1. HEART RATE VARIABILITY AND LEARNING IN THE 28-34 WEEK PREMIE Krueger, C., Behnke, M., Gerhardt, K., DeCasper, A., vanOostrom, H. Pilot Study funded through the Biobehavioral Research Center General Clinical Research Center University of Florida

2. Premature Infants Learning Disabilities Delayed Speech and Language Neurological Disorders

3. Survival Rates Have Increased Incidence of Disabilities has Stagnated

4. Interventions are preceded by complete descriptions of normal development Thus often unreliable and ineffective

5. RESEARCH QUESTIONS What are the developmental changes in HRV? What are the developmental changes in the learning capabilities? Are there interactions between with HRV as learning occurs?

6. Heart Rate Variability via Spectral Analysis Autonomic Nervous System Development –Chatow –Karin –Kotini Predict for Later Developmental Delay –DiPietro –Porges

7. Learning Capabilities as Indicated by Movement and Cardiac Orienting Response Description of Learning Capabilities –Movement Lecanuet Kiselevsky –Cardiac Orienting Response DeCasper Krueger

8. HF Interactions Between Learning and HRV PolyVagal Theory

9. PURPOSE Describe longitudinal changes in HRV and the learning capabilities of the premature infant (28-34 wk)

10. CONCEPTUAL MODEL A Systems Approach to Behavioral Development

11. Environmental A Systems Approach to Behavioral Development Behavioral Neural Genetic Individual Development

12. Environmental A Systems Approach to Behavioral Development Behavioral Neural Genetic MATERNAL VOICE

13. Environmental A Systems Approach to Behavioral Development Behavioral Neural Genetic COR MOVEMENT MATERNAL VOICE

14. Environmental A Systems Approach to Behavioral Development Behavioral Neural Genetic COR MOVEMENT HRV MATERNAL VOICE

15. Environmental A Systems Approach to Behavioral Development Behavioral Neural Genetic COR MOVEMENT HRV MATERNAL VOICE

16. Subjects and Setting Convenience sample 28 premature infants Neonatal Intensive Care Unit –General Clinical Research Center

17. Inclusion Criteria –28 weeks post menstrual age –English as native language –Dubowitz confirmation of age Exclusion Criteria –Abnormal head ultrasound –Cardiac abnormality –Viral/bacterial infection –Sensorineural hearing loss

18. Independent Variable –Nursery Rhyme Dependent Variable –Heart Rate Variability Via spectral analysis –Cardiac Orienting Response –Movement

20. Group 1 Group 2 28 29 30 31 32 33 34 Gestational Age in Weeks

21. Nursery Rhyme CD Recording of Maternal Recitation –Twice a day –15 min after meal –Quiet CD Recording of Unfamiliar Female –Once a week –15 min after meal –Quiet 55 + 5 dB 20cm from ear

22. WEEKLY TEST SESSION Quiet Rhyme HRV COR HRV Movement

23. Layout of NICU 4 3 1 2 6 Sink 9 7 8 5 Computer Door Door Sink General Work Station

26. Auditory Stimulus 57-59 dB 28 week

27. Auditory Stimulus 51-54 dB 28 weeks

28. Challenges Encountered Technological Physiological Environmental

29. Developmental Changes in HRV

30. Total Power via Spectral Analysis

31. High Frequency Component of HRV

32. Developmental Changes

33. Learning Capabilities Cardiac Orienting Response Movement

34. 32 Weeks Post-Menstrual Age

35. 33 Weeks Post-Menstrual Age

36. 34 Weeks Post-Menstrual Age

38. Arm Movements Before During After Maternal 32 weeks: total 9, mean 0.10, range 0-5 Maternal 34 weeks: total 29, mean 0.54, range 2-5 Non-maternal 32 weeks: total 36, mean 0.2, range 2-6 Non-maternal 34 weeks: total 40, mean 0.74, range 3-6

39. Mouth Movements Before During After Maternal 32 weeks: total 6, mean 0.07, range 0-4 Maternal 34 weeks: total 36, mean 0.70, range 2-5 Non-maternal 32 weeks: total 14, mean 0.19, range 0-4 Non-maternal 34 weeks: total 7, mean 0.13, range 0-4

40. Respiratory Movements Before During After Maternal 32 weeks: total 7, mean 0.07, range 0-4 Maternal 34 weeks: total 1, mean 0.02, range 0-1 Non-maternal 32 weeks: total 10, mean 0.14, range 0-3 Non-maternal 34 weeks: total 20, mean 0.37, range 0-4

41. HF Interactions Between Learning and HRV

43. Program of Research Fetus Premie

44. TENTATIVE CONCLUSIONS Experience Maturation of ANS Interactions across levels of analysis Maternal voice –Premature Infant

45. FUTURE RESEARCH 28-40 weeks gestation (R-15) –Memory Underlying behavioral process (NSF)