Mal dev psych

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


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


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


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


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)


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


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


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


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

Health & Medicine

Mal dev psych