No abstract

Skin-to-skin contact (SSC) is a cornerstone of neurodevelopmentally supportive and family-oriented care for very low-birth-weight preterm infants (VPIs). However, performing SSC with unstable and/or ventilated VPIs remains challenging for caregiving teams and/or controversial in the literature. We first aimed to assess the safety and effectiveness of SSC with vulnerable VPIs in a neonatal intensive care unit over 12 months. Our second aim was to evaluate the impact of the respiratory support (intubation or not) and of the infant's weight (above or below 1000 g) on the effects of SSC. Vital signs, body temperature, and oxygen requirement data were prospectively recorded by each infant's nurse before (baseline), during (3 time points), and after their first or first 2 SSC episodes. We compared the variations of each parameter from baseline (analysis of variance for repeated measures with post hoc analysis when appropriate). We studied 141 SSCs in 96 VPIs of 28 (24-33) weeks' gestational age, at 12 (0-55) days of postnatal age, and at a postmenstrual age of 30.5 (±1.5) weeks. During SSC, there were statistically significant increases in oxygen saturation (Sao2) (P < .001) with decreases in oxygen requirement (P = .043), a decrease in heart rate toward stability (P < .01) but a transient and moderate decrease in mean axillary temperature following the transfer from bed to mother (P < .05). Apneas/bradycardias requiring minor intervention occurred in 19 (13%) SSCs, without need for SSC termination. These variations were similar for intubated newborns (18%) as compared with newborns on nasal continuous positive airway pressure (52%) or breathing room air (30%). However, ventilated infants exhibited a significant increase in transcutaneous partial pressure of carbon dioxide (TcPco2) (P = .01), although remaining in a clinically acceptable range, and a greater decrease in oxygen requirements during SSC (P < .001) than nonventilated infants. Skin-to-skin contact in the neonatal intensive care unit seems safe and effective even in ventilated VPIs. Recording physiologic data of infants before, during, and after SCC provides data needed to secure changes of practice in SCC.

ABSTRACT. This study was designed to examine @-nerve ment and maintenance of sympathic and neural crest-derived growth factor (NGF) levels in human cord blood by a two-sensory innervation in the periphery and of cholinergic innersite enzyme immunoassay using MAb 27/21 to mouse NGF vation in the CNS (3, 4). and to determine whether @-NGF levels show develop-A fruitful method in NGF research has been the introduction mental changes. Blood was collected at delivery from 61 of a sensitive two-site EIA with MAb 27/21 to mouse @-NGF newborns, 55 neonates appropriate for gestational age (46 that allows reliable determination of low levels of 0-NGF present term infants and 9 premature infants), 5 neonates small for in peripheral and CNS tissue (5, 6). Recently, the two-site EIA gestational age, and 1 neonate with congenital hydroceph-was applied to human adult sera and showed low levels of /3-alus. In addition, samples were collected from 2 microce-NGF (0.4 f 0.1 ng/mL) (7). The specific objectives of this study phalic children (microcephaly vera) aged 15 and 18 mo, 2 were to examine levels of P-NGF in human cord blood using the control children, and 4 healthy adults. Mean levels of NGF two-site EIA with the MAb 2712 1 to mouse (3-NGF and to in preterm infants ( n = 9; 13.7 f 8 pg/mL) were signifi-determine whether levels of 8-NGF show developmental cantly lower than levels in term infants ( n = 47; 21.2 f changes, as has been reported for P-NGF in animals (3). During 8.8 pg/mL; p = 0.034 by Mann-Whitney U test). There the course of this study, we were also interested in measuring /3-was no correlation between birth weight, length, head NGF levels in two children with cerebral malformation (microcircumference, and @-NGF levels. In microcephalic chil-cephaly vera) and comparing their results with those found in dren, NGF levels were low (8 pg/mL) compared with the neonatal period and in otherwise healthy children and adults. control infants' values (22 pg/mL). In adults, 8-NGF levels were higher and ranged between 238 and 292 pg/mL. Our MATERIALS AND METHODS study demonstrates that @-NGF levels can be assessed in human newborn sera using a two-site enzyme immunoassay Subjects. Between October and December 1992, levels of Pwith MAb 27/21 to mouse @-NGF, that @-NGF levels are NGF were measured from cord blood in 6 1 newborn infants. As extremely low in newborns compared with adults, that j3-emphasized above, we included 2 microcephalic children, 2 NGF levels seems to show developmental changes, and healthy children considered controls, and 4 healthy adults after that @-NGF levels may be used to assess NGF utilization obtaining parental and adult consent. This study was approved under normal and pathologic conditions such as cerebral by our institutional committee for ethics. malformations. (Pediatr Res 35: 637-639, 1994) Blood samples and pretreatment. Immediately after birth and after clamping the cord, placenta and cord were removed. Then Abbreviations 2.5 mL of blood were collected by cord puncture. In children and a...