University Microfilms International 300 N

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ZEEB ROAD, ANN ARBOR, Ml 48106 18 BEDFORD ROW, LONDON WC1R 4EJ, ENGLAND 8015933 V r a n e k o v i c, G e o r g e Jo s e p h CARDIAC RESPONSIVITY AND NON-NUTRITIVE SUCKING PATTERNS OF FULL TERM, PREMATURE, AND HIGH RISK INFANTS The Ohio State University PH.D. 1980 University Microfilms I n t e r n a t i o n a l 300 N. Zeeb Road, Ann Arbor, MI 48106 18 Bedford Row, London WC1R 4EJ, England Copyright 1980 by Vranekovic, George Joseph All Rights Reserved CARDIAC RESPONSIVITY AND NON-NUTRITIVE SUCKING PATTERNS OF FULL TERM, PREMATURE, AND HIGH RISK INFANTS DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By George Joseph Vranekovic, B.A., M.A. ***** The Ohio State University 1980 Reading Committee: Approved By Dr. Henry Leland Dr. Phil Clark Dr. Barbara Edmonson Depart ipdnt of Psychology ACKNOWLEDGEMENTS When looking back over four years of graduate education, a stu dent realizes that certain individuals have been instrumental in shaping both his interests and philosophy. The first of those that come to mind is Dr. Donald Smith, my former adviser, who encouraged me in the early days of my graduate career, and led me to my initial contacts with the area of this particular study. Also included are those outstanding members of the Department of Psychology at The Ohio State University, such as Dr. George Thompson, Dr. Charles Wenar, Dr. Phil Clark, and Dr. Barbara Edmonson. The utmost thanks must go to my present adviser, Dr. Henry Leland, who has not only encouraged, guided, and supported my various research efforts, but also shown patience, interest, and acceptance of those projects. The two individuals who are most responsible for the completion of this dissertation and other related work are Dr. Leandro Cordero and Dr. Ellen Hock. Dr. Cordero's support of psychophysiological research has enabled me to enjoy a cordial, accepting atmosphere among the personnel of the University Hospital's Department of Pedi atrics and Neonatology. It was Dr. Hock who initiated the contact between the Department of Psychology and University Hospital, and completed the first of a series of heart rate studies, thus making it possible to garner the interdisciplinary support needed for such an effort. ii A note of appreciation is in order for Dr. Paul Isaac's assist ance in the analysis of the data, a task which involved reducing an unbelievable mass of data into something meaningful and understand able. I cannot fail to mention those who, at certain stages, assisted in the collection and tedious analysis of the data: Chris Harter and Patrice McCarthy, two nurses who were invaluable in their care and handling of the newborns during most of the procedures; Linda Knight, who was a constant help in my absence; and Dottie Turner, a knowl- edgable nurse who was always available when needed. Finally, to the nurses and staff of both the Newborn Nurseries and Neonatal Intensive Care Unit of The Ohio State University Hospi tal, my deepest thanks for the patience they showed while a strug gling student constantly wandered through their wards. VITA November 28, 1948 .......... Born - Cleveland, Ohio 1970......................... B.A., University of Miami, Coral Gables, Florida 1970-1971 . ............... University Fellow, Department of Psychology, The Ohio State University, Columbus, Ohio 1971-1972 ................. Teaching Assistant, Department of Psychology, The Ohio State University, Columbus, Ohio 1972......................... M.A., The Ohio State University, Columbus, Ohio 1972-1973 .......... Research Assistant, Department of Pediatrics, University Hospital, The Ohio State University, Columbus, Ohio 1973-1974 ................... Dissertation Fellow, Department of Psychology, The Ohio State University, Columbus, Ohio 1974-1976 .................. Psychology Intern, Parsons State Hospital and Training Center, Parsons, Kansas 1976-1980 .................. Staff Psychologist, Parsons State Hospital and Training Center, Parsons, Kansas PUBLICATIONS "Heart Rate Variability and Cardiac Response to an Auditory Stimulus." Biology of the Neonate, 1974, 24, 66-73. iv FIELDS OF STUDY Major Fields: Developmental Psychology and Developmental Disabili ties Studies in the Psychology of the Exceptional Child and Adult. Professors Henry Leland and Barbara Edmonson. Studies in Developmental Assessment and Psychological Test Con struction. Professors Donald Smith and Donald Bersoff. Studies in Social and Cognitive Development. Professor George Thompson. Studies in the Neuropsychological Aspects of Infant, Childhood, and Adult Behavior. Professors Donald Meyer, Ellen Hock, Charles Wenar, and Leandro Cordero. v TABLE OF CONTENTS Page ACKNOWLEDGEMENTS................................................ ii VITA ......... ................................................ iv FIELDS OF STUDY ................................................ v LIST OF T A B L E S .................................................... viii LIST OF F I G U R E S ................................................ x Chapter I . INTRODUCTION ............................................ 1 II. REVIEW OF THE L I T E R A T U R E ................................ 6 Determinants of the Cardiac Response to Stimulation . 6 Theories of the Cardiac Response to Stimulation ......... 14 The Development of Resting Heart Rate and Its Variability...................... ....................... 18 Developmental Studies of the Cardiac Response to Stimulation............................................. 23 Sucking Behavior in the Human Infant . ................ 29 III. METHODOLOGY...................... .. .................... 38 Subject Characteristics ................................. 38 Experimental Procedures ................................. 40 Methodological Issues ..... ......................... 47 IV. ANALYSIS OF THE D A T A ................................... 50 Reduction and Analysis of the Heart Rate D a t a ......................................... 50 Preparation and Analysis of the Sucking D a t a ................ 54 V. R E S U L T S .................................................. 57 Analysis of Group Differences on the Auditory Cardiac D a t a ................................... 57 vi Page Analysis of Group Differences on the Tactile Cardiac D a t a ........................................... 60 Correlational Analyses on the Auditory and Tactile Cardiac D a t a ................................... 63 Analysis of Responsivity Change Over Trials............... 64 Analysis of Group Differences and the Correlational Analysis on the Non-Nutritive Sucking Data ............. 65 Stepwise Regression Analysis on the Cardiac and Non-Nutritive Sucking Data .................. 67 Correlational Analyses Relating the Cardiac and Sucking D a t a ....................................... 69 VI. DISCUSSION............................................. 106 VII. SUMMARY................................................. 116 BIBLIOGRAPHY.................................................... 121 vii LIST OF TABLES Table Page 1. Subject Characteristics - Healthy Full Term Infants. 41 2. Subject Characteristics - Premature Infants. ...... 42 3. Subject Characteristics - High Risk Full Term Infants. ......................................... 43 4. Healthy Full Term Males - Average Cardiac Response - Auditory Modality ........................... 71 5. Healthy Full Term Females - Average Cardiac Response - Auditory Modality ........................... 72 6 . Premature Males - Average Cardiac Response - Auditory Modality .......... 73 7. Premature Females -

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