Skin‐to‐skin contact to support preterm infants and reduce NICU‐related stress

Abstract

Objective Hospitalization in the neonatal intensive care unit (NICU) with numerous painful medical interventions, being separated from parents, leads to the high risk of chronic stress for preterm infants. Today, many NICUs use more appropriate developmental care and pain management, but the early and long‐term outcomes of stress in these vulnerable infants require searching for more stress‐reducing interventions in neonatal care. The objective of the study was to investigate how skin‐to‐skin contact (SSC) can influence the biologic stress levels in preterm infants in the NICU by assessing cortisol and oxytocin levels. Participants and methods The study included 71 preterm infants with gestational age less than 34 + 0/7 weeks who were recruited from level III NICU. The overall design was a baseline‐response design. Saliva and urine were collected before (baseline) and after skin‐to‐skin contact to measure salivary cortisol and urinary oxytocin by enzyme immunoassay method. Results The infants' baseline hormonal status was represented by the following indicators: the level of salivary cortisol was 0.402 [0.227; 1,271] μg/dl, urinary oxytocin 48.88 [32.97; 88.11] pg/ml. There was a decrease in salivary cortisol levels to 0.157 [0.088; 0.351] μg/dl compared to baseline (p ˂ 0.001) with a simultaneous increase of the urinary oxytocin level −73.59 [45.18; 108.8] pg/ml (p = 0.028) in response to SSC. Conclusion Preterm infants in the NICU experience significant stress, characterized by hormonal imbalance: an increased level of the stress hormone cortisol and a decreased level of the anti‐stress hormone oxytocin. Skin‐to‐skin contact helps to ameliorate the hormonal stress in preterm infants by activating the oxytocin release with simultaneous reduction of cortisol secretion.

Measuring experience of and satisfaction with newborn care: a scoping review of tools and measures

“…Most of the studies covered the care between birth and discharge or birth to 72 hours,14 18–20 23 26 27 30 33–35 41 43 46 49 51–58 61 62 64 67 69–73 76 78–80 82–85 four studies reported on follow-up care at home,16 47 48 50 one on care during ground ambulance transport37 and five studies covered end-of-life care 25 36 42 72 84. We found no studies that reported on home birth.…”

“…Of those 19, eight focused on overall parental experience with newborn care,22 27 30 32 38 42 43 45 the remaining eleven focused on specific aspects of care, such as kangaroo mother care (KMC) provision,37 41 discharge education,26 postnatal diagnoses,18 24 end of life care21 25 31 or home-based postnatal care 47 48 50. Additionally, 16 studies measured newborn experience during hospital stay through physiological markers or measures of pain and comfort during routine procedures such as skin-to-skin contact, bathing, cobedding or heel prick, among others 52–67. Only two articles focused on mistreatment of the newborn during the immediate postpartum period, both using an adapted version of the Bohren et al 68 typology of mistreatment (developed to measure maternal experience) 69 70…”

Application of the Adverse Childhood Experiences Framework to the NICU

“…Early, prolonged, and frequent skin-to-skin care has been shown to have profound benefits to both the infant and the parent. 43 Positive auditory experiences, such as hearing the parents read 51 or sing, 52 have also been found to be beneficial to the infant and parents, Malin et al both in the short and long terms. Infant development is positively influenced as parental confidence and competence are increased.…”

“…If the intervention is necessary, then we must ask, "What can be done to support this infant in a way that will reduce the level of discomfort or trauma that the infant experiences?" For example, when painful or stressful procedures are performed (eg, skin-breaking procedures), there is evidence that skin-to-skin holding, 43 non-nutritive sucking, especially with glucose or mother's milk, 49 and exposure to the odor of mother's milk 50 reduce pain and stress. Encouraging positive experiences while in the NICU can play an important role supporting the infant's emotional development to build trust.…”

“…Nurses are uniquely positioned to champion this practice and set the standard of care in their unit, where every infant experiences skin-to-skin contact consistently over the duration of their hospitalization. 43 Several evidence-based relational health interventions exist in the NICU, and each unit should evaluate the appropriateness of interventions for their context when choosing which to implement. 44 For example, family-integrated care goes beyond supporting family presence and insists that the parent be supported as the primary caregiver for the infant.…”