Post on 16-Feb-2019
1
Dr Nils Bergman
MB ChB, DCH, MPH, MD
(USA equiv: MD, MPH ,PhD)
Cape Town, RSA
www.skintoskincontact.com
PERINATAL NEUROSCIENCE
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
Scientific
American,December 2011
INK
PENCIL
CORTISOL
HISTONE MODIFICATION
DNA METHYLATION
MICRO-RNA
2
“Phenotype” – specimen resulting from
gene – environment interactionPencil
EPIGENES …controls on the DNA/gene
“switches in the mind”
G x E
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
Making of theneural tube
200000 new nerve cells/minHammarberg 1896 Caviness 2008
Neuronal migration
12
The brain is not a computer, it is a jungle
G Edelman
3
13
(Ner
vous
tiss
ue
cell
s –
gli
al
cell
s)
Impulse
Presynaptic neuron
Vesicle
Transmitters
Synaptic cleft
ReceptorsPostsynaptic
neuronPostsynaptic activity
fetal REM sleep(or active sleep) seems to
be particularly importantto the developing organism
... spontaneous synchronous firing
Marks et al 1995
”Neurons that fire together wire together while those which don’t,won’t”
Hebb/Carla Shatz
”Neurons that fire together wire together while those which don’t,won’t”
Hebb/Carla Shatz
Optimal neural pathways are selected - J-P Changeux
Early wiring phase
Pruning of excess
Adult stage (efficient)
Panksepp 1998
Siegel 2005
Non-REM 4
4
REMNR1NR2NR3NR4
ACQUISITION CONSOLIDATION MEMORYFORMATION
poly-sensory input transfer information P wavesshort-term memory “SNR” strong signals returns infostored cortex amygdala / to neocortex:
hippocampus organizedAwake and REM NREM stage 4 REM
BRAIN WIRING
Stanley Graven 2006
BRAIN WIRING
Peirano 2003
In adult:sleep pertains
to memory
In child:neurodevelopment
(brain wiring)1st 1000 days
BRAIN WIRING
PATHWAYS CIRCUITSNETWORKSCONNECTOME
LUDINGTON-HOE … SCHER
5
SCHER … LUDINGTON-HOEBrain Architecture and Skills are
Built in a Hierarchical “Bottom-Up” Sequence
• Neural circuits that process basic information
are wired earlier than those that process more
complex information.
• Higher circuits build on lower circuits, and
skill development at higher levels is more
difficult if lower level circuits are not wired
properly.
Slide by: Jack P. Shonkoff, M.D.
Reflections for practice
Sleep organization should guide care”DEFENCE NUTRITION REPRODUCTION
HORMONES NERVES MUSCLES
endocrine autonomic NS somatic
HIGHLY CONSERVED NEURO-ENDOCRINE
BEHAVIOR
6
AT BIRTH,
the brain has TWO CRITICAL SENSORY NEEDS:
SMELL & CONTACT
... these data indicate that pups have a unique learning circuit relying onthe olfactory bulb for
neural plasticity and on the hyperfunctioning noradrenergic locus coeruleus flooding the olfactory bulb with norepinephrine to support the neural changes.
APPROACH RESPONSE … learned prenatally, reinforced both during the birth process and
repeatedly throughout the postnatal period,
… supported by a unique neural framework … a system that ensures rapid and robust maternal odor learning
SMELL vanilla / colostrum / water (control)
read NIRS activity FRONTAL LOBE
• This was confirmed by
demonstration of a statistically
significant negative correlation
between changes in [Hb O2] and
postnatal age (r 520.64, p 5 0.001
with 95% confidence interval) (Fig.
4). Those babies showing the
greatest increase in [Hb O2] were
between 6 and 24 h old at testing
• In the 14 babies older than 24 h
there was no significant difference
between the changes in [Hb O2]
during control and colostrum
exposure
APPROACH RESPONSE
In the 14 babies
older than 24 h
there was
no significant
difference
between the
changes in [Hb
O2] during control
and colostrum
exposure
Those babies
showing the
greatest
increase in
[Hb O2] were
between 6 and
24 h old at
testing
The first hours after birth are a
CRITICAL PERIOD
7
9 steps“Skin-to-skin contact” is the salient stimulus for infant-parent behavior.
“The newborn may appear
helpless, but
raises its own temperature,has a higher blood glucose,metabolic adaptation faster.
(Widstrom 1987)
METABOLIC ADAPTATION
SSC started in the first 20 minutes after birth
SSC CotBlood glucose (1 hr) 3.17 2.56Base excess drop 3.4 1.8
(Christenson 1992)Images courtesy of Prof Peter Hartmann, UWA
Warming, feeding and
protection behaviours areintricately, inseparablylinked to the right place.
(Alberts 1994)
The BOND is made up of the
sensory inputs from the parent to the infant
REGULATION
Bowlby 1969, 1973, 1980
8
Through “hidden maternal regulators” ...
warmth activity levelmilk heart rate
“ physiological set points “internal working modelsscripts – templates
a mother precisely controls everyelement of her infant’s physiology,
from its heart rate to its release of hormones
from its appetite to the intensity of its activity
(Gallagher 1992)
Through “hidden maternal regulators” ...
Through “hidden maternal regulators” ...
“ physiological set points “
“ internal working models’“ scripts – templates”
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BABY
BONDING
When does the infant
become conscious?
Scientific American 1986
Scientific American Mind 2009
Noradrenergic neurons from
LOCUS COERULEUS
may activate the whole brain during wakefulness
Awake at birth
AWAKE ON OFF ASLEEP
9
You can never reach the same highlevels of catecholamine levels
during your whole life as at birth Reduced catecholamine surge after C-section
Vaginal delivery Elective C-section
Reduced catecholamine surge after C-section
catecholamine surge required to activate (epithelial sodium channel) pump to get
lung liquid clearance BIRTH
Reduced catecholamine surge after C-section
Riccardo Pfister
Riccardo Pfister Riccardo Pfister
10
Reduced catecholamine surge after C-section
Why?
Vaginal delivery Elective C-section
The newborn brain consumes 50 %
of all the blood glucose-
In the adult 20 %
Scientific American 2010
The infant brain is not
blank!Resting activity
-“stream of
consciousness”
AT BIRTH,
the brain has TWO CRITICAL SENSORY NEEDS:
SMELL & CONTACTconnect direct to the amygdala
THE NEWBORN
BRAIN
SKIN-TO-SKINCONTACT
fires and wires
the amygdala-prefronto-orbital cortical pathway (PFOC)
AMYGDALA:EmotionalProcessingUnit CPU
Prefrontal cortexExecutive
function
SOCIAL and EMOTIONAL
INTELLIGENCE
SOCIAL EMOTIONALINTELLIGENCE INTELLIGENCE
Behavioural activation systemreward-based(dopamine)
11
In humans, oxytocin increases gaze to the
eye region of human faces and enhances
interpersonal trust and the ability to infer
the emotions of others from facial cues.
Interpersonal awareness
Emotions
Kerstin
Uvnas-Moberg
Ross 2009
OXYTOCIN
Simulation theory:EMPATHY is generated by inner imitationof actions of others
Morphing emotion AMYGDALA FUSIFORMGYRUS
12
Smell
Skin contact
A primary visual areas,
B somatosensory motor cortex
C primary auditorycortex
D parietal cortex & cerebellum
E m l anterior pre-frontal cortex
Fransson 2007
Smell
Skin contact
EMOTIONCONTROL CENTRE
FACE RECOGNITIONCENTRE
OXYTOCIN
E prefrontal
A primary visual
B somatosensory
C primary auditory
D parietal& cerebellum
Here we demonstrate that in 2-d-old infants, the language-related neural substrate is
fully active in both hemispheres with a preponderance in the right auditory cortex.
… although the brain responds to spoken language
already at birth, thereby providing a strong biological
basis to acquire language, progressive maturation
of intrahemispheric functional connectivity is yet to be established with language exposure as the brain develops.
28 days old, 30 w PMA
13
The BOND is made up of the
sensory inputs from the parent to the infant
REGULATION
Bowlby 1969, 1973, 1980
Through “hidden maternal regulators” ...
warmth activity levelmilk heart rate
“ physiological set points “internal working modelsscripts – templates
a mother precisely controls everyelement of her infant’s physiology,
from its heart rate to its release of hormones
from its appetite to the intensity of its activity
(Gallagher 1992)
Through “hidden maternal regulators” ...
The BOND is made up of the
sensory inputs from the parent to the infant
REGULATION
Bowlby 1969, 1973, 1980
SEPARATION
SEPARATION DYSREGULATES
CORTISOL
14
CORTISOL
Maternal absence causesneonatal instability.
PROTEST – DESPAIR is accompanied by
DYSREGULATION
“Phenotype” – specimen resulting from
gene – environment interactionPencil
EPIGENES …controls on the DNA/gene
“switches in the mind”
G x E
MICHAEL MEANEY
Unsafe environment activates HPAaxis (autonomic nervous system, ANS).
“In response to stress, CRF
… and vasopressin are
released … anterior pituitary
… synthesis release ACTH
…glucocorticoids ”CORTISOL
MICHAEL MEANEY epigenetics
Early stress alters gene expression,with health impact across lifespan.
Psychobiology
and molecular
genetics of
resilience
Adriana Feder*, Eric
J. Nestler‡, and
Dennis S. Charney‡ Nat Rev Neurosci. 2009 June ; 10(6): 446–457. doi:10.1038/nrn2649
15
Nat Rev Neurosci. 2009 June ; 10(6): 446–457. doi:10.1038/nrn2649
OXYTOCINCORTISOL
This maternal carewas NOT abusive,just sub-standard.
This care isbasicallyskin-to-skin contact.
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy unhealthyadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
HG BABY HG BABYLOW Grooming care
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
UNHEALTHYadult
LOW Grooming LG
Makes MOTHER
CORTISOL
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
LG BABY LG BABYHIGH grooming care
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
HEALTHYadult
HIGH Grooming HG
Makes MOTHER OXYTOCIN
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
HEALTHYadult
HIGH Grooming HG
Makes MOTHER
Earliest care at birth matters
Same gene switched
LG BABY LG BABYHIGH grooming care
OXYTOCIN
16
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
Earliest care at birth matters
Same gene switched
OXYTOCIN
Primate separation studies
Maternal Separation Paradigm0w 1w 2w 3w 4w 5w 6w 12w
n 4 Mat MNSgroup reared no mothern 4 Mat MNS group as aboven 4 Mat (control)
Gene specific for the AMYGDALA( GUYC1A3)
Separated at 1 week:
LOW gene expression
Increased self soothing Anxiety
Decreased sociality Depression
Primate separation studies
Maternal Separation ParadigmEarly Deprivation (ED) vs control (CON)
0d 2d 28d 48wED n 11 Mat 30 -120 min daily
CON n 4 Mat 48w
Repeated shortseparations:
LOW gene expression
Correlate to human adult depression
17
2ND
KNOCK
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
These findings translate previous results from rats / monkeys to humans
Sabatini
Arabadzisz
18
Nelson &
Panksepp 1998
SAFE UNSAFENEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BABY
BONDING
SEPARATION
MATERNAL DEPENDENCEHABITAT
MATERNALMOTHER
OTHERALTERNATE
AM I SAFE HERE ??
THE THE ““OLDOLD”” BRAIN HAS BRAIN HAS
3 PROGRAMMES3 PROGRAMMES
DEFENCE NUTRITION REPRODUCTION
SKIN-TO-SKIN CONTACT
SEPARATION
BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH
OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)
THE PLACE MODEL
R
Research funded byTHRASHER RESEARCH FUND, U.S.A.
Admin and stats byMEDICAL RESEARCH COUNCIL, R.S.A.
SKIN-TO-SKIN CONTACTFROM BIRTH
COMPARED TO CONVENTIONAL INCUBATOR CARE
Reference
RCT of skin-to-skin contact from birth versus conventional incubator care for physiological stabilisation in 1200- and 2199-gram newborns.
Bergman NJ, Linley LL, Fawcus SR.
Acta Paediatrica 2004 Vol 93(6); 779-785
19
Primary hypothesis
SSC (skin-to-skin contact) from birth is superior to incubator care for low birthweight infants
ONLY HABITAT DIFFERS
ResultsMinimisation techniqueensured groups balanced
for confounders.
( n = 34) KMC CMCMean weight 1813g 1866gMean GA 34.2w 35.3wApprop’ GA 65% 64%Male 60% 50%
(p 783)
RControl
Intervention
Research hypotheses
Stabilising
DURING 6h
Stabilised
AT 6 hours
BAILOUT H1a H1b
SCRIP H2a H2b
BAILOUT points ….
“physiological parameters exceeding normal limits, requiring medical assessment and or intervention”
1 Skin temp consistently <35.5oC
2 Heart rate <100; or > 180 bpm
3 Apnoea longer than 20 seconds
4 O2 sats below 89% (x2), (CPAP/60% O2)
5 Blood glucose < 2,6mmol/l, (laboratory) Bergman et al 2004
INSTABILITY
H1b (SPECIFIC)
Doctor Stablesummoned: .
INCUBATOR 92% 8% SKIN-TO-SKIN 17% 83%
Bergman et al 2004
BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH
OTHERPROTEST- STRESS SURVIVAL orDESPAIR (SNS)
SKIN-TO-SKIN CONTACT
SEPARATION
THE PLACE MODEL
8% “STABLE”
83% “STABLE”
20
monitors continuously
SCRIP
Heart rate
Oxygen saturation
Respiratory rate
STABILITY
SCRIPSCORE
2 1 0
Heart rate Regular Deceleration to 80-100
Rate <80 or >200 bpm
Respiratory rate
Regular Apnoea <10s, or periodic breathing
Apnoea >10sTachypnoea
>80 pm
Oxygen saturation
Regular >87% Any fall to 80 – 87%
Any fall below 80%
“Stability of Cardio-Respiratory system In Preterm Infants”
Score allocated for a five minute period ofcontinuous observation, maximum six for period
Fischer et al, 1988 STABILITY
“100% SCRIP STABILIY”
S S C C M C
1200g to
2200 g1 - 6h 56% 11%
@ 6h 100% 46%
1200g to
1800g1 - 6h 44% 0%
@ 6h 100% 25%
Stabilisation first 6 hours, average hourly SCRIP score
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
6
6.1
2nd 3rd 4th 5th 6th
KMC all
KMC <1800
CMC all
CMC <1800
Hourly average of SCRIP score, 2nd to 6th hour
Stabilization 1200g – 1800g
Skin-to-skin
Incubator
INCUBATORS DE-STABILISE
NEWBORNSStabilisation first 6 hours, average hourly SCRIP score
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
6
6.1
2nd 3rd 4th 5th 6th
KMC all
KMC <1800
CMC all
CMC <1800
SKIN-TO-SKIN
SEPARATION
BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH
OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)
Stabilization
Stabilisation first 6 hours, average hourly SCRIP score
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
6
6.1
2nd 3rd 4th 5th 6th
KMC all
KMC <1800
CMC all
CMC <1800
Bergman et al 2004 CORTISOL
21
SKIN-TO-SKIN CONTACT
SEPARATION
BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH
OTHER PROTEST- STRESS SURVIVAL DESPAIR (SNS)
THE PLACE MODEL
DEFENCE
NUTRITION
BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH
OTHERPROTEST- STRESS SURVIVAL orDESPAIR (SNS)
SKIN-TO-SKIN CONTACT
SEPARATION
THE PLACE MODEL
DYS-REGULATION
STABILISATION
CORTISOL
PROTEST – DESPAIRcauses
DYSREGULATION
SEPARATION DYSREGULATES
CORTISOL
Premature babies are not in incubators because they are unstable.
Premature babies are unstable because they are in incubators.
REGULATION vs STIMULATION
Expected vs UnexpectedEcologic salience vs Potential threatResource growth vs threat readiness
OXYTOCIN vs CORTISOL HOMEORHESIS vs HOMEOSTASIS
MOTHER vs OTHER
22
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
intricately, inseparablylinked to the right place.
(Alberts 1994)
CORTISOL
Maternal absence causesneonatal instability.
CORTISOL
Maternal absence causesneonatal instability.
Maternal presence (SSC)regulates preterm physiology.
Clinics in Perinatology,
June 2004, Vol 31(2) page 210
Stanley Graven
Early neurosensory visual
development of fetus and newborn.
“It is a serious mistake to assume that the
principles derived from careful animal studies
do not apply to human infants.
The risk of suppression or disruption of
needed neural processes ...
is very significant and potentially lasts a life time.
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BABY
BONDING
“needed
neural
processes”
BONDING components
ANS
Upstream
Downstream
EmotionalANS
Social
Physical
23
BONDING components
EmotionalANS
Social
Physical
SEES
Mum’s eyes
Hand TOUCH
Mum’s skin
Skin-to-skin
CONTACT
SENSATIONS THAT WIRE BRAIN
Back FEELS
Mum’s arm
holding
TASTES
Mum’s milk
Ear HEARS
Mum’s voice
SMELLS
Mum’s milk
WARMED on
Mum’s front
MOVES
with Mum
Slide from JILL BERGMAN
a kind of invisible hothouse
BREAST - FEEDING=
BRAIN - WIRING
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
BABY
BONDING
Secure attachment
John Bowlbysecure attachment
“a safe base from which to explore the world”.
Safe HavenSecure baseProximity
maintenanceSeparation
distress
BONDING consequence
EmotionalANS
Social
Physical
Child: Insecureattachment
Adult: AttachmentANXIETY to partner
Adult: Higher CORTISOL andlower immunity
(CD4 cells) Jaremka 2013
CORTISOL
24
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
MOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
SEPARATION
Critical period concept :
“Windows of opportunity in early life when a child’s brain is exquisitely primed to receive sensory input in order to develop more advanced neural systems.”
a mother’s brain …
SENSITIZATION
PREDATOR
Smell cingulate
FEARFREEZE
+ OXYTOCIN
cingulatesuppressed
Less fearFORAGE
OXYTOCINCORTISOL
SENSITIZATION
0
5
10
15
20
25
-0.2 0 0.2 0.4 0.6 0.8 1
Maternal Behavior Q-Sort
Ho
urs
of
SS
C i
n In
fan
ts' F
irst
24 H
ou
rs
Dose of SCC first 24 hours correlatesMaternal behaviour Q SortPredicts attachment security
0
5
10
15
20
25
-0.2 0 0.2 0.4 0.6 0.8 1
Maternal Behavior Q-Sort
Ho
urs
of
SS
C i
n In
fan
ts' F
irst
24 H
ou
rs
Dose of SCC first 24 hours correlatesMaternal behaviour Q SortPredicts attachment security
SENSITIZATION
0
5
10
15
20
25
25 27 29 31 33 35 37 39 41 43 45
Maternal Behavior Subscale of the NCATS
Ho
urs
of
SS
C i
n In
fan
ts' F
irst
24 H
ou
rs
Dose of SCC first 24 hours correlatesNCATS ( Nursing Child Assessment Teaching Scale )
Predicts cognitive outcome
25
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
MOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
SEPARATION
Resilience
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”
Resilience
Secure attachment
Attuned parenting
RESPONSESTRESS
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
Resilience
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
Severity of stress uniquely determined by
individual.
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
HEALTH
elevated activity of mediators,
with return to baseline and no impact on
health.
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
HEALTH
elevated activity –sustained over time,
or severe … changes the “set
points” for homeostasis(e.g. increasing blood pressure,
change in cholesterol level)
26
CORTISOL
http://www.imr.no/copewell/work_packages/wp3/en
CORTISOL
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
HEALTH
the point at which chronic load results in actual
disease or abnormal conditions.
2ND
KNOCK
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
DISEASEHEALTH
CORTISOLOXYTOCIN
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”
DISEASEHEALTH
CORTISOLOXYTOCIN
27
Noradrenergic neurons from
LOCUS COERULEUS
may activate the whole brain during wakefulness
Awake at birth
AWAKE ON OFF ASLEEP
A primary visual areas,
B somatosensory motor cortex
C primary auditorycortex
D parietal cortex & cerebellum
E m l anterior pre-frontal cortex
Fransson 2007
Smell
Skin contact
EMOTIONCONTROL CENTRE
FACE RECOGNITIONCENTRE
OXYTOCIN
E prefrontal
A primary visual
B somatosensory
C primary auditory
D parietal& cerebellum
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”
DISEASEHEALTH
CORTISOLOXYTOCIN
28
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
… there is considerable overlap in the brain structures associated with these neural mechanisms … functional interactions among the circuits.
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
An overly responsive fear circuit … may negatively influence functioning of the reward system.
… a properly functioning reward circuit may be necessary for …positive social behaviors.
PR - Peer Reared
MR – Mother Reared
Plasma CORTISOL response to STRESS (2y)
RESILIENCE:“capacity to maintain
healthy emotional functioning in the after-
math of stressful experiences”
DISEASEHEALTH MR PR
CORTISOLOXYTOCIN
DISEASEHEALTH
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”
CORTISOLOXYTOCIN
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Toxic stress
CORTISOLOXYTOCINResilience
Garner 2011
29
Shonkoff 2012
The basic
science of
pediatrics.
Shonkoff J P et al.
Pediatrics 2012;
129:e232-e246
©2012 by American Academy of Pediatrics
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS Positive Stress
• Moderate, short-lived stress responses, such
as brief increases in heart rate or mild changes
in stress hormone levels.
Slide by: Jack P. Shonkoff, M.D.
Bad
Good
• An important and necessary
aspect of healthy development
that occurs in the context of
stable and supportive relationships.
High
StressLow
Stress
Tolerable Stress
• Stress 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.
30
Toxic Stress
• Strong 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. CORTISOL
“Non-pharmacological reduction of
hypercortisolaemia in preterm infants”(Modi & Glover 1998, Mooncey et al 1997)
Preterm infants experience prolonged severe stresswith tenfold increases in stress hormones.
Stress hormones at such levels are neurotoxic.
RCT on methods to reduce of stress (at one hour):
Cortisol EndorphinMassage slightly lower no change
Soft music no change no change
Skin-to-skin 66% lower 74% lower
SEPARATION CORTISOL
OXYTOCIN
SEPARATION CORTISOL
SKIN-TO-SKINCONTACT
OPPOSITES
“Of a good beginning cometh a good end”John Heywood, Proverbs (1546)
When is the beginning?
SEPARATION CORTISOL
Garner 2011
EARLY YEARS LIFE SPAN
LearningBehavior
Physical well beingMental well being
BERGMAN COMMENTARY – NEWBORNEarly years = early hours & days
“FIRST 1000 MINUTES”
31
EARLY YEARS LIFE SPAN
LearningBehavior
Physical well beingMental well being
TOXIC STRESS
EARLY LIFE ADVERSITY
BERGMAN COMMENTARY – NEWBORNMaternal absence is TOXIC STRESS
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
EARLY YEARS LIFE SPAN
LearningBehavior
Physical well beingMental well being
TOXIC STRESS
EARLY LIFE ADVERSITY
MAKES POORER LinguisticCognitiveEmotionalAdaption
responsivity unhealthy lifestyle
Chronic diseasehealth disparity
BERGMAN COMMENTARY – NEWBORNFor separated preterm newborns, wehave decades of evidence for this.
EARLY YEARS LIFE SPAN
LearningBehavior
Physical well beingMental well being
TOXIC STRESS
EARLY LIFE ADVERSITY
MAKES POORER LinguisticCognitiveEmotionalAdaption
responsivity unhealthy lifestyle
Chronic diseasehealth disparity
MASSIVE COST $$$$
BERGMAN COMMENTARY –NEWBORN even more massive ??
EARLY YEARS LIFE SPAN
LearningBehavior
Physical well beingMental well being
TOXIC STRESS
EARLY LIFE ADVERSITY
MAKES POORER LinguisticCognitiveEmotionalAdaption
responsivity unhealthy lifestyle
Chronic diseasehealth disparity
MASSIVE COST $$$$
REDUCETOXIC STRESS
BERGMAN COMMENTARY – NEWBORNReducing toxic stress IS VERY EASY !!
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
REDUCETOXIC STRESS
BERGMAN COMMENTARY – NEWBORNReducing toxic stress IS VERY EASY !!
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Disordered attachment
Toxic stress
Insensitiveparenting
Resilience Vulnerability
CORTISOLOXYTOCIN
32
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
“buffering
protection of
adult support”
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
SEPARATIONMOTHERBABY
BONDING Sensitization
Vulnerability
DISEASE
Disordered attachment
Toxic stress
Insensitiveparenting
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
BONDING ATTACHMENT
MRI HRVEEG
STRESS RESPONES
RESILIENCE
DOHAD
(MAL) ADAPTATION
EPIGENETICS
GENE X ENVIRONMENT
GENETIC VARIANTS
HOSPITAL ACQUIRED INFECTIONIMMUNITY
SLEEP PHYSIOLOGY
GUT FUNCTIONMICROBIOTA
“STABILITY”
TRANSITION
LONG TERM FOLLOW-UP
NEUROENDOCRINE BEHAVIOURS
MATERNAL NEUROPLASTICITY
ENVIRONMENT WHAT IS THE EFFECT OF MATERNAL ABSENCE ON …
MORTALITY
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
HOSPITAL ACQUIRED INFECTIONIMMUNITY
GUT FUNCTIONMICROBIOTA LONG TERM FOLLOW-UP
ENVIRONMENT WHAT IS THE EFFECT OF MATERNAL ABSENCE ON …
MORTALITY
33
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
the key toneurodevelopment …
RIGHT PLACE !!
MOTHER
is the key toneurodevelopment …… because she is the
RIGHT PLACE !!
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
MOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience
HEALTH
A mother and baby
DYADare asingle
psychoneurobiologicalorganism
BIRTH BONDING Sensitization Toxic stress
IT MATTERS
HOW WE ARE BORN
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
SEPARATION
Vulnerability
DISEASE
Disordered attachment
Toxic stress
Insensitiveparenting
SEPARATION
VIOLATESthe innate agendaof mother and baby
ZERO
SEPARATION
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
SEPARATIONMOTHERBABY
BONDING Sensitization
Disordered attachment
Toxic stress
Insensitiveparenting
34
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
An ecobiodevelopmental framework for early childhood policies and programs.
Shonkoff J P et al. Pediatrics 2012;129:e232-e246
©2012 by American Academy of Pediatrics
Innovative strategies …… reduce toxic stress
Creative new strategies
“compelling need for bold new strategies”
National Research Council 2000 Shonkoff 2010
“compelling need for bold new strategies”
35
Skin-to-Skin
Contact
Attachment
Bonding
Breast-feeding
Regulation
An ecobiodevelopmental framework for early childhood policies and programs.
BERGMAN COMMENTARY – NEWBORNReducing toxic stress IS VERY EASY !!
Attachment
Bonding
Breast-feeding
Skin-to-Skin
Contact
www.skintoskincontact.com
INTRODUCTION
“It is easier to build strong children
than to repair broken men.”Frederick Douglass (1817–1895)
PERINATAL NEUROSCIENCE and SKIN-TO-SKIN CONTACT
Reflections for practice
“It is easier to build strong children
than to repair broken men.”
ZERO SEPARATION