Systematic review of the effects of skin-to-skin care on short-term physiologic stress outcomes in preterm infants in the neonatal intensive care unit

Hospitalization in the neonatal intensive care unit (NICU) exposes infants to many different stressors. There is increasing evidence that chronic stress early in life can have long-term impacts on health. Skin-to-skin care (SSC) is an intervention that can be used to reduce stress in the NICU. In this review of the literature, we found that current research suggests that SSC improves short-term cardiorespiratory stress outcomes compared with incubator care. There is strong evidence that SSC reduces cortisol and increases oxytocin levels in preterm infants. Additional research is needed on timing of initiation, duration, and frequency of SSC to optimize the stress-reducing benefits.

Authors: Britt Pados & Francis Hess

Publication Information: Advances in Neonatal Care. 2020; 20(1): 48-58. doi: 10.1097/ANC.0000000000000596

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Benefits of infant massage for infants and parents in the neonatal intensive care unit

In this review of the literature, we explore the current research available on the ancient therapeutic technique of massage for infants hospitalized in the neonatal intensive care unit (NICU). This review identified literature to support that infant massage has beneficial effects on preterm infants, including shorter length of stay; reduced pain; and improved weight gain, feeding tolerance, and neurodevelopment. There are benefits for parents of infants hospitalized in the NICU as well. Parents who performed massage reported less stress, anxiety, and depression. Teaching parents infant massage techniques can provide benefits to both infants and their parents.

Authors: Britt Pados & Kelly McGlothen-Bell

Publication Information: Nursing for Women’s Health. 2019; 23(2): 265-271. doi: 10.1016/j.nwh.2019.03.004

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Physiology of stress and use of skin-to-skin care as a stress-reducing intervention in the neonatal intensive care unit

Critically ill infants often experience significant stress related to painful procedures and physical separation from their parents. In this article, I describe the physiologic mechanisms of the stress response and how this relates to mortality and morbidity in infants in the NICU. Skin-to-skin care (SSC) is a safe and effective intervention to counteract the stress of the NICU experience and optimize outcomes of care.

Authors: Britt Pados

Publication Information: Nursing for Women’s Health. 2019; 23(1): 59-70. doi: 10.1016/j.nwh.2018.11.002

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Heart rate variability as a feeding intervention outcome measure in the preterm infant

In this study, we explored the use of heart rate variability (HRV) as a measure of stress in infants during feeding. HRV was compared between usual care feeding and feeding with a gentle, coregulated (CoReg) approach. In the 14 preterm infants in this study, we found that infants fed using the CoReg approach had fewer apneic events and higher RR (they were able to breathe more during feeding). Infants fed using the usual care approach had significantly higher SD12, a measure of HRV indicating randomness in the heart rate, which has been found to be a measure of physiologic stress in other populations. Further research on HRV as an intervention outcome measure is needed. SD12 may be a more sensitive indictor than other physiologic outcomes.

Authors: Britt Pados, Suzanne Thoyre, George Knafl, & Brant Nix

Publication Information: Advances in Neonatal Care. 2017; 17(5): E10-E20. doi: 10.1097/ANC.0000000000000430

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