By Alice K. Gong, MD

Early Relational Health Starts with Newborn Care

By Alice K. Gong, MD

newborn baby comes with the promise of a brave new world, a new beginning. For that child to become the best that he or she can be, one thousand days of nurture and nutrition is needed, starting from when that fertilized egg is implanted through the first two years of life. For the purpose of this article, due to the high rates of mental health disruptions in our pandemic society, I will focus on the importance of emotional development and nurture.

With every new life, connections between mother and baby start in-utero with the development of the autonomic nervous system (ANS). The vagus nerve, cranial nerve X, originates in the brainstem and controls autonomic functions of the heart, lungs, stomach, pharynx, larynx, trachea, esophagus and gastrointestinal tract. The sensory branch mediates sensations from pharynx, larynx, thorax and abdomen. It is the main component of the parasympathetic nervous system, overseeing crucial bodily functions, controlling mood, immune responses, digestion and heart rate. Afferent fibers send information about the state of inner organs to the brain. Myelination of the vagus nerve starts in the last trimester of fetal life and continues to develop through the first year. These changes ensure that the newborn can breathe, obtain food and maintain body temperature.

When birth is undisturbed and the baby is placed on the mother’s abdomen, he/she will naturally crawl to the breast, latch and suckle. This baby crawl is driven by smell. If the breast is washed, the baby will not find the breast. However, amniotic fluid on the breast will get the baby there. The mother will respond with

Aa milk letdown. The smell of the baby also triggers an oxytocin release in the mother, which helps jump-start the emotional connection between the dyad. The pressure receptors of the baby’s body are stimulated by the crawl. When mother hugs the baby, the pressure receptors are stimulated further. Skin to skin care of the newborn calms both mother and baby, allowing the baby to access nutrients whenever he/she wants. Research has shown that blood pressure, blood sugar and temperature are better regulated. The mother’s breasts can modulate the amount of heat that the baby needs. The distance of the baby’s face latch is perfect for the newborn to see the mother. The mother will hear the baby nursing. This early reciprocal social engagement of the mother and baby continues through the newborn period, allowing

mother and baby to develop an emotional connection and co-regulate each other. This is the basis of the nurture science, to share emotions with all the senses of smell, taste, touch, sight and hearing. It is critical for optimal family communication, behavior and development.

We know that adverse childhood experiences are associated with poor adult health outcomes. Research has shown that chronic stress activation affects early brain development, as well as wear-and-tear of multiple systems that lead to poor health outcomes. Nurture science informs us that disruptions to the mother-infant relationship, such as the need for Newborn Intensive Care Unit (NICU) to save the baby’s life, can lead to adverse conditioning. The preterm infant’s ANS myelinates outside of the mother’s womb, and thus cannot develop to the highest circuit of social communication. A NICU randomized controlled trial (RCT) carried out at Columbia University showed that mother-preterm baby dyads who had the services of a nurture specialist to help them emotionally connect as compared to standard care had much better neurodevelopmental outcomes up to age five. In addition, the mothers had less anxiety and depression. We at UT Health and University Hospital (UH) participated in a replication trial with Columbia University that is near completion. Preliminary results of the primary endpoint of improved EEG power in term equivalent newborns showed that we were able to replicate the positive results of the original trial. Through the generosity of a Baptist Health Foundation grant, UH is currently implementing nurture care in the NICU with a trained nurture specialist. This will be the first large hospital with a program that ensures the fragile NICU patients develop that important social emotional connection to their families.

Nurture science teaches us that infants can understand, react to and are developmentally influenced by the psychological states of the parents whose role is to be protector, role model and emotional navigator. As parents, we should not insulate our children. We should be able to share the good and the bad, and let them know our feelings. It is alright to have flaws and to let our children know them. Teach your young children to name their feelings – sadness, happiness, anger, fear; that no emotion is bad or wrong. Tell them that is it okay to ask for help, and how to use the tool of an honest and earnest apology. There is so much sadness in the state of the world today. Due to changes wrought by the pandemic, our shaken societies are finding that emotional intelligence is associated with resiliency. Schools are implementing social emotional learning in their curriculum. It is time to share, communicate and find joy in everyday things with our children to help them develop resiliency.

Alice K. Gong, MD is a William and Rita Head Distinguished Chair in Developmental and Environmental Neonatology and Professor of Pediatrics at the UT Health San Antonio Long School of Medicine. She is a member of the Bexar County Medical Society.