Post on 19-Jan-2016
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Maternal Affect and Behavior Predicts Infant Affect and Behavior During Feeding in Infants with Transposition of the Great Arteries
Tondi M. Harrison, PhD, RN, CPNP
Nationwide Children’s Hospital and the Department of Pediatrics, The Ohio State University
Allison Ferree, BS
College of Medicine, The Ohio State University
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The Critical Importance of Maternal-Infant Interaction
Infant Attachment Physiologic regulation Brain development Social, emotional, and behavioral health Mother• Stimulates the neurobiology of caregiving behavior
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Infants with Congenital Heart Defects
40,000 infants each year
Most common birth defect - 1/100 infants in the U.S.
25% have complex defects
High risk for adverse social, emotional, behavioral, & cognitive outcomes
Stress Response
ANS Function in Infant with Heart Defect
Neurodevelopment• Attention• Cognition• Emotional
regulation
Early Environment of Infant with Serious Heart Defect
Physical environment• Bright lighting• Loud sounds• Painful procedures
Social environment• Aversive touch• Multiple caregivers • Maternal separation
• Intermittent caregiving
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Maternal-Infant Separation = Delayed Interaction
Effects of delayed interaction: animal models
Premature infants & their mothers
Infants with CCHD & their mothers
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Specific Aims
1. Describe the relationship between infant and maternal affect and behavior during feeding.
2. Compare the relationship between infant and maternal affect and behavior in infants with transposition of the great arteries (TGA) and healthy infants.
3. Examine stability or change in the relationship over time.
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Methods
Secondary data analysis
Sample: 15 infants with TGA and their mothers, and 16 healthy infants and their mothers
Data collection: Dyads were videotaped during feeding at two weeks and two months of age
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Parent-Child Early Relational Assessment
Parent• Positive affective involvement, sensitivity, &
responsiveness• Negative affect and behavior
Infant • Positive affect, communicative, and social skills • Dysregulation and irritability
Dyadic • Mutuality and reciprocity • Dyadic tension
(Clark, 1985)
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Data Analysis
Hierarchical linear regression• Infant dysregulation & irritability• Dyadic tension
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Sample: MothersHealthy TGA
Age: mean (SD) 29.69 (5.8) 28.67 (5.0)
range 18-37 21-37
Education: (median) some college assoc degree
Income: (median) 30-50,000 75-100,000
Marital status: n (%)
Married/partnered 9 (56) 15 (100)
Divorced/single 7 (44) 0
Race/ethnicity: n (%)
Am Indian 0 1 (6.7)
African American 4 (25) 1 (6.7)
Non-Hispanic White 11 (68.8) 13 (86.6)
Hispanic White 1 (6.2) 0
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Sample: InfantsHealthy
TGAGender: n(%) Male 10 (62.5) 9 (60) Female 6 (37.5) 6 (40)Race/ethnicity: n(%) African American 5 (31.3) 1 (6.7) Non-Hispanic White 10 (62.5) 14 (93.3) Hispanic White 1 (6.2) 0Type of feeding
Breast 5 (31.3) 5 (33.3)Bottle 11 (68.7) 10 (66.7)
Prenatal diagnosis 6 (40)
mean (SD) rangeAge of surgery (days) 6.8 (2.98)
2-11Length of stay (days) 20.13
(6.05) 9-28
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Parent-Child Early Relational Assessment
PAB NAB IPACS IDI DMR DT1
1.5
2
2.5
3
3.5
4
4.5
5
PAB NAB IPACS IDI DMR DT1
1.5
2
2.5
3
3.5
4
4.5
5
2 weeks 2 months
Blue = Healthy Red = TGA
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PAB = Positive affect & behaviorNAB = Regulation of negative affect & behavior
IPACS = Infant positive affect, communicative and social skillsIDI = Infant dysregulation and irritability
DMR=Dyadic mutuality & reciprocityDT=Dyadic tension
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Regulation of Negative Affect and Behavior, Infant Dysregulation & Irritability, and Dyadic Tension
2 weeks 2 months
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Maternal Correlations: 2 Weeks of Age
IPACS IDI DMR DT
PAB .202 -.065 .836* .130
NAB .738* .423 .661* .799*
IPACS IDI DMR DT
PAB .600* .287 .873* .610*
NAB .585* .346 .764* .792*
Healthy TGA
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Maternal Correlations: 2 Months of Age
IPACS IDI DMR DT
PAB .313 .318 .832* .397
NAB .619* .737* .578* .857*
IPACS IDI DMR DT
PAB .749* -.031 .940* .740*
NAB .727* .466 .706* .862*
Healthy TGA
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Infant Correlations: 2 Weeks of Age
DMR DT
IPACS .557* .659
IDI .362 .653*
HealthyDMR DT
IPACS .850* .642*
IDI .476 .554*
TGA
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Infant Correlations: 2 Months of Age
DMR DT
IPACS .594* .584*
IDI .349 .778*
HealthyDMR DT
IPACS .816* .726*
IDI .096 .345
TGA
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Infant Dysregulation and Irritability
Variable B SE B β t
Constant 4.463 .246 18.134***
Time (2 wk or 2 mo) .043 .095 .052 .456NAB .653 .162 .624
4.028** Group (TGA=1; Healthy=0) -.222 .100 -.265 -
2.211* Group X NAB -.199 .255 -.119 -.782
*p < 0.05, **p < 0.01, ***p < 0.001NAB = Maternal regulation of negative affect and behaviorTotal R2 = 0.28
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Dyadic Tension
Variable B SE B β t
Constant 4.710 .172 27.452***
Time (2 wk or 2 mo) -.089 .066 -.099 -1.350NAB 1.073 .113
.954 9.493** Group (TGA=1; Healthy=0) -.182 .070 -.202 -2.597* Group X NAB -.260 .177 -.145
-1.464
*p < 0.05, **p < 0.01, ***p < 0.001NAB = Maternal regulation of negative affect and behaviorTotal R2 = 0.70
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Conclusions
Infants with TGA were more likely to be dysregulated and irritable.
TGA dyads were more likely to have interactions characterized by tension.
Infants with TGA are at risk for suboptimal maternal-infant interactions.
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Future Research
• Describe diverse trajectories in the development of the maternal-infant relationship.
• Identify specific experiential and individual factors associated with suboptimal maternal-infant interactions, e.g. maternal, infant, and environmental characteristics.
• Develop and test interventions to support positive maternal-infant relationships.
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AcknowledgementsThe authors gratefully acknowledge The Ohio State University College of Medicine Medical Student Research Scholarship awarded to Allison Ferree for this project.