Newborn infants' cry after heel-prick: analysis with sound spectrogram

The aim of the study was to test the hypothesis that a newborn infant's cry can be used in conjunction with an instrument to measure pain. Crying due to pain was analysed after a heel-prick stimulus. In a prospective, descriptive study, 50 healthy newborn infants were subjected to a heel-prick for phenylketonuria screening. Their cries of pain were recorded and analysed. Duration of the crying sound was analysed and, using a sound spectrogram, the fundamental frequency and the cry melody of the first five cry sounds were analysed. The analysis showed that the crying sound after the painful stimulus of the heel-prick had a significantly higher fundamental frequency and lasted longer at the first than at the fifth cry. The first cry had a more varied crying melody than the fifth. There were large differences between individual cries from a single infant, as well as in the duration of each cry, total crying time, and fundamental frequencies between infants. While the first cry was more like a cry of pain, the fifth cry more resembled crying for reasons other than pain. The results suggest that newborn infants react to pain in a recognizable way. However, other stimuli may cause a similar reaction. Crying can therefore be used to measure pain in newborn infants only when the cause of crying is known.

Phonation in the newborn, infant cry

Sound spectrographic studies have shown that the crying of newborn infants has a fundamental frequency of about 400-600 cycles per second, and mostly a slightly rising-falling melody contour. In sick infants, and especially those with diseases affecting the central nervous system, abnormal cry characteristics occur. The fundamental frequency has been increased, and the melody contour is unstable. Various cry characteristics, which rarely occur in cries of healthy infants, are more often present in cries of the sick ones. Studies of cries in newborn infants have been especially aimed to determine whether cry analysis could be successful in diagnostics and in the early detection of the infant at risk for developmental difficulties.

Two-year group treatment for children with learning difficulties: assessing effects of treatment duration and pretreatment characteristics

The results of a 2-year treatment study of children with learning problems are reported. During the first treatment year, half of the children participated in a multifaceted neurocognitive treatment and the other half in a treatment that provided supervision of school tasks and peer group support. During the second treatment year, all children participated in the neurocognitive treatment. The participants were 74 Chilean children 6 to 11 years old. The issues under investigation were the effect of treatment duration, and the relationship between pretreatment neurocognitive and behavioral characteristics and academic treatment outcome. The results indicated that significant gains occurred during both the first and the second treatment year. No major differences were found between the treatment groups. Pretreatment negative behavioral traits were associated with lesser academic growth in the group participating in the homework supervision treatment but not in the neurocognitive treatment group.

Comparing efficacies of neurocognitive treatment and homework assistance programs for children with learning difficulties

The purpose of the study was to analyze the relative efficacies of two treatments for children with learning difficulties. The first treatment consisted of multiple training components targeting specific cognitive and behavioral factors; the second treatment provided emotional support and supervision of school tasks. The participants were 94 Chilean schoolchildren (6 to 11 years of age). The efficacies were compared on (a) neurocognitive tests, (b) school achievement tests, and (c) behavior in school and at home. The results indicated that both groups improved on most of the outcome measures. The first group showed best results in parents' rating of home behavior, and the second group in reading. The findings also emphasized the importance of emotional support and the inclusion of a parents' group in treatment for children with learning difficulties.

Crying in separated and non-separated newborns: sound spectrographic analysis

During the first 1-2 h after birth crying occurs during separation from the mother and stops on reunion. In rats, such "separation distress calls" have distinct phonetic properties. We examined this early crying by sound spectrography in 29 healthy, full-term, vaginally delivered babies, randomly assigned either to be kept in a cot or to be placed in body contact with the mother during the 90 min following birth. The former babies cried almost 10 times more than the latter ones. The duration of the cry signal (the smallest element of a cry analysed by spectrography) in both groups was 0.8-09s; the melody contour was flat or slightly rising--falling with a fundamental frequency of around 500 hertz. The cry is provisionally characterized as a discomfort cry, elicited mainly by separation from the mother.

Crying, feeding and sleeping patterns in 1 to 12-month-old infants

The crying, feeding and sleeping patterns of 270 infants 0-12 months old were studied using a 24-hour schedule included in a questionnaire given to mothers visiting four well-baby clinics in Finland in 1987-88. Of these infants 78 were under 3, 84 were 3-5, 65 were 6-8 and 43 were over 9 months old. The results showed that the infants less than 3 months old slept on average 15.2 hours per day, whereas those over 9 months slept 13.4 hours. The sleeping periods were longer at night. Continuous night-time sleep for at least 6 hours was noted in 35% of the infants under 3 months old and the proportion increased to 72% by the age of 9-12 months. The youngest infants were fed on average 6-7 times per day at 2- to 3-hour intervals in the daytime and at 4- to 6-hour intervals at night. The number of feedings decreased slightly with age. The average total crying time decreased from 1.6 hours per day for the youngest group to 1.1 hours for the 9-12 months old. At the time of the study, 23 mothers felt the need for help because of excessive crying or night waking. The help needed ranged from information about colic and child care, help with housework or the baby and encouragement. Of the mothers who needed help, a significantly higher proportion had a first-born baby compared with those not in need of help. There were also significant differences in the mothers' perception of the cry and feelings towards it.

Prediction of early school-age problems by a preschool neurodevelopmental examination of children at risk neonatally

A group of 350 children who had had neonatal developmental risk-factors were assessed at the age of five years with a neurodevelopmental examination. At nine years they were assessed again for neuropaediatric, motor, psycholinguistic, cognitive and school-achievement problems. (Children with major handicaps were excluded). Poor performance at age five was significantly associated with failure in the nine-year examinations and with school problems. Sensitivity of the five-year neurodevelopmental examination in predicting problems at nine years was 0.30 to 0.50, and its predictive value for an abnormal performance was 0.30 to 0.60. Predictively, the neurodevelopmental examination was accurate in defining children without later problems, but less satisfactory in defining those who did develop problems. Multiple linear regression analyses between the neurodevelopmental examination and the scores at nine years revealed low explanatory power. A shortened neurodevelopmental examination, based on the best predictors, seemed to be as efficient as the full examination.

Neonatal risk factors and later neurodevelopmental disturbances

Background factors of developmental outcome in a group of 386 neonatal 'at-risk' infants and 107 controls were examined in a prospective nine-year follow-up study. Dichotomized outcome variables were computed for each of the assessments; neurodevelopmental, motor, psycholinguistic, cognitive and school progress. In the study group, 17 to 29 per cent were found to have significant problems, compared with 10 to 17 per cent of the control group. Children with low birthweight, neonatal neurological symptoms or several neonatal disorders were found to have most problems at the age of nine years. In stepwise logistic regression analyses, smallness for gestational age, neonatal signs of cerebral depression and low social-class were found to be the most significant predictors of neurodevelopmental problems at age nine. Factors suggesting intra-uterine hypoxia or poor nutrition were also associated with developmental problems. The background pathology of the neonatal conditions seemed to be of more importance than the neonatal manifestations themselves.

Neurodevelopmental significance of minor and major congenital anomalies in neonatal high risk children

Minor and major congenital anomalies were studied in 395 neonatal risk children and 107 normal school children at the age of nine in the context of follow-up of the risk children. The purpose of the study was to evaluate the impact of early prenatal disturbances on the long term prognosis. Minor physical anomalies (MPA) were scored by a weighted scoring system modified from that of Waldrop and Halverson. The children with minor or major congenital anomalies performed worse in a cognitive test (WISC) and in a motor performance test. The differences were significant in the neonatal risk group. There were more small for gestational age (SGA) children in the anomaly group of the neonatal risk group as a whole and in the low birthweight group than in the non-anomaly group. Hyperactivity was associated with a high MPA score in the comparison group, but not in the study group. The results are consistent with earlier reports of associations between intrauterine growth disturbance and minor physical anomalies. Our findings suggest an additive effect of prenatal insults and neonatal risk factors in the origin of neurodevelopmental disturbances.

Ten-year follow-up of adolescent dyslexics

A follow-up study of 26 dyslexics with an age range from 20 to 28 years revealed that reading and writing problems were essentially unchanged from the time of diagnosis 7-10 years earlier. The intellectual capacity of all subjects was normal. One of the ten who finished high school had started university studies. Sixteen (62%) had completed only the obligatory nine years of schooling. Fourteen (54%) were in practical occupations such as a cook, storeman, and truck driver. Our results suggest that with late diagnosis and no remedial treatment, dyslexia remains. The subjects report that their handicap has interfered with their choice of occupation.

Nine-year follow-up of infants weighing 1 500 g or less at birth

A nine-year follow-up of 116 children born consecutively in 1971-74 with a birthweight of 1 500 g or less showed that 59 had died. Of those who were alive, four had severe motor and/or mental handicaps and three were blind because of retrolental fibroplasia. The low birthweight children without severe handicaps were found to have impaired motor function, speech defects and impaired school achievement more often than the controls. There was a significant correlation between the test results at the age of five and nine years, which indicates that children with school failure can be recognized and early remedial treatment started before school or on starting school.

Sound spectrographic cry analysis of infants with hydrocephalus

Altogether 248 cries from 62 infants with hydrocephalus were analysed by sound spectrography: 92 cries from infants with congenital hydrocephalus and 52 cries from each of the groups with cerebral malformations, hydrocephalus as sequelae of meningitis, and after closure of a meningomyelocele. The cries were compared with 104 cries of normal healthy infants of corresponding age. The cry analysis showed that the most abnormal cries were seen in infants with congenital hydrocephalus and cerebral malformations. The pitch of the fundamental frequency did not differ from normal crying in cries of infants collected after recovery from meningitis and after closure of a meningomyelocele. The cries in hydrocephalus after meningitis showed more commonly flat melody types and the occurrence of bi-phonation.

Neurological, psychological and articulatory impairment in five-year-old children with a birthweight of 2000 g or less

The study comprised 324 children with a birthweight less than or equal to 2000 g born in 1971-1974 at the Institute of Midwifery, Helsinki. The low birthweight (LBW) infants totalled 1.46% of the live-born during that time. At the age of 5 years 197 children were investigated; 15 had severe handicaps while 182 were without any immediate noticeable defects. The rest were not investigated for the following reasons: 86 had died, seven were severely handicapped and 34 could not be traced or the parents did not want to participate in the examination. The 197 children were given a neurodevelopmental screening examination, psychological and articulatory tests. A score of greater than or equal to 23 in the neurodevelopmental screening examination was noted in 8% of the controls, in 87% of the severely handicapped and in 34% of children without severe handicaps. All psychological test results differed significantly from those of the controls. The articulatory tests showed that the speech problems were more common among the LBW children. According to the teachers' assessments at the age of 9 years, 32% of the LBW children were in need of special education, compared with 12% of the controls. A significant correlation was found between the test results at 5 years and the school achievement at the age of nine.

Sound spectrographic analysis of pain cry in preterm infants

Sound spectrographic cry analysis was performed on 302 cries of 48 preterm infants born at 30-37 gestational weeks. The cries were recorded during the first week of life and thereafter weekly until the infants were discharged. The control series comprised 54 cries from 27 fullterm healthy infants. The results showed that the cries of the smallest prematures compared with the controls were shorter, more high-pitched, and included bi-phonation and glide more often. The cry characteristics changed with increasing conceptual age and the older the child the more the cry pattern resembled that of the fullterm. The cries of the preterm infants when they had reached 38 conceptual weeks were similar to those of newly born fullterm infants. The results indicate that the gestational age should be taken into consideration in cry analysis.

[Effect of antenatal hypoxia on the nature of the cry of newborn rats]

Spectrography was used to examine spontaneous and pain (induced by pricking the foot with a needle) cries of newborn Wistar rats of the first three days of life. Three groups of animals were employed: non-operated control rats, those which suffered hypoxia on days 17-21 of gestation (clamping of the umbilical cord), and control rats born to operated females. The cries were recorded on Kometa or Vesna tape recorders and analyzed with the use of a Sona Graph, type 7029A. Antenatal hypoxia was found to produce an increase in the minimum and maximum pitches of fundamental frequency and to a decrease in the duration of the cry. It is likely that the changes in the cry are related to the impairment of the thalamic and hypothalamic nuclei and external respiration distress because of hypoxia.

Cry analysis in infants with infectious and congenital disorders of the larynx

Thirty induced pain cries from the same number of infants with infectious or congenital disorders of the larynx (infectious laryngitis, laryngomalacia, paresis of the recurrent nerve and subglottic stricture) have been analyzed by means of sound spectrography. For each cry 21 phonetic features have been evaluated. This cry material was then compared with 120 pain cries from healthy infants. In the pathological group a significant increase could be noted in the occurrence of the following cry attributes: second pause, abnormal melody types (rising, falling-rising, flat and no melody types), instability of the fundamental frequency, bi-phonation, vibrato, half-voiced voice quality, noise concentration, and inspiratory stridor. Furthermore, a significant decrease could be noticed in the occurrence of voiceless cries, falling and rising-falling melody types, and glottal roll. These findings show that such spectrographic features as very high maximum and minimum pitch, bi-phonation, gliding, and abnormal melody type occur more often in cries of infants with central nervous system involvement. Moreover, such parameters as instability of the fundamental frequency and noise concentration as indicators of neurologic disorders need further consideration. Except features of inspiratory stridor, this study revealed no really clear parameters typical of peripheral diseases of the vocal tract.

Efficacy of salbutamol in treatment of infant pertussis demonstrated by sound spectrum analysis

The value of sound spectrum analysis (sonography) as an indicator of the severity of symptomatic pertussis was assessed in four infants aged 3 weeks to 5 months. Coughing paroxysms and whooping could be clearly distinguished and measured on the sonogram. Sonography was then used to evaluate the effects of oral salbutamol on pertussis. The drug reduced the frequency and shortened the duration of the whoops; however, it did not have corresponding effect on the cough. Salbutamol seemed to relieve the laryngeal spasms and consequently eased the infant's breathing difficulties.

Neurodevelopmental screening at five years of children who were at risk neonatally

A neurodevelopmental screening test with cumulative scoring for abnormal test responses was performed on 845 five-year-old Finnish children who, in the newborn period, had had disorders which placed them in a high-risk group, and on 70 controls. The results showed a significant difference between the neurodevelopmental scores of the risk-group children and those of the controls. The scores were higher if the child had had many of the risk factors simultaneously. Boys had significantly higher scores than girls. The mean scores also varied between different risk factors. It is evident that slight neurodevelopmental deviations at the age of five years can derive from disorders in the newborn period.

Cry analysis of infants with karyotype abnormality

Sound spectrography was used to analyze 135 pain cries from 14 infants with a karyotype abnormality. At the time of the cry recording the children were from one day to seven months old, except for one child who was 2 years 10 months at the second recording. The cries were compared with 30 pain cries from 15 healthy infants of corresponding age. The children with an abnormality of chromosome 4 or 5 had cries with a significantly higher fundamental frequency than the control infants. Additionally, the cry in the "Cri-du-Chat" syndrome had a flat, monotonous melody type. The cries of infants with 13- or 18-trisomy were hoarse, low-pitched, with the shift parts absent. The cries in karyotype abnormalities were also different from pain cries of infants with other disorders involving the central nervous system. This study suggests that cry analysis can provide a valuable indication of the presence of a chromosome anomaly.

Occurrence of risk factors in newborn infants. A study of 22359 consecutive cases

All the 22359 deliveries in 1971-1974 at the Institute of Midwifery, Helsinki, were analyzed for risk factors. 1196 infants (5.35%) had one or more risk factor at birth, the most common being an Apgar score of 6 or less at 5 or 15 minutes, hyperbilirubinaemia, and a birth weight of 2000 g or below. The other risk factors registered were neurological symptoms, respiratory difficulties, hypoglycaemia, newborn infants of diabetic mothers and cases with sepsis. 124 infants in the risk group died during the first week. This was 83% of the total neonatal mortality. Except for hyperbilirubinaemia, which was less frequent in 1974, there was no marked change in the composition of the risk group from 1971 to 1974.

Cry analysis in infants with severe malnutrition

Sound spectrographic investigations of the cries of 5 infants, age 7 m to 2 y, with severe malnutrition (one with kwashiorkor and four with marasmus) were compared with the cries of 15 healthy children of corresponding age. The cry of the child with kwashiorkor resembled those of the normal infants. The cries of the marasmic children showed a significant increase in the minimum and maximum pitch, and the occurrence of biphonation and flat melody types. These features have also been found in the cries of children with brain damage. We therefore believe that cry and analysis can be an additional means of investigating to what degree the brain is affected in children with malnutrition.

Pain cry in full-term asphyxiated newborn infants correlated with late findings

115 pain-induced cries from 45 full-term newborn infants with pre- and perinatal asphyxia were analyzed by sound spectrographic methods. All the infants had signs of intrauterine asphyxia and Apgar score of 6 or less at 5 min. The mean birth weight was 3170 g. The pain cries were recorded before the age of 8 days, 83% of the cries before 3 days of age. The cry analysis was compared with the pain cries of 75 full-term, healthy newborn infants of corresponding birth weight and gestational age. The results showed significant differences between the cries of the asphyxiated newborn and the healthy infants. The duration of the phonation was shorter, the maximum and minimum pitch of the fundamental frequency was significantly higher. Bi-phonation and vibrato occurred more often, double harmonic break and glottal roll less often. An increase in rising, falling-rising and flat types of melody was observed. Retrospectively, the cries were more abnormal if the infant was found to be neurologically damaged at t he check-up at 2-8 years.

Spectrographic analysis of pain cry in neonates with cleft palate

52 phonations of 13 cleft palate neonates were analyzed by sound spectrographic methods. 17 phonetical attributes were included in the study and the first signal after the pain stimulus was analyzed. The cries of the cleft palate infants were compared with the crying of 75 normal babies of the same age. No change in the fundamental frequency, melody type and duration of the cries was seen in association with these anatomical defects. Two of the characteristics studied, vibrato and the 'tonal pit', occurred significantly more often in cries of the cleft palate infants than in cries of the control series. The changes in the qualities seen in association with cleft palate and/or cleft lip do not mimic the abnormalities produced by brain damage.