Physiological Effects of Handling in Moderate to Late Preterm Infants Receiving Neonatal Intensive Care

Abstract

Background: Of all preterm births, approximately 82% are moderate to late preterm. Moderate to late preterm infants are often treated like full-term infants despite their physiological and metabolic immaturity, increasing their risk for mortality and morbidity. Purpose: To describe the relationship between routine caregiving methods and physiological markers of stress and hypoxemia in infants born between 32 and 366/7 weeks' gestation. Methods: This descriptive study used a prospective observational design to examine the relationship between routine caregiving patterns (single procedure vs clustered care) and physiological markers of stress and hypoxemia such as regional oxygen saturation, quantified as renal and cerebral regional oxygen saturation (StO2), systemic oxygen saturation (Spo2), and heart rate (HR) in moderate to late preterm infants. Renal and cerebral StO2 was measured using near-infrared spectroscopy during a 6-hour study period. Spo2 and HR were measured using pulse oximetry. Results: A total of 231 procedures were captured in 37 participants. We found greater alterations in cerebral StO2, renal StO2, Spo2, and HR when routine procedures were performed consecutively in clusters than when procedures were performed singly or separately. Implications for Practice and Research: Our results suggest that the oxygen saturation and HR of moderate to late preterm infants were significantly altered when exposed to routine procedures that were performed consecutively, in clusters, compared with when exposed to procedures that were performed singly or separately. Adequately powered randomized controlled trials are needed to determine the type of caregiving patterns that will optimize the health outcomes of this vulnerable population.

Transcutaneous Bilirubin and Minimal Handling of Extremely Preterm Infants

“…In summary, concerning the findings of Brashear et al,1 TcB should be regarded as an SPC. It is helpful in term infants,2 but its use in preterm infants should be viewed critically.…”

“…The findings of Brashear et al1 and Sankar et al3 pose an important question: Do we need TcB in EP infants in addition to TSB? To find the answer, we performed a quick scan of our neonatal intensive care unit to see the range of TSB levels and the time taken to obtain the first TSB in a selected group of EP infants born at less than 30 weeks' gestational age.…”

“…They showed that preterm infants had significant changes in heart rate and oxygen saturation when exposed to stressful care procedures (SPCs), defined as "direct or indirect procedures causing physical uneasiness or annoyance or disrupting the balance between the neonate and its environment." Although transcutaneous bilirubin (TcB) was not listed as an SPC in Brashear et al's Table 1, 1 we assume it is an SPC, just like the temperature measurement.…”

“…I read with great interest the article by Brashear et al,1 demonstrating the effect of handling on preterm infants. They showed that preterm infants had significant changes in heart rate and oxygen saturation when exposed to stressful care procedures (SPCs), defined as “direct or indirect procedures causing physical uneasiness or annoyance or disrupting the balance between the neonate and its environment.” Although transcutaneous bilirubin (TcB) was not listed as an SPC in Brashear et al's Table 1,1 we assume it is an SPC, just like the temperature measurement.…”