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Tondi M. Harrison, PhD, RN, CPNP

Tondi M. Harrison, PhD, RN, CPNP Nationwide Children’s Hospital and the Department of Pediatrics, T he Ohio State University Allison Ferree, BS College of Medicine, The Ohio State University.

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Tondi M. Harrison, PhD, RN, CPNP

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  1. 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 Maternal Affect and Behavior Predicts Infant Affect and Behavior During Feeding in Infants with Transposition of the Great Arteries

  2. 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

  3. 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

  4. ANS Function in Infant with Heart Defect Early Environment of Infant with Serious Heart Defect • Physical environment • Bright lighting • Loud sounds • Painful procedures • Neurodevelopment • Attention • Cognition • Emotional regulation Stress Response • Social environment • Aversive touch • Multiple caregivers • Maternal separation • Intermittent caregiving

  5. Maternal-Infant Separation = Delayed Interaction • Effects of delayed interaction: animal models • Premature infants & their mothers • Infants with CCHD & their mothers

  6. Specific Aims • Describe the relationship between infant and maternal affect and behavior during feeding. • Compare the relationship between infant and maternal affect and behavior in infants with transposition of the great arteries (TGA) and healthy infants. • Examine stability or change in the relationship over time.

  7. 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

  8. Parent-Child Early Relational Assessment • Parent • Positive affective involvement, sensitivity, & responsiveness • Negative affect and behavior • Infant • Positive affect, communicative, and social skills • Dysregulationand irritability • Dyadic • Mutuality and reciprocity • Dyadic tension (Clark, 1985)

  9. Data Analysis • Hierarchical linear regression • Infant dysregulation & irritability • Dyadic tension

  10. Sample: Mothers • Healthy 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

  11. Sample: Infants HealthyTGA Gender: 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) 0 Type of feeding Breast 5 (31.3) 5 (33.3) Bottle 11 (68.7) 10 (66.7) Prenatal diagnosis 6 (40) mean (SD) range Age of surgery (days) 6.8 (2.98) 2-11 Length of stay (days) 20.13 (6.05) 9-28

  12. Parent-Child Early Relational Assessment 2 months 2 weeks * * Blue = Healthy Red = TGA DMR=Dyadic mutuality & reciprocity DT=Dyadic tension IPACS = Infant positive affect, communicative and social skills IDI = Infant dysregulation and irritability PAB = Positive affect & behavior NAB = Regulation of negative affect & behavior

  13. Regulation of Negative Affect and Behavior, Infant Dysregulation & Irritability, and Dyadic Tension 2 weeks 2 months *

  14. Maternal Correlations: 2 Weeks of Age Healthy TGA

  15. Maternal Correlations: 2 Months of Age Healthy TGA

  16. Infant Correlations: 2 Weeks of Age TGA Healthy

  17. Infant Correlations: 2 Months of Age TGA Healthy

  18. Infant Dysregulationand Irritability • Variable B SE B β t • Constant 4.463 .246 18.134*** • Time (2 wk or 2 mo) .043 .095 .052 .456 • NAB .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 < 0.001 NAB = Maternal regulation of negative affect and behavior Total R2 = 0.28

  19. Dyadic Tension • Variable B SE B β t • Constant 4.710 .172 27.452*** • Time (2 wk or 2 mo) -.089 .066 -.099 -1.350 • NAB 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 < 0.001 NAB = Maternal regulation of negative affect and behavior Total R2 = 0.70

  20. 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.

  21. 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.

  22. Acknowledgements • The authors gratefully acknowledge The Ohio State University College of Medicine Medical Student Research Scholarship awarded to Allison Ferree for this project.

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