早期介入對於極低出生體重早產兒在矯正年齡六個月情緒調節功能之療效

Abstract

實驗背景：極低出生體重早產兒(出生體重小於1,500公克)在兒童及青少年時期有較高比例產生發展與情緒行為的問題。雖然之前的研究顯示早期介入對於極低出生體重早產兒認知與動作發展有輕度至中等的短期療效，但是較少檢視社會情緒發展的結果。因此，本篇研究目的為檢視早期介入對於極低出生體重早產兒在矯正年齡六個月時其情緒調節功能之療效。嬰兒將於手臂限制實驗中，藉由行為與生理的測量，進行早期情緒調節功能的評估。 實驗方法：本實驗共徵召178位極低出生體重早產兒，經隨機分配至常規照護組、門診介入組以及家訪介入組。同時徵召62位性別配對的足月兒擔任本實驗的參照組別。早期介入計畫提供嬰兒照護、家長支持及親子互動的服務，介入時間從出生開始至矯正年齡12個月。所有嬰兒在矯正年齡6個月接受情緒調節功能的評估，施測情境為手臂限制活動。嬰兒的行為使用錄影機紀錄的方式，而生理部分則是使用心電圖來測量。記錄下來的行為以負向反應與調節行為的出現做分析，而心電圖的數據則是以心跳變異率分析為主。 實驗結果：所有回來接受追蹤且有完整生理資料的嬰兒中，門診介入組和常規照護組負向情緒持續增加(p<0.05)；然而，家訪介入組從手臂限制至手臂釋放過程中並無顯著負向情緒的改變。手臂釋放期間，門診介入組和常規性照護組甚至呈現比足月兒及家訪介入組更高強度負向情緒的表現(p<0.05)。但在各調節行為中，各組間則無顯著的差異。在生理調節的反應，門診介入組呈現與足月兒相似的模式：心跳變異率高頻能量從基準點至手臂限制呈現顯著的上升，而在手臂釋放之後呈現顯著的下降。相較之下，接受家訪介入和常規性照護早產兒在生理反應部分並無隨著階段不同而變化。在這些於手臂限制下使用增加心跳變異率高頻能量的嬰兒中，門診介入組採用較多注視母親的行為策略來調控其負向的情緒，而足月兒則是使用注視環境中的物體為主要的行為調節反應(p<0.05)。 實驗結論：早產兒早期介入於矯正年齡六個月時情緒調節的療效主要呈現在門診介入組。在嬰兒早期，對於觀察情緒調節在手臂限制活動下，其生理的反應似乎比行為觀察更能反應出調控的變化。

Background and Purpose: Very low birth weight (VLBW) preterm infants (birth weight <1,500 g) sustain an increased risk of developmental and emotional/behavioral disorders in childhood and adolescence. Although previous studies have demonstrated small to moderate benefits of early intervention to the cognitive and motor function in VLBW preterm infants, these studies have rarely examined the socio-emotional outcome. This study was, therefore, aimed to examine the effect of early intervention on emotion regulation in VLBW preterm infants at 6 months of corrected age. Methods: A total of 178 VLBW preterm infants were randomly assigned to the usual care program (UCP), clinic-based intervention program (CBIP) and home-based intervention program (HBIP). Sixty-two full-term infants were also included to serve as the reference group. Early intervention consisted of child- and parent-focused services that began in hospitalization and ended at 12 months of corrected age. Infants were assessed for emotion regulation under the arm restraint procedure at 6 months of corrected age with their behaviors recorded using a video camera and physiological responses by an electrocardiography. The video records were coded for negative reactivity and regulatory behaviors; the heart rate data were analyzed for variability. Results: For infants who returned for follow up and had complete physiological data, full-term, UCP and CBIP groups showed an increase in negative vocalization (all p<0.05); whereas HBIP exhibited no change from the restraint to release period. Furthermore, UCP and CBIP groups manifested higher levels of negative vocalization than full-term and HBIP groups in the release period (all p<0.05). However, regulatory behaviors in response to arm restraint did not vary between groups. Physiologically, CBIP and full-term groups exhibited similar tendency showing an incline in high-frequency power of heart rate variability (lnHF) from the baseline to restraint period, which was followed by an incline from the restraint to release period (both p<0.05). In contrast, HBIP and UCP groups manifested no change in lnHF throughout the procedure. For those exhibiting increased lnHF from the baseline to restraint period, CBIP group showed more mother orientation and full-term group showed more object orientation in self regulation (both p<0.05). Conclusion: Early intervention, specifically CBIP, appeared to favor emotion regulation in VLBW preterm infants at 6 months of corrected age. Physiological regulation was more sensitive to infants’ reactivity to arm restraint procedure than that of behavioral reactivity at 6 months.