mal dev psych
TRANSCRIPT
Neonatal Crying as an Assessment Device
Neonatal Crying as an Assessment Device
1. Neonatal cryinga. Serves several important functions:
1. Physiologically –
a. crying facilitates the reorganization of the cardio-respiratory system
b. Improves pulmonary capacity
c. Helps maintain homeostasis
Crying Cont.
2. Crying is thought to express different states,
needs and demands
2. It may also have diagnostic utility
3. It is also discussed in relation to the care-giving environment
a. Motivates caregiver to pay attention to the infant, etc.
Crying Cont.
b. Different types of cry:
1. Wasq-Höckert has identified four basic types of cry:
a. birth
b. hunger
c. pain
d. pleasure
Crying Cont.
1. Barry M. Lester views crying along a continuum:
Basic Painful
Crying Cont.
c. Diagnosis of certain difficulties1. Infants with chromosomal abnormalities have
characteristic cry sounds
a. Down's Syndrome:
1. low pitched, hoarse, and guttural
2. higher threshold for production of the cry
3. longer latency to cry onset from aversive stimulation
Crying Cont.
b. Maladie du cri du chat (Cry of the cat; 5p- Syndrome)1. Partial deletion of the short arm of Chromosome 52. fundamental frequency of 850 Hz3. 400-600 Hz in for healthy neonates
b. High pitch cries are mentioned in pediatric handbooks and in neurological exams as evidence of pathology
Crying Cont.
Crying Cont.
Crying Cont.
2. High pitch is also the dominant feature in:a. Asphyxiab. Meningitisc. Hyperbilirubinemiad. Hypoglycemia
Crying Cont.
2. Barry M. Lester’s Worka. Lester was initially interested in malnourished infants
b. Guatemalan infants who were living in poverty
c. He collected data on their
weight, height, heart rates, etc.
Lester Cont.d. Lester made spectographic recordings
1. Compared the cries of the malnourished and well nourished infants
Lester Cont.
e. Barry M. Lester (1976). Spectrum analysis of the cry sounds of well-nourished and malnourished infants
1. Fox - found that the fundamental frequency of cries increased with the degree of pathology
2. Since the cry originates in the CNS, it seems reasonable to assume that deviations from normal cries may be indicative of CNS dysfunction
Lester cont.
3. Methoda. Participants
Variable
Group
Well Nourished Malnourished
Age
Weight
Height
Head Circumference
% Weight for Age
12.37 months 12.20 months
6.69 kg 9.26 kg 14.8 lbs20.4 lbs
71.8 cm 28.3” 66.2 cm 26.1”
45.2 cm 42.9 cm17.8” 16.9”
67.7%84.9%
Lester Cont.
4. Procedure
a. 20 trials of a pure tone stimulus (habituation paradigm)
ME
AN
GL
AN
CE Infants can discriminate
between and
Lester Cont.
4. Procedure
a. 20 trials of a pure tone stimulus (habituation paradigm)
ME
AN
GL
AN
CE
Infants cannot discriminate between and
Lester Cont.
4. Results
Cry Measure
Group
Well Nourished Malnourished
Duration
Latency
Frequency
Amplitude
1.52 s 2.66 s
0.47 s 1.80 s
308 Hz 480 Hz
50.3 dB 38.2 dB
Note: All significantly different
Lester Cont.
5. Discussion
a. Malnourished infants’ cries to infants with CNS difficulties
b. Behavioral data and cry data act as convergent validities
c. Other research shows malnutrition related to CNS damage
Zeskind & Lester
f. Zeskind & Lester (1978). Acoustic features and auditory perceptions of the cries of newborns with prenatal and perinatal complications.
1. Experiment #1
a. Participants: 48 two-day old neonates
1. From pool of 150 two-day olds
2. All neonates were:
3. Full-term
4. Full birth weight
5. Appropriate weight for their gestational age
6. 1 and 5 minute Apgar Scores of at least 7
Maternal FactorsAge (< 18 or > 30) ToxemiaSingle marital status HypertensionParity (> 6) HypotensionAbortion history (>2) Heart rate irregularitiesRh Antagonism Previous c-sectionInfection during pregnancy Cephalo-pelvic disproportionMaternal disease Bleeding during pregnancyEdema Low socio-economic status
Parturitional (Childbirth) FactorsMultiple birth ForcepsInduced delivery Artificial membrane ruptureProlonged labor Premature membrane ruptureCurtailed labor C-sectionAbnormal presentation Wrapped cordDrugs (other than local anesthesia) Knot in cord
Prechtl Scale
Zeskind & Lester Cont.
b. Complication Groups:
1. Low Complication Group – 0 to 2 complications
2. High Complication Group – 5 to 9 complications
Zeskind & Lester Cont.
c. Procedure1. A pain cry was elicited by snapping the heel of the
infant's foot with an Arco # 64 rubber band stretched 15 cm along the edge of a ruler
Zeskind & Lester Cont.d. Results
Cry Measure
Group
Low Complication High Complication
Threshold (# of snaps)
Latency
Activity
Length (expiration)
Intensity
Frequency
3.201.25
2.1 s1.4 s
13.70 s21.25 s
3.80 s6.40 s
46.38 dB42.75 dB
813.9 Hz468.3 Hz
Zeskind & Lester Cont.
f. Conclusions:
1. Clinically healthy subjects may be at risk
2. Can care givers tell the differences between the cries of infants with low complication and high complication?
Neonate with 1 complication
Neonate with 6 complications
Neonate with cry of the cat syndrome
Zeskind & Lester Cont.
2. Experiment #2a. Participants
1. 30 men and 30 women 2. 1/2 unmarried with no children3. 1/2 married with children
b. Procedure1. Listened to cries of low and high complication
infants and rated them on eight 7-point Likert scales
2. Balanced, no knowledge of infant group membership (low or high complication)
Zeskind & Lester Cont.c. Results
ScaleGroup
Low Complication High Complication
Urgent
Grating
Sick
Arousing
Piercing
Discomforting
Aversive
Distressing
3.1 5.7
3.8 5.93.1 5.0
4.2 6.12.5 6.0
3.9 6.13.4 5.53.3 6.0
Zeskind & Lester Cont.
d. Results Continued
1. Parents rated all of the cries as less aversive than non-parents (.007)
2. Women rated all cries as more arousing than males (.002)
Zeskind & Lester Cont.
e. Conclusions
1. Everyone could discriminate between the low and high complication group cries
2. The cries carry different information
e. Summary
1. Neonatal cries indicate CNS functioning
2. Individuals can tell the differences in cries
3. Care giving environment should be formed based on information such as the cry features of infants
a. Infants contribute to their care giving environment
Zeskind & Lester
3. Zeskind & Lester (1981). Analysis of cry features in newborns with differential fetal growth
a. Similar to Zeskind & Lester (1978)
b. Used Ponderal index (PI)
1. PI = ratio of the infant’s birth weight to birth length
2. A direct measure of the infants' body mass
Zeskind & Lester Cont.
c. Participant characteristics
MeasureGroup (PI)
Low Average High
Ponderal Index
Birth Weight
Birth Length
Gestational Age
Birth Weight for GA %tile
2.05 2.47 3.07
3,065 g 3,254 g 3,728 g
52.9 cm 50.8 cm 49.2 cm
39.7 39.3 39.8
45.7 60.5 82.2
Zeskind & Lester Cont.
d. Results
MeasureGroup (PI)
Low Average High
Threshold (snaps)
Latency
Activity
Frequency
2.5 1.1 2.8
1.8 s 1.2 s 1.7 s
16.9 s 21.6 s 13.0 s
665.3 Hz 487.9 Hz 664.7 Hz
Zeskind & Lester Cont.
e. Conclusions
1. Low and high PI infants had cry features similar to infants with CNS difficulties
2. To the extent that cry features reflect CNS development, differential fetal growth may play a role
3. Similar to previous study with a different group of infants with different characteristics