Parent Engagement Correlates With Parent and Preterm Infant Oxytocin Release During Skin-to-Skin Contact

Abstract

Background: Preterm infants remain increasingly neurodevelopmentally disadvantaged. Parental touch, especially during skin-to-skin contact (SSC), has potential to reduce adverse consequences. Purpose: To examine relationships between parental engagement and salivary oxytocin and cortisol levels for parents participating in SSC intervention. Methods: A randomized crossover design study was conducted in a neonatal intensive care unit; 28 stable preterm infants, mothers, and fathers participated. Parental engagement was measured using the Parental Risk Evaluation Engagement Model Instrument (PREEMI) prior to hospital discharge. Saliva samples for oxytocin and cortisol levels were collected 15-minute pre-SSC, 60-minute during-SSC, and 45-minute post-SSC. Results: Data were analyzed using Pearson's correlation to measure relationships between parental engagement composite scores and salivary oxytocin and cortisol levels. A significant negative correlation between paternal engagement and paternal oxytocin levels (r = −0.43; P = .03) and a significant negative correlation between infant oxytocin levels and maternal engagement (r = −0.54; P = .004) were present. Adjusted linear regression models demonstrated that as infant oxytocin levels increased during SSC, maternal engagement scores significantly decreased at discharge (β = −.04; P = .01). Linear regression, adjusting for infant oxytocin and cortisol levels, showed that as paternal oxytocin levels increased, there was a significant decrease in paternal engagement (β = −.16; P = .03) and as paternal cortisol levels increased, there was a significant decrease in paternal engagement (β = −68.97; P =.05). Implications for Practice: Significant relationships exist between parental engagement and salivary oxytocin and cortisol levels. Defining parent engagement facilitates identification of parent risks and needs for intervention to optimize preterm outcomes. Implications for Research: The PREEMI can serve as a standardized instrument to examine parent engagement.

Parent–Infant Skin-to-Skin Contact and Stress Regulation: A Systematic Review of the Literature

“…In Hardin et al’s [ 43 ] study, for example, KC had moderate to significant effects on increasing oxytocin levels in mothers and infants at three months postpartum and decreasing cortisol reactivity in infants after acute stressor exposure. Identical results were obtained in the study of Cong et al [ 40 ] and Vitnner et al [ 57 ] for both maternal and paternal oxytocin levels. Indeed, Vitnner et al’s study showed how parents’ lower cortisol and higher oxytocin levels activated during SSC sessions were significantly related to pre-discharge parental involvement [ 57 ].…”

“…Identical results were obtained in the study of Cong et al [ 40 ] and Vitnner et al [ 57 ] for both maternal and paternal oxytocin levels. Indeed, Vitnner et al’s study showed how parents’ lower cortisol and higher oxytocin levels activated during SSC sessions were significantly related to pre-discharge parental involvement [ 57 ]. Furthermore, rises in oxytocin levels and concurrent decreases in cortisol levels during SSC enable both infants and parents to develop a more synchronous relationship, improving bonding and attachment opportunities, especially in the challenging NICU environment [ 57 ].…”

“…Results showed that compared with the SC group, salivary cortisol reactivity was significantly lower in the SSC group. Similarly, Vitnner and colleagues [ 57 ] found, during a 60-min SSC intervention, a decrease of salivary cortisol compared with baseline parameters; this finding was consistent whether the mother or father provided SSC ( p < 0.001). Additionally, in Varela et al’s [ 56 ] study, fathers who held their baby in SSC for the first time showed a significant decline in physiological cortisol.…”

“…Indeed, analysis of the 22 selected studies revealed that nine studies focused on HRV [ 36 , 38 , 44 , 45 , 46 , 47 , 48 , 50 , 51 ], six studies on stress [ 26 , 36 , 38 , 41 , 54 , 55 ], and nine on cortisol [ 40 , 42 , 43 , 51 , 52 , 54 , 55 , 56 , 57 ], while the remaining six focused on oxytocin [ 40 , 43 , 48 , 53 , 55 , 57 ]. The studies are summarized in Table 1 .…”

The Role of Affectionate Caregiver Touch in Early Neurodevelopment and Parent–Infant Interactional Synchrony

“…Gentle stroking of rats increases Fos expression in the oxytocin-producing paraventricular nucleus of the hypothalamus (PVN), and increased plasma oxytocin levels are observed in rats following a wide variety of forms of peripheral sensory stimulation (Stock and Uvnäs-Moberg, 1988;Okabe et al, 2015). In humans, skin-to-skin contact (SSC) and KMC increase peripheral oxytocin levels in both parents and their infant (Vittner et al, 2019;Hardin et al, 2020). It is important to note that this effect is observed only when measured by enzyme immunoassay rather than radioimmunoassay, which may indicate a specific role for active fragments of oxytocin (Uvnäs Moberg et al, 2019); future studies should examine this discrepancy.…”