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Pregnancy Timeline by SemestersDevelopmental TimelineFertilizationFirst TrimesterSecond TrimesterThird TrimesterFirst Thin Layer of Skin AppearsEnd of Embryonic PeriodEnd of Embryonic PeriodFemale Reproductive SystemBeginning Cerebral HemispheresA Four Chambered HeartFirst Detectable Brain WavesThe Appearance of SomitesBasic Brain Structure in PlaceHeartbeat can be detectedHeartbeat can be detectedFinger and toe prints appearFinger and toe prints appearFetal sexual organs visibleBrown fat surrounds lymphatic systemBone marrow starts making blood cellsBone marrow starts making blood cellsInner Ear Bones HardenSensory brain waves begin to activateSensory brain waves begin to activateFetal liver is producing blood cellsBrain convolutions beginBrain convolutions beginImmune system beginningWhite fat begins to be madeHead may position into pelvisWhite fat begins to be madePeriod of rapid brain growthFull TermHead may position into pelvisImmune system beginningLungs begin to produce surfactant
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Mom in Single Family NICU room is best for preemies

Research has established the single greatest contributor to long-term neuro and behavioral development in preterm infants is mothers' care. This is found in single-family room Neonatal Intensive Care Units (NICUs) that allow the most immediate opportunity for a mother's involvement.

Research evaluating the 18-month neurobehavioral outcomes in single-family rooms of Neonatal Intensive Care Units (NICU), suggests that the environment in a NICU contributes not only to short-term, but also to long-term neuro and behavioral development in preterm infants.

According to the Centers for Disease Control and Prevention (CDC), preterm birth affects nearly 500,000 babies each year, or one of every eight babies born in the USA. While medical care has improved survival rates for preterm infants, questions remain about positive impact on preterm neuro-development.

The increase in preterm births — or births before 37 weeks of pregnancy — is a significant health problem continually rising over the past two decades. Research led by Barry M. Lester PhD, director of the Brown University Center for the Study of Children at Risk, Women & Infants Hospital of Rhode Island and professor of Psychiatry and Pediatrics at The Warren Alpert Medical School of Brown University, is published currently in The Journal of Pediatrics.

"The single family room NICU appears to 'jump start' high maternal involvement. We found the amount of maternal involvement was greater shortly after birth, increased rapidly, peaked within the first two weeks, and then was sustained in the single-family room NICU, in contrast to a more gradual increase in maternal involvement in an open bay NICU."

Barry M. Lester PhD, Director, Brown Center for the Study of Children at Risk, Women & Infants Hospital of Rhode Island, Professor of Psychiatry and Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.

Dr. Lester had preveiously worked with James F. Padbury MD, Pediatrician-in-Chief and Chief of Neonatal/Perinatal Medicine at Women & Infants Hospital and the William and Mary Oh - William and Elsa Zopfi Professor of Pediatrics for Perinatal Research at the Alpert Medical School, publishing research together in October 2014 in the journal Pediatrics2. They had found how a single-family room NICU provided for more maternal involvement, as well as staff involvement. This kind of care is essential to optimize medical and neurodevelopmental in a preterm infant, even leading to preventive interventions reducing later impairment.

An 18-month follow-up was then undertaken to compare infants born earlier than 30 weeks gestation at Women & Infants Hospital, where 93 were cared for in an open bay NICU and 123 were cared for in single-family rooms in NICUs. Infants were divided into high vs. low maternal involvement based on the number of days per week mothers gave kangaroo care, breastfeeding, bottle feeding, and general maternal care. Infants with high vs. low maternal involvement in the single-family room and open bay NICUs were compared on the Bayley Cognitive, Language and Motor scores and Pervasive Developmental Disorders autism screen.

"We learned that of the four components of maternal involvement, Kangaroo Care (a method of caring for premature babies where infants are held skin-to-skin with a parent, usually the mother, for as many hours as possible every day) was the most important contributor — followed by maternal care. It is likely that Kangaroo Care — started early — triggers a cascade of maternal care, breastfeeding and bottle feeding.

"In the original study, we found that the single-family room model of care facilitated maternal involvement, and that more maternal involvement related to better neurobehavioral outcomes at NICU discharge.

"For this most recent study ... Our results suggest, as hypothesized, that the improvements are sustained through 18 months ... a fact that ... suggests that the improvements could be permanent.

"Notably, infants in a single-family room NICU also had fewer symptoms of autism spectrum disorder (ASD), so that model of care might also help combat ASD in preterm infants."

Barry M. Lester PhD

Abstract:18-Month Follow-Up Infants Cared for in a Single-Family Room Neonatal Intensive Care Unit
To determine whether the single-family room (SFR)-neonatal intensive care unit (NICU) is associated with improved 18-month neurodevelopmental outcome, especially in infants of mothers with high maternal involvement.

Study Design
An 18-month follow-up was undertaken that compared infants born <30 weeks gestational age; 123 from a SFR-NICU vs 93 from an open-bay NICU. Infants were divided into high vs low maternal involvement based on days/week of kangaroo care, breast/bottle feeding, and maternal care. Infants with high vs low maternal involvement in the SFR and open-bay NICUs were compared on the Bayley Cognitive, Language, and Motor scores and Pervasive Developmental Disorders autism screen.

There were more mothers in the high maternal involvement SFR than in the high maternal involvement open-bay group (P = .002). Infants with high maternal involvement in both NICUs had greater Cognitive (P = .029) and Language (P < .000) scores than infants with low maternal involvement. Effect sizes within NICU were moderate to large in the SFR-NICU for Language scores and moderate for the Language composite in the open-bay NICU. The number of days of maternal involvement was greater in the SFR than open-bay NICU (P < .000), and length of stay was shorter in the high maternal involvement SFR than high maternal involvement open-bay NICU (P = .024). Kangaroo and maternal care predicted Cognitive (kangaroo, P = .003) and Language scores (P = .015, P = .032, respectively). Infants with ≥1 symptom of autism were more likely to be in the open-bay low maternal involvement group vs the SFR high maternal involvement group (OR = 4.91, 95% CI = 2.2-11.1).

High maternal involvement is associated with improved 18-month neurodevelopmental outcome, especially in infants cared for in a SFR-NICU.

The research team also included Women & Infants/Brown University colleagues Amy L. Salisbury, PhD; Katheleen Hawes, PhD; Lynne M. Danserreau, MSPH; Rosemary Bigsby, ScD; Abbot Laptook, MD; Marybeth Taub, RN; Linda Lagasse, PhD; Betty R. Vohr, MD; and James F. Padbury, MD.

Abstract2: Single-Family Room Care and Neurobehavioral and Medical Outcomes in Preterm Infants

OBJECTIVE: To determine whether a single-family room (SFR) NICU, including factors associated with the change to a SFR NICU, is associated with improved medical and neurobehavioral outcomes.

METHODS: Longitudinal, prospective, quasi-experimental cohort study conducted between 2008 and 2012 comparing medical and neurobehavioral outcomes at discharge in infants born <1500 g. Participants included 151 infants in an open-bay NICU and 252 infants after transition to a SFR NICU. Structural equation modeling was used to determine the role of mediators of relations between type of NICU and medical and neurobehavioral outcomes.

RESULTS: Statistically significant results (all Ps ≤.05) showed that infants in the SFR NICU weighed more at discharge, had a greater rate of weight gain, required fewer medical procedures, had a lower gestational age at full enteral feed and less sepsis, showed better attention, less physiologic stress, less hypertonicity, less lethargy, and less pain. NICU differences in weight at discharge, and rate of weight gain were mediated by increased developmental support; differences in number of medical procedures were mediated by increased maternal involvement. NICU differences in attention were mediated by increased developmental support. Differences in stress and pain were mediated by maternal involvement. Nurses reported a more positive work environment and attitudes in the SFR NICU.

CONCLUSIONS: The SFR is associated with improved neurobehavioral and medical outcomes. These improvements are related to increased developmental support and maternal involvement.

Authors: Barry M. Lester, Katheleen Hawes, Beau Abar, Mary Sullivan, Robin Miller, Rosemarie Bigsby, Abbot Laptook, Amy Salisbury, Marybeth Taub, Linda L. Lagasse, James F. Padbury

About Women & Infants Hospital
Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women's medicine, Women & Infants is the 12th largest stand-alone obstetrical service in the country and the largest in New England with approximately 8,500 deliveries per year. A Designated Baby-Friendly® USA hospital, U.S.News & World Report 2014-15 Best Children's Hospital in Neonatology and a 2014 Leapfrog Top Hospital, in 2009 Women & Infants opened what was at the time the country's largest, single-family room neonatal intensive care unit.

Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation's first mother-baby perinatal psychiatric partial hospital, as well as the nation's only fellowship program in obstetric medicine.

Women & Infants has been designated as a Breast Imaging Center of Excellence by the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center of Biomedical Research Excellence by the National Institutes of Health (NIH); and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute's Gynecologic Oncology Group and the Pelvic Floor Disorders Network. Return to top of page

Aug 17, 2016   Fetal Timeline   Maternal Timeline   News   News Archive   

Pre-term 34 weeks

Infants receiving high maternal care in single-family NICU room had improved
survival rates and positive impact on their preterm neuro-development .
Image Credit: Public Domain



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