A Case Study of Infant Physiologic Response to Skin-to-Skin Contact After Surgery for Complex Congenital Heart Disease

Abstract

Background Infants with complex congenital heart disease requiring surgical intervention within the first days or weeks of life may be the most seriously ill infants needing intensive nursing and medical care immediately after birth. Skin to skin contact (SSC) is well-accepted and practiced as a positive therapeutic intervention in premature infants, but is not routinely offered to infants in cardiac intensive care units. Physiologic effects of SSC in the congenital heart disease population must be examined before recommending incorporation of SSC into standard care routines. Objective The purpose of this case study was to describe the physiologic response to a single session of SSC in an 18-day-old infant with hypoplastic left heart syndrome. Methods Repeated measures of heart rate, respiratory rate, oxygen saturation, blood pressure, and temperature were recorded 30 minutes prior to SSC, during SSC (including interruptions for bottle and breast feedings), and 10 minutes after SSC was completed. Results All physiologic parameters were clinically acceptable throughout the 135-minute observation. Conclusion This case study provides beginning evidence that SSC is safe in full-term infants following surgery for complex congenital heart disease. Further research with a larger sample is needed to examine effects of SSC on infant physiology before surgery and earlier in the postoperative time period as well as on additional outcomes such as length of stay, maternal-infant interaction, and neurodevelopment.

Physiology of Stress and Use of Skin-to-Skin Care as a Stress-Reducing Intervention in the NICU

“…Preterm newborns receiving SSC were found to have decreased respiratory rates (Cho et al, 2016), decreased heart rates, increased oxygen saturation, and decreased oxygen requirements (Carbasse et al, 2013). In infants with congenital heart disease, researchers not only found SSC to be safe but reported improvements in physiologic parameters in these particularly vulnerable infants (Harrison & Brown, 2017;Harrison & Ludington-Hoe, 2015).…”

Improving neurodevelopment in infants with complex congenital heart disease

“…For a thorough review of the multiple aspects of developmentally supportive care for infants with CCHD, see Lisanti et al (2019). Pilot studies have provided initial support for the safety, feasibility, and acceptability of providing KC to infants with CCHD both before and after neonatal surgical interventions (Gazzolo et al, 2000;Harrison et al, 2019;Harrison & Brown, 2017;Harrison & Ludington-Hoe, 2015). However, there are currently no research-based guidelines for providing KC in the cardiac units.…”

The evolution of the science of kangaroo (mother) care (skin‐to‐skin contact)

“…Infants with CHD who experienced KC were safe, had stable and within normal range HRs, RRs, and O 2 Sat levels and experienced improvement in heart rate variability (HRV), a measure of autonomic function. CHD infants who received KC had learning and autonomic nervous system functions similar to healthy infants (Harrison & Brown, ; Harrison, Chen, Stein, Brown, & Heathcock, ; Harrison & Ludington‐Hoe, ). More research is still needed for this population especially the use of KC as a part of care after surgical intervention.…”