An intervention to teach mothers of preterm infants
how to interact with their babies more effectively results
in better weight gain and growth for the infants,
according to a study funded in part by the National
Institutes of Health.
A subsequent study showed that infants who had the
benefit of a major component of this intervention more
rapidly developed the muscle control needed for
feeding successfully from a bottle. The initial findings
were published online in the Journal of Perinatology
and the subsequent study in Advances in Neonatal Care.
Briefly, the intervention involved teaching mothers to
recognize and respond to the subtle cues their preterm
infants were hungry — far less pronounced than term
infants. Mothers were also taught how to provide
appropriate social and physical stimulation — such as
soothing talk, and gentle massages — to spur their
infants’ neurological development.
Infants born preterm often are not developed enough to
feed on their own. Typically, the muscle control needed
for infants to feed unassisted does not completely develop
until the 34th week of pregnancy. Infants born before this
time usually are fed through a nasogastric tube — a line
passed through the nose and down the throat into the
stomach. The study authors developed the intervention to
help mothers stimulate their infant’s alertness before
feeding so that the infants would be better able to feed
by mouth. The intervention also sought to spur the infants’
social behaviors, such as keeping alert and looking at the
mother, and neurological development, in hopes of
offsetting at least some of the developmental delays often
seen in preterm infants.
“Preterm infants who fail to gain sufficient weight are at a
higher risk for delays and even impairments in cognitive
ability and motor skills,” said Valerie Maholmes, Ph.D.,
chief of the Pediatric Trauma and Critical Illness Branch
at the NIH’s Eunice Kennedy Shriver National Institute of
Child Health and Human Development, which funded the
research. “We are hopeful that this intervention will prove
to be an important tool in safeguarding the long-term health
of an extremely vulnerable group of infants.”
Additional funding for the research was provided by the
National Institute of Nursing Research, also at NIH.
The study was conducted by Rosemary C. White-Traut,
Ph.D, R.N. , and colleagues at the University of Illinois,
Mercy Hospital and Medical Center, and Sinai Hospital
Medical Center, all in Chicago. Dr. White-Traut is now
at Children’s Hospital of Wisconsin in Milwaukee.
During their first year, infants born preterm are at high risk
for life-threatening infections, blindness, breathing
problems, feeding problems, learning and developmental
disabilities, and cerebral palsy. According to the U.S.
Centers for Disease Control and Prevention, nearly
500,000 U.S. infants were born preterm in 2013, the
most recent year for which statistics are available.
Roughly 11 percent of births to Hispanics were preterm.
The study authors write that it is common for preterm infants
to grow more slowly than normal. Infants who grow at an
appropriate rate have the best chances for avoiding problems
in their neurological development.
“Preterm infants face increased health risks, just due to their
having come into the world too early,” Dr. White-Traut said.
“So further complications, such as poor feeding and delayed
growth, can worsen the problems they already face.”
The intervention, dubbed H-HOPE, stands for Hospital to
Home Transition — Optimizing Premature Infant’s
Environment. H-HOPE instructs mothers on how to provide
behavioral, social, and physical stimulation designed to
engage the baby’s attention and spur brain development.
Compared to a term infant, preterm infants spend much more
time sleeping and much less time awake and aware of what’s
going on around them. They’re also are less able to
communicate their needs than is a term infant. For this reason,
the researchers devised the H-HOPE intervention to show
new mothers how to provide appropriate stimulation for their
newborns, and how to pick up on their often times cues
indicating that the baby is hungry.
The intervention is made up of two parts. The first part, called
the Auditory, Tactile, Visual and Vestibular (ATVV) intervention,
teaches mothers how to interact socially with their infants and
gently stimulate their senses. The other part teaches the
mothers how to interpret and respond to their infants’
behavioral cues while giving the ATVV intervention and
when feeding them.
The ATVV consists of a 15-minute intervention, undertaken
twice daily, just before feeding. A nurse and community health
worker team teaches the mother the steps involved. The mother
is first taught to begin speaking to the infant in calm, soothing
tones, before touching the infant. The sound of a female voice
is intended to gently alert the infant that the caregiver is
present. For the next ten minutes, the mother places the
infant on his or her back, and gently massages the infant’s
head, chest, abdomen, and arms, and then turns the infant over
to massage the head and back. For the final five minutes, the
infant is swaddled, held in the mother’s arms, and rocked
horizontally. Throughout the procedure, the mother is taught to
make eye contact with the baby when the baby is awake. This
sequence is repeated twice a day, from the time the baby
reaches 31 weeks and continues after the baby is discharged
from the hospital until 1 month after the approximate date
the baby would have been born, had the pregnancy reached
The other part of the intervention teaches the mother how to
recognize, interpret, and respond to her preterm infant’s
subtle behavioral cues. For example, a term infant will cry loudly
when he is hungry, and perhaps put his hand in his mouth. In
contrast, a preterm infant may not cry, may only weakly pull his
hand toward his mouth to signal that he is hungry.
The researchers enrolled 183 mothers and their preterm
infants, born from the 29th through the 34th week of
pregnancy. Half of the mothers were Hispanic. Roughly half
of the mother-infant pairs were assigned at random to the
H-HOPE intervention, and roughly half to another program
that provided instruction on how to care for preterm infants.
The study took place at two hospitals serving impoverished
“When we planned our research, we thought that preterm
infants from impoverished backgrounds likely would benefit the
most from this intervention,” Dr. White Traut said. “Poverty is
linked to poorer long-term health and infant development. And
as with other negative health influences, preterm infants usually
are affected more strongly than term infants.”
Mothers received two visits from the nurse-community health
advocate team while they were in the hospital to teach them the
intervention’s procedures and to monitor the mothers to make
sure they carried out the steps correctly. The mothers also
received two at-home visits from the nurse-community health
advocate team after their infants had been discharged from the
"Promoting Maternal Interaction Improves Growth, Weight Gain in Preemies." NIH.gov. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), n.d. Web. 13 Mar. 2016.
"Mothers received two visits from the nurse-community health advocate team while they were in the hospital to teach them the intervention's procedures and to monitor the mothers to make sure they carried out the steps correctly."
What word could replace advocate and make the most sense in the context of the sentence?