Parent-infant interaction in infants at very high risk for cerebral palsy: a systematic review of the literature and experimental pilot trial with microanalytic behavioral analysis.

Infants born with perinatal adverse events are at high risk for short and long-term disabilities including Cerebral Palsy, a condition with a severe negative impact on the quality of life in most of the cases. Habilitative interventions initiated as early as the first year of life are crucial in maximising the benefits of intervention during neuroplasticity period and minimizing further medical complications. Extensive literature, including studies both on typical and clinical populations, supports the hypothesis that early dyadic interactions are pivotal for infant’s developmental maturation trajectory. Furthermore, evidences from neurobiological studies increasingly support the evolutionary value of these early social skills. Given the crucial role for early and later infant development, compromised intersubjectivity is considered to be a critical area of intervention since the very first weeks of life, when early parent-infant bonding could be disrupted by the occurrence of a severe neurological damage. In order to define new protocols of intervention, specifically aimed at reconnecting and strengthening parent-infant attunement, an accurate analysis of primary intersubjectivity characteristics in children at high neurological risk is required. For this purpose, a systematic review of the literature has been conducted on this focus. Eighteen publication met the inclusion criteria. The included studies reported compromised dyadic interactive patterns between parents and infants who faced adverse perinatal events compared with healthy controls. Anyway, given the significant level of heterogeneity in the clinical inclusion, in criteria of risk, infant age, and in the assessments or rating system used to code interactive behaviours, a need for further studies has emerged. We then developed an experimental protocol to achieve a standardized evaluation of early intersubjectivity and started an experimental study to characterize parent-infant interaction in a cohort of newborns at high risk for CP. Results from the pilot study have started to characterize atypical behaviours in this population, showing a significant reduction of specific early communicative cues which typically sustain reciprocation between infants and caregivers. An enlargement of population is however necessary to better understand infant’s abilities in processing caregiver’s stimuli and elaborate a response with accurate timing and form in order to structure appropriate interventions