc H, et al, & Duong PDT. (2020) Analgesic effect of non-nutritive sucking in term neonates: A randomized control trial. Pediatrics and Neonatology, 61 (1): 106-113. doi: org/10.1016/j.pedneo.2019.07.003 11. Blass E, Watt L. 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