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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

*

*

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.