27Positive StressModerate, short-lived stress responses, such as brief increases in heart rate or mild changes in stress hormone levels.An important and necessary aspect of healthy development that occurs in the context of stable and supportive relationships.Slide by: Jack P. Shonkoff, M.D.
28= Eustress Positive Stress EUSTRESS Under- activity Over- activity An important and necessary aspect of healthy development that occurs in the context of stable and supportive relationships.EUSTRESSOver- activity
29Tolerable StressStress responses that could disrupt brain architecture, but are buffered by supportive relationships that facilitate adaptive coping.Generally occurs within a time-limited period, which gives the brain an opportunity to recover from potentially damaging effects.Slide by: Jack P. Shonkoff, M.D.
30Toxic StressStrong and prolonged activation of the body’s stress management systems in the absence of the buffering protection of adult support.Disrupts brain architecture and leads to stress management systems that respond at relatively lower thresholds, thereby increasing the risk of stress-related physical and mental illness.Slide by: Jack P. Shonkoff, M.D.
31Unsafe environment activates HPA axis (autonomic nervous system, ANS). MICHAEL MEANEY“In response to stress, CRF … and vasopressin are released … anterior pituitary … synthesis release ACTH …glucocorticoids ”Unsafe environment activates HPAaxis (autonomic nervous system, ANS).Early stress alters gene expression,with health impact across lifespan.
33Vocabulary Homeostasis the coordinated operation of physiological processes that maintainthe steady state required to sustain lifeAllostasis the mechanism by whichhomeostatic systems are maintained in balanceas life cycle and environment changesAllostatic state elevated activity ofmediators, with returnto baseline and no impact on health.
34REGULATION (similar to earlier … ) the objective is to achieve the ability to establish:‘STABILITY THROUGH CHANGE’The foundation forINFANT MENTAL HEALTH
35Allostatic load elevated activity – VocabularyAllostatic load elevated activity –sustained over time, or severe, or mediatorsdysregulated changes target cells of mediators,and so changes the “set points” for homeostasis (e.g. increasing blood pressure,change in cholesterol level)Allostatic overload the point at whichchronic load results in actual diseaseor abnormal conditions.
36“wear and tear that results from KNOCKTOXIC STRESSSensitivityHIGHALLOSTATIC LOAD:“wear and tear that results fromchronic overactivity (or underactivity)of allostatic systems.”(McEwen 1998, 1999)
37TEICHER’S Developing Brain (1) Early Stress (2) EARLY STRESS NeurogenesisNeural morphologySynaptogenesisMyelinationEarlyStress (2)Neuronal death, smaller brainFewer dendritic spinesPoorer connectionsFewer glial cells, less myelinTEICHER’SEARLY STRESSCASCADE MODELSensitivity (3)GeneticGenderTimingDevelopmental rateGCR densityEnduring (4)consequencesAttenuated L brain devlopmentPoor R / L integrationIrritability limbic systemPoorer function vermisStimulationResilienceMENTAL HEALTHNeuropsychiatricvulnerabilities (5)Dissociative identity disorderDepression Personality disorderSubstance abusePost Traumatic Stress Disorder
38Schore:“Infant trauma will interfere withcritical period limbic organisation ...future capacity to adapt ...correlated with maladaptiveadult mental health”
39Schore:“long term alterations brain function“risk for developing severe psycho-pathologies at later stages of life.”
41SPECTRUM of expression in POPULATION ALLOSTATIC LOAD:“wear and tear that results ….HEALTHDISEASESPECTRUM of expression in POPULATION
42“Scientific foundation” … a synthesis EVOLUTIONARYBIOLOGYNEUROSCIENCEEPIGENETICSEverything elseThe BrainThe DNAThe PlaceENVIRONMENTFITNESSEXPERIENCEADAPTATIONEXPECTED UNEXPECTEDHEALTHDISEASESPECTRUM of expression in POPULATIONPlatform for better understanding of PUBLIC HEALTH.… policy and practice that impacts the care of mothers and babies.
44“Environment”is the usual place andcontext for which thegenes have adjusted
45… because she is the RIGHT PLACE !! MOTHER is the key toneurodevelopment …… because she is the RIGHT PLACE !!
46Anthropological and sociological aspects of skin-to-skin contact. AnthropologyEvolutionary BiologyDNA & EpigeneticsNeuroscience of stressMal-AdaptationSociological consequenceIntro
47Anthropological and sociological aspects of skin-to-skin contact. SCIENTIFICAND EVIDENCEBASIS FORINCUBATOR ??Intro
48Stephane TARNIER 1828 -97 French obstetrician Saw a warmed box for hatching chickens, hadone designed for“weaklings” …… invented incubator
49Pierre BUDIN 1846 - 1907 Friend of Tarniers …took Incubators, made centresfor the care of weaklings,wrote book on subject.Political support …France versus GermanyBUDIN was very particular to includemother, reason for the glass window ….
50Martin COUNEY 1860 - 1950 Born in Germany claims he learned the techniques forBudin ....Berlin Exhibition 1896, success !Photograph: Pan-American Exhibition in Buffalo, New York, 1901.
51Martin COUNEY 1860 - 1950 Berlin 1896, success to USA: Buffalo Omaha ,Chicago Fair nd highest receipts,Last show New York 1940.Baby Incubator,1904 St.Louis Fair
52Martin COUNEY 1860 - 1950 ... famous for “preemie road show”. MONEY MAKING SHOWPERMANENTpavilion inDreamlandNew York Worlds Fair, 1939
53Martin COUNEY 1860 - 1950 Born in Germany claims he learned the techniques forBudin ....Berlin Exhibition 1896, success !London World fair 1898, fiasco!ALL THE BABIES DIED ....“MOTHERS TO BLAME”
54Martin COUNEY 1860 - 1950 Couney succesfully raised 5000 prems! BUT – used wet-nurses,excluded mothers(mother got free pass to the shows !)Mothers were excluded – “germs” …
55Sarah Morris Hospital,Chicago 1923,others followed –accepting the“policy of strict separation”.
56WHY do we separate mothers from babies ?? INCUBATOR & SEPARATION = ACCIDENT of HISTORY
57PERINATAL NEUROSCIENCE & SKIN-TO-SKIN CONTACT THE INCUBATORHAS NO SCIENTIFICFOUNDATION !!
58… because she is the RIGHT PLACE !! MOTHER is the key toneurodevelopment …… because she is the RIGHT PLACE !!
59MOTHER is the key to Environment of Evolutionary Adaptedness neurodevelopment …Environment ofEvolutionaryAdaptedness
60KEY TO MONITORINGWELL BEING AUTONOMIC NERVOUSSYSTEM MONITOR ! if HARM can be monitored,HARMING CARE MUST CHANGE
61Separation from mother is stressful for humans.Salivary cortisol is agood measure of stress.
62Separation DOUBLES CORTISOL RCT (Anderson et al 1998)Two groups of newborns,both given best care, onlyone separated from motherat one hour ageCortisol levels measuredevery hour.Cortisol separate = 9Cortisol with mom = 4SEPARATION = STRESS
63Skin-to-skin 66% lower 74% lower Preterm infants experience prolonged severe stress, with tenfold increases in stress hormones.Stress hormones at such levelsare neurotoxic.(Modi & Glover 1998, Mooncey et al 1997)RCT on methods to reduce of stress (at one hour):Cortisol EndorphinMassage slightly lower no changeSoft music no change no changeSkin-to-skin 66% lower 74% lower