Early specialized foster care, developmental outcomes and home salivary cortisol patterns in prenatally substance-exposed infants

The purpose of this study was to investigate possible associations between developmental outcomes of prenatally substance-exposed infants and early specialized foster care. Participants were volunteer foster families and 22 infants from the Vancouver Coastal Safe Babies program; this specialized care program included selective recruitment of foster parents, training and support for foster infant retention. Subdivided in two gestational groups (preterm and full-term), the infants were assessed at home using BDI-2 Screening Test to determine their development in cognitive and social domains. Salivary cortisol was sampled three times (awakening, morning and evening) on two different days to determine the infants' basal cortisol patterns. No evidence of clinically significant atypical development was found in either the preterm or full-term group. The preterm group had consistently lower mean cortisol levels than the full-term group but when the mean cortisol concentrations were corrected for number of months spent in foster care, the differences between preterm and full-term groups were no longer significant. From a perspective of clinical significance, these results suggest that stable, committed and specialized early foster care may be associated with "better than expected" developmental outcomes in prenatally substance-exposed infants.