Examining the Biobehavioral Components of Mother-Infant Dyadic Synchrony in the NICU: An Empirical Review

• In Event: Physical and mental health across the lifecourse

Abstract

Purpose: Dyadic synchrony is a co-constructed social process relating to the serve and return interactions between mothers and infants that is strongly associated with neurodevelopment, self-regulation, and attachment (Harrist & Waugh, 2002; Provenzi et al., 2018). In the NICU, this process becomes interrupted due to the physiological state of the infant, the emotional state of the mother, and the physical environment of the NICU itself. In applying the Biobehavioral Model of Synchrony (Feldman, 2012), this theoretical paper deconstructs the process of dyadic synchrony in the NICU context with the aim to describe a conceptual model to guide both research and clinical practice. Methods: We conducted a comprehensive review of the theoretical and empirical literature to explicate the structural and biobehavioral components of synchrony and relate these constructs to the extant research on premature infants. A literature search was performed in PubMed, PsychInfo, and Google Scholar databases followed by a thorough screening of reference lists and review articles. Key words included mother-infant interaction, dyadic synchrony, dyadic interaction, parenting, NICU, prematurity, and attachment. Next, we extracted and synthesized the maternal, infant, and contextual factors that facilitate or inhibit the ontogenesis of dyadic synchrony in the NICU. Finally, we summarized the state of the science, including gaps and recommendations for future research, as it pertains to mother-infant dyadic synchrony development in the NICU. Findings: Based upon the empirical review synthesis, a conceptual framework was constructed (see Figure 1) to illustrate multiple processes of maternal, infant, and contextual influences of mother-infant synchrony in the NICU. This conceptual illustration integrates the behavioral and physiological components of synchrony (Harrist & Waugh, 2002; Feldman, 2012) within the Synactive Theory of Development (Als, 1986) and links them with the direct and indirect influences on mother-infant interaction as presented in this review. Additionally, this framework summarizes the infant and maternal characteristics and communication patterns that function as key interpersonal attributes that impact the development of the mother-infant dyadic relationship. Future studies are necessary to address the following gaps: (1) understand how mother-infant synchrony evolves at different phases of the NICU hospitalization; (2) examine the infant’s role in influencing maternal behavioral and physiological responses; and, (3) explore the unique contribution different cultural contexts have on mother-infant synchrony in the NICU setting. Implications: Despite the challenges posed to mother-infant reciprocal engagement in the NICU, the empirical evidence indicates that promoting increased opportunities for quality mother-infant dyadic interactions through developmental and family-centered interventions will lay the foundation for positive mother-infant interaction patterns that will continue beyond the NICU hospitalization experience (Filippa et al., 2019; Mehler et al., 2011; Vittner et al., 2018). Indeed, mother-infant patterns established during the NICU period remain consistent across time thus having long-term implications for the developmental process of dyadic synchrony (Forcada-Guex et al., 2006; Lean et al., 2018). The conceptual framework abstracted from this review synthesis can serve as both a clinical and research framework to advance a comprehensive understanding of the complex interrelationships among the numerous factors influencing the ontogenesis of mother-infant synchrony in the NICU.

Authors

• Christine Neugebauer, Texas Tech University
  Presenting Author

• Ann M Mastergeorge, Texas Tech University
  Non-Presenting Author