scientific & evidence base for skin-to-skin contact

1

Dr Nils Bergman

MB ChB, DCH, MPH, MD

(USA equiv: MD, MPH ,PhD)

Cape Town, RSA

www.skintoskincontact.com

SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT


Speaker DisclosureUnder ACCME guidelines:

a) I am the South African distributor of

MIRIS : Human Milk Analyzer

b) My wife markets educational materials and shirts related

to the talk content – NINO ACADEMY

www.ninobirth.org

NEUROSCIENCE

The DNAEverything else

EVOLUTIONARYBIOLOGY

The PlaceENVIRONMENT

EXPERIENCEFITNESS ADAPTATION

“Scientific foundation” … a synthesis

The Brain

EPIGENETICS

EVOLUTIONARYBIOLOGY,

NEUROSCIENCE,EPIGENETICS


THE HUNTER GATHERER (cont)

Infant care patterns in such societies (which are closest to our origins):

1 Infant carried most of time2 Mother sleeps with infant same bed3 Immediate feeding response to crying4 Breastfeeding 24 months or more5 Father frequently and closely involved ...

“For species such as primates, the mother IS the environment.”

Sarah Blaffer Hrdy, Mother Nature (1999)

Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.



Nothing an infant can or

cannot do makes sense,

except in light of mother’s body

http://www.ninobirth.org/

2

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS




“except in the light

of mother’s body.”



Skin-to-skin contact


CENTRAL DOGMA – all biological processes

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS



Key that unlocks the neuroscience:

Skin-to-skin contact

“Cells which

FIRE TOGETHER, WIRE TOGETHER,

and those which don’t, won’t.”

Carla Shatz

Prof Hugo Lagercrantz

Neuronal migration

The brain is not a computer, it is a jungle

G Edelman

Convolutions of the cortex

One million new synapses/second at 1 year!

0 10 20 30 40w 6m 2y 10y 60y

Birth

NEUROGENESIS

Myelination

Arborisation

SYNAPTOGENESIS

Programmed cell deathCOMPETITIVEELIMINATION

NEURONAL PLASTICITYMIGRATION

3

0 10 20 30 40w 1y 3y 13y 50y 80y

28 Birth Puberty

MAXIM

AL O

CCURRENCE

Synapses

Dendrification:

peak 2m & 6m

0 10 20 30 40w 1y 3y 13y 50y 80y

28 Birth Puberty

MAXIM

AL O

CCURRENCE

RELATIVE BRAIN ACTIVITY

METABOLIC ACTIVITY

peaks3 years

NEW SYNAPSE FORMATION

The HARD DISK

Computer has 500 GB=500 000 000 000 b

Brain connections = 500 000 000 000 000 000 000

50 billion neurons, 50000 synapses, 2000 neuron networks

SYNAPSE DEVELOPMENT

At birth, the human being has more synapses in its brain than at any other stage of life.

Impulse

Presynaptic neuron

Vesicle

Transmitters

Synaptic cleft

ReceptorsPostsynaptic

neuronPostsynaptic activity

SENSORY STIMULUS

synapse store chemical signal

chemical signal stronger

THRESHOLD EXEMPT from elimination

(synapse stabilised)PATHWAY

(Rima Shore 1997)

4

fetal REM sleep(or active sleep) seems to be

particularly importantto the developing organism

... spontaneous synchronous firing

Marks et al 1995

REMNR1NR2NR3SWS

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

EARLY DEVELOPMENT

Gestational age20w all structures completed

parallel development of structure & function

(Hugo Lagercrantz 2004)

Brain growth depends on experiences !!

5

NEURO DEVELOPMENT

NEURO PHYSIOLOGY

NEURO BEHAVIOUR

NEURO DEVELOPMENT

NEURO BEHAVIOUR

Gestational age 20wall structures completed

BRAIN WIRING

PATHWAYS CIRCUITS NETWORKS

Brain 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.

R Shore

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.”

Schore

Critical period :

“Early interpersonal events positively and negativelyimpact the

structural organisationof the brain.”

“The perinatal sensorium is never in chaos …. DEVELOPMENT IS

EVER MORE ORDERED

COMPETENT

COMPETENT MORECOMPLEX

COMPETENT

ALWAYS! MORE FLEXIBLE

1st 28w unmyelinated

immobilise

2nd 2 m sympathetic

fight or flight

3rd 6 m myelinated vagus

engage/disengage

Laughlin 1991

6

DVC

VVC

SNS

100%

28w PMA

OLD vagus (dorsal vagal complex)

Sympathetic nervous system)

Social vagus (ventral vagal complex)

From Porges, Schore, others…

• Higher circuits build

on lower circuits,

development more difficult if

lower circuits not wired properly.

DVC

VVC

SNS

DVC

VVC

SNS

DVC

VVC

SNS

100%

28w PMA 48w PMA2 months 6 months

Jacksonian Dissolution - BERGMAN

The more threatened the PREMATURE,the SOONER 'primitive' (or regressed) becomes the style of thinking and behaving. (Perry 1995)

DVC

VVC

SNS

Our cortex distinguishes us from

other animals …

BUTThe “primitive”hindbrain is vital We can learn

about ourselves from animals, and mammals!

THE “OLD” BRAIN HAS

3 PROGRAMMES

DEFENCE NUTRITION REPRODUCTION

EVOLUTIONARY BIOLOGY

DEFENCE NUTRITION REPRODUCTION

HORMONES NERVES MUSCLES

endocrine autonomic NS somatic

HIGHLY CONSERVED NEURO-ENDOCRINE

BEHAVIOR

7

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.

All mammals have set sequence of behaviours at birth ………….

……. All with a single purpose : to

BREASTFEED

After birth, events are

determined …

… by the neonate

stimulating the mother!

(Rosenblatt 1994)

Breast-feeding is “established

through a set of mutual,

complex sensory stimulations

in mother and child.”

(Kjellmer & Winberg 1994)

HABITAT

DETERMINES

BEHAVIOUR

BEHAVIOUR ENSURES

BIOLOGICALNEEDS

Warming, feeding andprotection behavioursare intricately, inseparablylinked to the right place.

(Alberts 1994)

= NUTRITION PROGRAMME

8

Warming, feeding andprotection behavioursare intricately, inseparablylinked to the right place.

(Alberts 1994)

= NUTRITION PROGRAMME“Habitat – niche” place determinebehaviors that ensure basic needs.

ALBERTS “habitat – niche”

In the right habitat, developing organism behaves competently.

“Each state of development

is a form of completeness,

rather than an approximation

the final adult goal”

Fetus “fetally mature” competent in uterus

Newborn “neonatally” mature competent on mother

Infant competent in the attachment environment

Adult mature competent in world

ALBERTS “habitat – niche” All mammals have set sequence of behaviours at birth ………….

……. All with a single purpose : to

BREASTFEED

In all mammals …….

….. the newborn is responsible for initiating breastfeeding,

not the mother !!

EXCEPT IN HUMAN ???

Sequence human newborn breast-feeding

Pre-requisite = habitat

hand to mouth

tongue moves

mouth moves

eye focuses nipple

crawls to nipple

latches to nipple

suckles

(Widstrom et al 1994)

9

“The newborn may appear

helpless, but displays an

impressive and purposeful

motor activity which, without

maternal assistance, brings the

baby to the nipple.

(Michelson et al 1996) There are “needed neural processes” !

Activation of Olfactory Cortex in Newborn

Infants After Odor Stimulation:

A Functional Near-Infrared

Spectroscopy Study

SMELL vanilla / colostrum / water (control)

read NIRS activity FRONTAL LOBE

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

• 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

10

The first hours after birth are a

CRITICAL PERIOD

mutual psycho-neuro-physiological

caregivers

R Shore



“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)

Warming, feeding and

protection behaviours areintricately, inseparablylinked to the right place.

(Alberts 1994)

“The perinatal sensorium is never in chaos ….DEVELOPMENT IS

EVER MORE ORDERED

COMPETENT

COMPETENT MORECOMPLEX

COMPETENT

ALWAYS! MORE FLEXIBLE

1st 28w unmyelinated

immobilise

2nd 2 m sympathetic

fight or flight

3rd 6 m myelinated vagus

engage/disengage

11

NEUROSCIENCE


EVOLUTIONARYBIOLOGY




The Brain

EPIGENETICS

BIRTH SKIN-TO-SKIN CONTACTPLACE DEPENDENT COMPETENCE

In the right habitat, developing organism behaves competently.



PERINATAL NEUROSCIENCE and SKIN-TO-SKIN CONTACT

When does the infant

become conscious?

Scientific American 1986

Scientific American Mind 2009

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

The infant brain is not

blank!Resting activity

-“stream of

consciousness”

12

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”

Noradrenergic neurons from

LOCUS COERULEUS

Awake at birth

AWAKE / ALERT CENTRE

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE

SOCIALCONTROL CENTRE

OXYTOCINDOPAMINE

CORTISOL

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

13

Frontal alpha EEG asymmetry= a measure of temperament

( i.e. trait emotion).

an index of potential risk for emotion-related psychopathology.

a sizable literature ( +/- 100 studies ) embeds the measure in a network of psychological and behavioural constructs, thus bestowing frontal EEG asymmetry with sizable construct validity as a measure of an underlying approach-related or withdrawal-related motivational style,or as an index of potential risk for

emotion-related psychopathology.

Frontal alpha EEG asymmetry

Greater Left-sided EEG asymmetry greater positive affect and greater psychological and greater physiological resilience

Greater Right-sided EEG asymmetry greater negative affect and poorer psychological and poorer physiological resilience

Thibodeau 2006

Aaron Jones et al. (2004)conducted a study of four groups

of mother – infant dyads:EEG done on baby at 1 month of age

The first group wasDepressed-Bottlefed

EEG asymmetrycorrelates as

expected ...Aaron Jones 2004

Frontal EEG asymmetry at 1 month

-0.25

-0.2

-0.15

-0.1

-0.05

0

0.05

0.1

0.15

DBt DBr NDBt NDBr

Ln

(R)

- L

n(L

)

Depressed-Breastfed Breastfeeding is PROTECTIVE

Schore

In early postnatal life, maintenance of critical levels of tactile input … is important for normal brain maturation.

Areas of the amygdala …. are in a critical period of maturation,… in the first two months of life

14

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

Simulation theory:EMPATHY is generated by inner imitationof actions of others

Morphing emotion AMYGDALA FUSIFORMGYRUS

Smell

Skin contact

FACE RECOGNITIONCENTRE

OXYTOCIN

EMOTIONCONTROL CENTRE

15

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE


OXYTOCINDOPAMINE

CORTISOL


SchoreIn early postnatal life,maintenance of

critical levels of tactile input … is important for normal brain maturation.

Areas of the amygdala …. are in a critical period of maturation,… in the first two months of life

Basic neuroscience:neurons, synapses

fire and wire,PATHWAYSCIRCUITSNETWORKS

SCIENTIFIC BASIS For Skin-to-Skin Contact

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.

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS




“needed neural

processes”

16

28 days old, 30 w PMA

R Shore



a kind of invisible hothouse

“the wiring of the brain’s pathways is best supported when it can integrate quality sensory input through several pathways at once, particularly during critical periods of development.” (McCain 1999)

“... createsa kind of invisible hothousein which the infant’s development can unfold.”

(Hofer in Gallagher 1992) a

SEES

Mum’s eyes

Hand TOUCH

Mum’s skinSkin-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

17

NEWBORN DEVELOPMENT

skin-to-skin contactTactile stimulations build the

amygdala - preorbital

cortical tract

during the first 8 weeks

The next pathway requires

eye-to-eye contact

This is the basis of healthy

right brain development!

NEWBORN DEVELOPMENT

Tactile stimulations facilitate “the flow of affective information

from the infant … to the mother”“the language of mother and infantconsists of signals produced by the

autonomic nervous systemof both parties”.

This is the basis of healthy development!Schore 2001a

Myron Hofer

… the private realm ofsensory stimulation constructed by the mother and infant from numberless exchanges of subtle clues.

(Gallagher 1992)

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)

18


“ physiological set points “

“ internal working models’“ scripts – templates”

REGULATION

the objective is to achieve theability to establish:

‘STABILITY THROUGH CHANGE’

The foundation for INFANT MENTAL HEALTH

SENSORY STIMULATION

AUTONOMICBODY CONTROL

EMOTIONAL EXCHANGES

WELL-BEING

HEALTH

The First Idea: How Symbols, Language,

and Intelligence Evolved from our

Primate Ancestors to Modern Humans

Stanley I. Greenspan & Stuart G. Shanker

The First Idea

“It is necessary for a child to be engaged in a series of affective (emotional) interactions that give rise to the developmentof motor sensory and social capacities,which, when combined with symbol formation, lead to language.

Greenspan & Shanker 2006, p39

The First Idea (p39)

“The symbolic use of language, in turn, creates the foundationfor more advanced social and intellectual capacities, including higher and higher levelsof reflective thinking.

Greenspan & Shanker 2006, p39

SENSORY STIMULATION

BODYLANGUAGE


EMOTIONAL EXCHANGES

COMMUNICATIONWELL-BEING

SPEECHHEALTH

19

ATTACHMENT - REGULATION

the objective is to achieve theability to establish an efficiently regulated right brain:

‘STABILITY THROUGH CHANGE

The foundation for INFANT MENTAL HEALTH

Schore 2001a

RESILIENCE(= STRESS RESISTANCE)

“capacity to maintainhealthy emotional functioning in the after-math of stressful experiences”

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE


OXYTOCINDOPAMINE

CORTISOL


SENSORY STIMULATION

BODYLANGUAGE


EMOTIONAL EXCHANGES

COMMUNICATIONWELL-BEING

SPEECHHEALTH

The brain is a

SENSORY ORGANBREAST - FEEDING

=BRAIN – WIRING

SOCIAL ORGAN

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS




20

The BOND is made up of the

sensory inputs from the parent to the infant

REGULATION

Bowlby 1969, 1973, 1980

Under-activity

EUSTRESS

Over-activity

Positive Stress

= Eustress

• An important and necessary

aspect of healthy development

that occurs in the context of

stable and supportive relationships.

Positive Stress

• Moderate, 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.


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.


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

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS




“buffering protection

of adult support”

21

Perry: Responses to threat

DISSOCIATION

TERRORFEARAROUSALCALMMental State

REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition

BRAINSTEM

Autonomic

MIDBRAIN

Brainstem

LIMBIC

Midbrain

SUBCORTEX

LimbicNEOCORTEX

Subcortex

PRIMARY

secondary

Brain Areas

FAINTING

‘Mini-

psychosis’

DISSOCIATION

‘Numbing’COMPLIANCE

Freeze

AVOIDANCE

(Crying)

REST

(Female

Child)

Dissociative

Continuum

AGGRESSIONDEFIANCE

‘Posturing’

RESISTANCE

Freeze

VIGILANCE

(Crying)

REST

(Male Child)

Hyperarousal

Continuum

FIGHTFLIGHTFREEZEVIGILANCEREST

(Adult Male)Adaptative

Response

TERRORFEARAROUSALCALMMental State

REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition

BRAINSTEM

Autonomic

MIDBRAIN

Brainstem

LIMBIC

Midbrain

SUBCORTEX

LimbicNEOCORTEX

Subcortex

PRIMARY

secondary

Brain Areas

FAINTING

‘Mini-

psychosis’

DISSOCIATION

‘Numbing’COMPLIANCE

Freeze

AVOIDANCE

(Crying)

REST

(Female

Child)

Dissociative

Continuum

AGGRESSIONDEFIANCE

‘Posturing’

RESISTANCE

Freeze

VIGILANCE

(Crying)

REST

(Male Child)

Hyperarousal

Continuum

FIGHTFLIGHTFREEZEVIGILANCEREST

(Adult Male)Adaptative

Response

Jacksonian Dissolution

The more threatened the individual,the more 'primitive' (or regressed) becomes the style of thinking and behaving.

Perry 1995

DVC

VVC

SNS

SEPARATION DYSREGULATES

CORTISOL

SEES

Mum’s eyes

Hand TOUCH

Mum’s skinSkin-to-skin

CONTACT

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’s

SEPARATION is

LIFE THREATENING

(WRONG PLACE)

22

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS





of adult support”




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

Scientific

American,December 2011

INK

“Genome” – genes of species

“Genotype” - genes in specimen

… highly conserved neuro-endocrine behaviors

INK

PENCIL

23



“Phenotype” – specimen resulting from

gene – environment interaction


INK

Pencil

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

CORTISOL



“Phenotype” – specimen resulting from

gene – environment interaction


INK

Pencil

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

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

24



“BIRTH” – earliest environment

Earliest care at birth matters

Same gene switched

MICHAEL MEANEY epigenetics

Early stress alters gene expression,with health impact across lifespan.

CORTISOL

SEPARATION causesPROTEST – DESPAIR

(hyperactivity depression)

PROTEST – DESPAIRis accompanied by

DYSREGULATIONThis pathology ... cannot be cured ...

Social deprivation alters neurobiological systems.

Scientific Committee 2002

3-day separation:

induces physiological changes (immune,system, heart rate, sleep, cortisol, loss of body temperature..

anaclitic depression:•hyperactivity•conservation- withdrawal;•death or recovery

Slide & photo from

James McKenna

CONCLUSIONSScientific findings do not support the perceived benefits of permanent, preweaning mother–infant separation.

NO separation6 months

Continued contact 18 m

25

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

MR – Mother Reared

Locomotion passive active

Stereotypicity neurotic relaxed

Sitting togetherreclusive social

Peer Reared - PR

Peer Reared - PR


Plasma CORTISOL response to STRESS (2y)

CORTISOL

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

CORTISOL

Repeated shortseparations:

LOW gene expression

Correlate to human adult depression

26

Repeated shortseparations:LOW gene expression

smalller hippocampal volume

Adults with depression, suicides:LOW gene expression

smalller hippocampal volumereduced expression frontal lobe





These findings translate previous results from rats / monkeys to humans

2ND

KNOCK

CORTISOL

27

Sabatini

Arabadzisz Als

Luby CORTISOL


“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”

BRUCE McEWEN allostasis

CORTISOL

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


RESPONSESTRESS

ALLOSTATIC STATE

ALLOSTASIS


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)

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS




CORTISOL

28



RESPONSESTRESS

ALLOSTATIC STATE

ALLOSTASIS


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD

HEALTH

the point at which chronic load results in actual

disease or abnormal conditions.

2ND

KNOCK



RESPONSESTRESS

ALLOSTATIC STATE

ALLOSTASIS


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD

DISEASEHEALTH

WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY


Spectrum of health:



RESPONSESTRESS

ALLOSTATIC STATE

ALLOSTASIS


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD


DISEASEHEALTH

RESILIENCE VULNERABILITY

RESILIENCE:“capacity to maintain

healthy emotional functioning in the after-

math of stressful experiences”

PR - Peer Reared


Plasma CORTISOL response to STRESS (2y)




DISEASEHEALTH MR PR

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE


OXYTOCINDOPAMINE

CORTISOL




RESPONSESTRESS

ALLOSTATIC STATE

ALLOSTASIS


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD


DISEASEHEALTH





29



RESPONSESTRESS

ALLOSTATIC STATE

ALLOSTASIS


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD


DISEASEHEALTH


The Fetal Matrix:

PREDICTIVEADAPTIVE

RESPONSES(PARs)

Gluckman &Hanson 2005


DISEASEHEALTH


BARKER ‘thrifty phenotype’

“Fetal programming hypothesis”

Developmental Origins of

Health and Disease

DOHaD

Epigenetic processes operate in the human fetus, and beyond.

DOHAD

Developmental

Origins of

Health and

Adult Disease


DISEASEHEALTH




Adaptation and MALADAPTATION …

NEUROSCIENCE


EVOLUTIONARYBIOLOGY


The Brain

EPIGENETICS

30

Schore:

“Infant trauma will interfere withcritical period limbic organisation ...

future capacity to adapt ...correlated with maladaptive adult mental health”

Schore:

“long term alterations brain function

“risk for developing severe psycho-pathologies at later stages of life.”

NEUROSCIENCE


EVOLUTIONARYBIOLOGY



HEALTH DISEASE


The Brain

EPIGENETICS

EXPECTED UNEXPECTED

“risk for developing severe psycho-pathologies at later stages of life.”

NEUROSCIENCE


EVOLUTIONARYBIOLOGY



SPECTRUM of expression in POPULATION

HEALTH DISEASE


Platform for better understanding of PUBLIC HEALTH.… policy and practice that impacts the care of mothers and babies.

The Brain

EPIGENETICS

EXPECTED UNEXPECTED


“capacity to maintainhealthy emotional functioning in the after-math of stressful experiences”

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS




“except in the light

of mother’s body.”

31

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS




“needed neural

processes”

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS





of adult support”

NEUROSCIENCE


EVOLUTIONARYBIOLOGY

The Brain

EPIGENETICS




ZERO

SEPARATION

MOTHERis the key to

neurodevelopment …

… because she is the

RIGHT PLACE !!

... the newborn child is a small human being, with all its senses developed,

open and receptive.(John Lind, 1979)

scientific & evidence base for skin-to-skin contact

Documents