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Elhoff JJ, Acosta S, Flores S, LaSalle J, Loomba R, McGetrick M, McKinney C, Ostrom M, Pande CK, Schlosser R, Schwab S, Savorgnan F. Parental holding of infants improves haemodynamics in the cardiac ICU. Cardiol Young 2024; 34:1004-1009. [PMID: 38014584 DOI: 10.1017/s1047951123003931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
We performed a single-centre, retrospective study to assess physiologic changes of infants in the cardiac ICU while being held by their parent. Continuous data streaming of vital signs were collected for infants included in the study from January 2021 to March 2022. Demographic and clinical characteristics were collected from the electronic medical record. The physiologic streaming data were analysed using mixed-effects models to account for repeated measures and quantify the effect of parental holding. Comparison analysis was also performed controlling for intubation, pre-operative versus post-operative status, and whether the holding was skin-to-skin or not. Ninety-five patients with complete physiologic data were included in the study. There were no immediate adverse events associated with holding. Heart rate decreased during the response time compared to its baseline value (p = 0.01), and this decrease was more pronounced for the non-intubated and pre-operative patients. The near-infrared spectroscopy-based venous saturation increased overall (p = 0.02) in patients while being held. We conclude that parental holding of infants in the cardiac ICU can be safely accomplished, and the haemodynamic and oximetric profile during the holding is favourable compared to the infants' baseline prior to holding.
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Affiliation(s)
- Justin J Elhoff
- Department of Pediatrics, Pediatrix Medical Group, Sunrise Children's Hospital, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Sebastian Acosta
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Saul Flores
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | - Rohit Loomba
- Department of Pediatrics, Advocate Children's Hospital, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Molly McGetrick
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Chetna K Pande
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Fabio Savorgnan
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Yilmaz Kurt F, Küçükoğlu S, Aytekin Özdemir A, Oğul T, Türkön H, Atay S, Aşki N. The effect of kangaroo care on cortisol levels and immune factors in breast milk. Dev Psychobiol 2023; 65:e22402. [PMID: 37338250 DOI: 10.1002/dev.22402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/03/2023] [Accepted: 04/27/2023] [Indexed: 06/21/2023]
Abstract
This paper investigated the effect of kangaroo mother care (KMC) in the early postpartum period on cortisol levels and immune factors in breast milk. This quasi-experimental study was conducted at the obstetrics clinic of a university hospital in western Türkiye. The sample consisted of 63 mothers and their infants. All mothers had a cesarean delivery. Participants were divided into control (n = 32) and experimental groups (n = 31). The control group received routine care at the clinic. The experimental group received KMC for the first 3 days after birth in addition to the routine care at the clinic. Milk samples were collected on the third day after delivery to examine cortisol, IgA, IgM, and IgG levels. All parameters were measured using the enzyme-linked immunosorbent assay method. The experimental group had lower cortisol levels (17.740 ± 1.438) than the control group (18.503 ± 1.449) (p < .05). This result showed that the difference between the two groups was clinically significant (effect size = .53). There was no significant difference in IgA, IgM, and IgG levels between the groups (p > .05). The experimental and control groups had similar immunological factors, but the former had lower cortisol levels than the latter. Therefore, healthcare professionals should encourage mothers to provide KMC to their infants as soon as possible.
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Affiliation(s)
- Fatma Yilmaz Kurt
- Department of Children Health and Diseases Nursing, Faculty of Health Sciences, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | - Sibel Küçükoğlu
- Department of Children Health and Diseases Nursing, Faculty of Nursing, Selçuk University, Konya, Türkiye
| | - Aynur Aytekin Özdemir
- Department of Nursing, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Tanju Oğul
- Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Hakan Türkön
- Medical Biochemistry, Meddem Hospital, Isparta, Türkiye
| | - Selma Atay
- Department of Fundamental Nursing, Faculty of Health Sciences, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | - Nesrin Aşki
- Çanakkale Onsekiz Mart University Health Practice and Research Hospital, Obstetrics and Gynecology Clinic, Çanakkale, Türkiye
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Benefits of Kangaroo Mother Care on the Physiological Stress Parameters of Preterm Infants and Mothers in Neonatal Intensive Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127183. [PMID: 35742429 PMCID: PMC9223087 DOI: 10.3390/ijerph19127183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
It is well documented that the stress of separation of mother and baby can lead to short-term physiological instability as well as neurological, sociological or psychological consequences that may last a lifetime. Objective: The goal was to estimate the effect of kangaroo mother care (KMC) on physiological and biochemical parameters of preterm infant stress and maternal stress in neonatal intensive care. Methods: The investigation involved 112 preterm infants. Two groups were compared according to the mean duration of KMC during 12 days of study: the KMC group (mean duration more than 90 min daily) and the control group (less than 90 min). Results: Kangaroo mother care for more than 90 min on average per day in preterm infants is associated 12 days after the intervention with lower mean cortisol levels (p = 0.02), greater weight gain and less need for parenteral nutrition in preterm infants, as well as less postpartum depression (p = 0.02) and lower cortisol levels (p = 0.002) in the mothers of preterm infants. Conclusions: This study suggests that KMC can be used to improve the stress of preterm infants and their mothers, and that the greater weight gain observed in these preterm infants could contribute to a shorter average hospital stay and lower healthcare expenditure.
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A Systematic Review of the Effects of Skin-to-Skin Contact on Biomarkers of Stress in Preterm Infants and Parents. Adv Neonatal Care 2022; 22:223-230. [PMID: 34054011 PMCID: PMC9150851 DOI: 10.1097/anc.0000000000000905] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Premature infants and their parents experience significant stress related to separation and lifesaving procedures. While evidence suggests that skin-to-skin contact (SSC) is a stress-reducing intervention for both neonates and parents, the mechanisms that underlie its efficacy are not well understood. OBJECTIVE Purpose of this systematic review is to summarize the current state of knowledge on changes in biomarkers (ie, oxytocin [OT], cortisol, hypoxanthine, xanthine, uric acid, and allantoin), associated with SSC in premature infants and parents, that may reflect physiologic responses to stress. METHODS A comprehensive literature search was conducted from 1990 to 2020. Studies were selected using prespecified inclusion and exclusion criteria. RESULTS Of the 175 studies identified, only 19 are included in this review. Ten studies evaluated only infants, 2 evaluated only parents, and 7 evaluated for changes in biomarkers in both infants and parents. Cortisol was the most common biomarker evaluated. While changes in infants' cortisol levels were highly variable, in 55% of the parent studies, parent cortisol levels decreased following SSC. In both parents and infants, OT levels decreased following SSC. Only 1 study found that allantoin levels were significantly lower in infants who received SSC. IMPLICATIONS FOR PRACTICE AND RESEARCH While evidence suggests the numerous benefits of SSC, additional research is needed to identify the optimal biomarker to determine the mechanisms that underlie these effects. The use of novel biomarkers (eg, gene expression changes microbiome) may provide new insights into the mechanisms that underlie the efficacy of SSC.Video Abstract available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=48.
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Using complexity science to understand the role of co-sleeping (bedsharing) in mother-infant co-regulatory processes. Infant Behav Dev 2022; 67:101723. [PMID: 35594598 DOI: 10.1016/j.infbeh.2022.101723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022]
Abstract
Human infants spend most of their time sleeping, but over the first few years of life their sleep becomes regulated to coincide more closely with adult sleep (Galland et al., 2012; Paavonen et al., 2020). Evidence shows that co-sleeping played a role in the evolution of infant sleep regulation, as it is part of an ancient behavioral complex representing the biopsychosocial microenvironment in which human infants co-evolved with their mothers through millions of years of human history (Ball, 2003; McKenna 1986, 1990). This paper is a conceptual, interdisciplinary, integration of the literature on mother-infant co-sleeping and other mother-infant co-regulatory processes from an evolutionary (biological) perspective, using complexity science. Viewing the mother-infant dyad as a "complex adaptive system" (CAS) shows how the CAS fits assumptions of regulatory processes and reveals the role of the CAS in the ontogeny of mother-infant co-regulation of physiological (thermoregulation, breathing, circadian rhythm coordination, nighttime synchrony, and heart rate variability) and socioemotional (attachment and cortisol activity) development.
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Preterm infant heart rate is lowered after Family Nurture Intervention in the NICU: Evidence in support of autonomic conditioning. Early Hum Dev 2021; 161:105455. [PMID: 34517207 DOI: 10.1016/j.earlhumdev.2021.105455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac complications after premature birth are associated with negative long-term consequences to health. The Family Nurture Intervention (FNI) has been designed to support mother-infant parasympathetic calming sessions in the neonatal intensive care unit (NICU). FNI has shown neurodevelopmental and autonomic benefit across infant development. AIMS We tested the hypothesis that heart rate (HR) will decrease after FNI over the course of the NICU stay, compared to matched controls. STUDY DESIGN We used a case-matched design. The intervention included on average four ~1-hour facilitated mother-infant 'calming' sessions per week. We collected 24/7 real time heart rate data from a central monitoring system and analyzed data from two time-periods. SUBJECTS The intervention group comprised 37 infants born ~30 weeks gestational age (GA) in a level IV NICU, treated with FNI. From the same NICU and time-period, we created a contemporaneous comparison group of 32 infants who were case-matched to each intervention infant for sex, age-at-birth, singleton or twin status, month of admission and length of stay. OUTCOME MEASURES Using generalized estimating equation (GEE) modeling, we analyzed 24/7 HR data during a 1-hour period between 4:30 and 5:30 am each day in the NICU, when all infants were least disturbed. Using repeated measures ANOVA, we analyzed 24/7 HR data during a 6-week period starting 1 week prior to the start of FNI and ending 5 weeks after start. RESULTS GEE modeling of the 1-hour data from all subjects showed significant lower HR in the FNI group, compared with controls. ANOVA modeling on a subset of subjects over the five-week period showed that FNI infant HR decreased in a dose-response manner relative to SC HR. CONCLUSION This study suggests FNI may condition lower infant HR in a dose-response manner during the NICU stay.
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Lisanti AJ, Demianczyk AC, Costarino A, Vogiatzi MG, Hoffman R, Quinn R, Chittams JL, Medoff-Cooper B. Skin-to-Skin Care is Associated with Reduced Stress, Anxiety, and Salivary Cortisol and Improved Attachment for Mothers of Infants With Critical Congenital Heart Disease. J Obstet Gynecol Neonatal Nurs 2020; 50:40-54. [PMID: 33181093 DOI: 10.1016/j.jogn.2020.09.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the effect of skin-to-skin care (SSC) on biobehavioral measures of stress (anxiety and salivary cortisol) and attachment (attachment scores and salivary oxytocin) of mothers before and after their infants' neonatal cardiac surgery. DESIGN A prospective interventional, baseline response-paired pilot study. SETTING Cardiac center of a large, metropolitan, freestanding children's hospital. PARTICIPANTS Thirty women whose infants were hospitalized for neonatal cardiac surgery. METHODS Participants acted as their own controls before, during, and after SSC at two time points: once before and once after surgery. We measured the stress response of mothers, as indicated by self-reported scores of anxiety and maternal salivary cortisol, and maternal-infant attachment, as indicated by self-reported scores and maternal salivary oxytocin. RESULTS Significant reductions in self-reported scores of anxiety and salivary cortisol were found as a result of SSC at each time point, as well as increased self-reported attachment. No significant differences were found in oxytocin. CONCLUSION Our findings provide initial evidence of the benefits of SSC as a nurse-led intervention to support maternal attachment and reduce physiologic and psychological stress responses in mothers of infants with critical congenital heart disease before and after neonatal cardiac surgery.
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Skin-to-Skin Care Is a Safe and Effective Comfort Measure for Infants Before and After Neonatal Cardiac Surgery. Pediatr Crit Care Med 2020; 21:e834-e841. [PMID: 32740179 PMCID: PMC8865053 DOI: 10.1097/pcc.0000000000002493] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the effect of skin-to-skin care on stress, pain, behavioral organization, and physiologic stability of infants with critical congenital heart disease before and after neonatal cardiac surgery. DESIGN A baseline response-paired design was used, with infants acting as their own controls before, during, and after skin-to-skin care at two distinct time points: once in the preoperative period (T1) and once in the postoperative period (T2). SETTING Cardiac ICU and step-down unit in a large metropolitan freestanding children's hospital. SUBJECTS Convenience sample of 30 infants admitted preoperatively for critical congenital heart disease. INTERVENTIONS Eligible infants were placed into skin-to-skin care for 1 hour with their biological mothers once each at T1 and T2. MEASUREMENTS AND MAIN RESULTS Measurements of stress (salivary cortisol), pain and behavior state (COMFORT scale), and physiologic stability (vital signs) were assessed immediately before skin-to-skin care, 30 minutes into skin-to-skin care, and 30 minutes after skin-to-skin care ended.At both T1 and T2, infant pain scores were significantly decreased (p < 0.0001) and infants moved into a calmer behavior state (p < 0.0001) during skin-to-skin care as compared to baseline. At T1, infants also had significantly reduced heart rate (p = 0.002) and respiratory rate (p < 0.0001) and increased systolic blood pressure (p = 0.033) during skin-to-skin care. At both T1 and T2, infant cortisol remained stable and unchanged from pre-skin-to-skin care to during skin-to-skin care (p = 0.096 and p = 0.356, respectively), and significantly increased from during skin-to-skin care to post-skin-to-skin care (p = 0.001 and p = 0.023, respectively). Exploratory analysis revealed differences in cortisol reactivity for infants with higher baseline cortisol (> 0.3 μg/dL) versus lower (≤ 0.3 μg/dL) prior to skin-to-skin care. Infants with higher baseline cortisol at T2 experienced significantly reduced cortisol during skin-to-skin care (p = 0.025). No significant differences in demographics or baseline variables were found between infants in either group. CONCLUSIONS Skin-to-skin care is a low-cost, low-risk intervention that promotes comfort and supports physiologic stability in infants before and after neonatal cardiac surgery.
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Systematic Review of the Effects of Skin-to-Skin Care on Short-Term Physiologic Stress Outcomes in Preterm Infants in the Neonatal Intensive Care Unit. Adv Neonatal Care 2020; 20:48-58. [PMID: 30893092 DOI: 10.1097/anc.0000000000000596] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants in the neonatal intensive care unit (NICU) are exposed to many stressors. There is growing evidence that chronic stress early in life has long-term neurodevelopmental implications. Skin-to-skin care (SSC) is an intervention used to reduce stress in the NICU. CLINICAL QUESTION In premature infants in the NICU, what is the available evidence that SSC improves short-term physiologic stress outcomes compared with incubator care? SEARCH STRATEGY PubMed and CINAHL were searched for terms related to SSC, stress, physiology, and premature infants. Of 1280 unique articles, 19 were identified that reported on research studies comparing SSC with incubator care in the NICU and reported stress-related physiologic outcome measures. RESULTS Although there have been some mixed findings, the research supports that SSC improves short-term cardiorespiratory stress outcomes compared with incubator care. The evidence is clearer for studies reporting stress hormone outcomes, with strong evidence that SSC reduces cortisol and increases oxytocin levels in preterm infants. IMPLICATIONS FOR PRACTICE AND RESEARCH SSC is safe and has stress-reducing benefits. SSC should be considered an essential component to providing optimal care in the NICU. More research is needed to determine the timing of initiation, duration, and frequency of SSC to optimize the stress-reducing benefits. Future research should include the most fragile infants, who are most likely to benefit from SSC, utilize power analyses to ensure adequate sample sizes, and use sophisticated data collection and analysis techniques to more accurately evaluate the effect of SSC on infants in the NICU.
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Klawetter S, Neu M, Roybal KL, Greenfield JC, Scott J, Hwang S. Mothering in the NICU: A qualitative exploration of maternal engagement. SOCIAL WORK IN HEALTH CARE 2019; 58:746-763. [PMID: 31219407 PMCID: PMC10027385 DOI: 10.1080/00981389.2019.1629152] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
Research suggests maternal engagement in the neonatal intensive care unit (NICU) may positively impact maternal and infant health outcomes. However, the U.S. has lower rates of maternal engagement in the NICU compared to other developed countries. This qualitative study reflects a transdisciplinary research partnership between social work, nursing, and neonatology. Qualitative inquiry explores maternal experiences in the NICU from the perspectives of mothers of preterm infants hospitalized in 2 U.S. NICUs. Results support an ecological systems framework to understanding barriers and facilitators to maternal engagement in the NICU and the utilization of a trauma-informed health care approach in NICU settings.
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Affiliation(s)
| | - Madalynn Neu
- College of Nursing, University of Colorado, Aurora, CO, USA
| | | | | | - Jessica Scott
- Department of Pediatrics/Neonatology, University of Colorado, Aurora, CO, USA
| | - Sunah Hwang
- Department of Pediatrics/Neonatology, University of Colorado and Children’s Hospital Colorado, Aurora, CO, USA
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Klawetter S, Greenfield JC, Speer SR, Brown K, Hwang SS. An integrative review: maternal engagement in the neonatal intensive care unit and health outcomes for U.S.-born preterm infants and their parents. AIMS Public Health 2019; 6:160-183. [PMID: 31297402 PMCID: PMC6606523 DOI: 10.3934/publichealth.2019.2.160] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/21/2019] [Indexed: 11/18/2022] Open
Abstract
Hospitals and perinatal organizations recognize the importance of family engagement in the neonatal intensive care unit (NICU). The Agency for Healthcare Research and Quality (AHRQ) defines family engagement as "A set of behaviors by patients, family members, and health professionals and a set of organizational policies and procedures that foster both the inclusion of patients and family members as active members of the health care team and collaborative partnerships with providers and provider organizations." In-unit barriers and facilitators to enhance family engagement are well studied; however, less is known specifically about maternal engagement's influence in the NICU on the health of infants and mothers, particularly within U.S. social and healthcare contexts. In this integrative review, we examine the relationship between maternal engagement in the NICU and preterm infant and maternal health outcomes within the U.S. Results from the 33 articles that met inclusion criteria indicate that maternal engagement in the NICU is associated with infant outcomes, maternal health-behavior outcomes, maternal mental health outcomes, maternal-child bonding outcomes, and breastfeeding outcomes. Skin-to-skin holding is the most studied maternal engagement activity in the U.S. preterm NICU population. Further research is needed to understand what types of engagement are most salient, how they should be measured, and which immediate outcomes are the best predictors of long-term health and well-being.
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Affiliation(s)
| | | | | | - Kyria Brown
- Graduate School of Social Work, University of Denver, Denver, CO USA; School of Public Health, University of Colorado, Aurora, CO, USA
| | - Sunah S Hwang
- School of Medicine, University of Colorado; Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
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Kahraman A, Başbakkal Z, Yalaz M, Sözmen EY. The effect of nesting positions on pain, stress and comfort during heel lance in premature infants. Pediatr Neonatol 2018; 59:352-359. [PMID: 29248383 DOI: 10.1016/j.pedneo.2017.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 08/21/2017] [Accepted: 11/10/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nesting positions are commonly used in procedural analgesic administration in premature neonates. The effectiveness of nesting positions is questioned. The aim of the this study was to assess the pain, stress, comfort and salivary cortisol and melatonin values in nesting positions during the heel lance procedure in premature infants at the NICU. METHODS Experimental research; repeated measurement design. The sample comprised 33 premature neonates with gestational age of 31-35 weeks who had been hospitalized in the NICU. Nesting positions were given using linen or towels. The procedure of heel lance was recorded on camera. The camera recordings were evaluated according to the NIPS and the COMFORTneo scale. Saliva samples were obtained five minutes prior to and 30 min after the heel lance procedure. Salivary Cortisol and Melatonin were measured using the Salimetrics Cortisol Elisa Kit and the Salimetrics Melatonin Elisa Kit. RESULTS The crying time, the mean NIPS score, the COMFORTneo score, the COMFORTneo NRS-pain scores and the COMFORTneo NRS-distress scores for premature neonates who were in the prone position during the procedure were significantly lower than the scores in the supine position (p < 0.000). Furthermore, the level of salivary cortisol five minutes prior to and 30 min after the heel lance procedure had significantly decreased in the prone position; however, there were insignificant differences in the mean levels of salivary melatonin between the positions. CONCLUSIONS Nesting in the prone position has a pain reducing effect, enhancing comfort and reducing stress in premature infants.
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Affiliation(s)
- Ayşe Kahraman
- Ege University Faculty of Nursing, Bornova, İzmir, Turkey.
| | | | - Mehmet Yalaz
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bornova, İzmir, Turkey.
| | - Eser Y Sözmen
- Ege University Faculty of Medicine, Department of Medical Biochemistry, Bornova, İzmir, Turkey.
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Angelhoff C, Blomqvist YT, Sahlén Helmer C, Olsson E, Shorey S, Frostell A, Mörelius E. Effect of skin-to-skin contact on parents' sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial. BMJ Open 2018; 8:e021606. [PMID: 30068615 PMCID: PMC6074633 DOI: 10.1136/bmjopen-2018-021606] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Separation after preterm birth is a major stressor for infants and parents. Skin-to-skin contact (SSC) is a method of care suitable to use in the neonatal intensive care unit (NICU) to minimise separation between parents and infants. Less separation leads to increased possibilities for parent-infant interaction, provided that the parents' sleep quality is satisfactory. We aimed to evaluate the effect of continuous SSC on sleep quality and mood in parents of preterm infants born <33 weeks of gestation as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge. METHODS AND ANALYSIS A randomised intervention study with two arms-intervention versus standard care. Data will be collected from 50 families. Eligible families will be randomly allocated to intervention or standard care when transferred from the intensive care room to the family-room in the NICU. The intervention consists of continuous SSC for four consecutive days and nights in the family-room. Data will be collected every day during the intervention and again at the time of discharge from the hospital. Outcome measures comprise activity tracker (Actigraph); validated self-rated questionnaires concerning sleep, mood and bonding; observed scorings of parental sensitivity and emotional availability and salivary cortisol. Data will be analysed with pairwise, repeated measures, Mann Whitney U-test will be used to compare groups and analysis of variance will be used to adjust for different hospitals and parents' gender. ETHICS AND DISSEMINATION The study is approved by the Regional Research Ethics Board at an appropriate university (2016/89-31). The results will be published in scientific journals. We will also use conferences and social media to disseminate our findings. TRIAL REGISTRATION NUMBER NCT03004677.
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Affiliation(s)
- Charlotte Angelhoff
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
- Department of Clinical and Experimental Medicine and Department of Paediatrics, Linköping University, Linköping, Sweden
| | | | - Charlotte Sahlén Helmer
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
- Department of Clinical and Experimental Medicine and Department of Paediatrics, Linköping University, Linköping, Sweden
| | - Emma Olsson
- Department of Pediatrics and Centre for Health Care Sciences, Örebro University, Örebro, Sweden
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Anneli Frostell
- Division of Psychology, Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
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Fallah R, Naserzadeh N, Ferdosian F, Binesh F. Comparison of effect of kangaroo mother care, breastfeeding and swaddling on Bacillus Calmette-Guerin vaccination pain score in healthy term neonates by a clinical trial. J Matern Fetal Neonatal Med 2016; 30:1147-1150. [PMID: 27364689 DOI: 10.1080/14767058.2016.1205030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND/AIM The purpose of this research was to compare the analgesic effect of kangaroo mother care (KMC), breastfeeding and swaddling in Bacillus Calmette-Guerin (BCG) vaccination in term neonates. METHODS In a randomized 120 healthy term neonates who received routine BCG vaccination in the first day of their life are distributed into three groups. In group 1, neonates breastfed two minutes before, during and one minute after BCG vaccination. In group 2, neonates received KMC 10 minutes before, during and one minute after vaccination and in group 3, they were swaddled 10 minutes before, during and one minute after vaccination. Primary outcomes included pain score during, one minute and two minutes after BCG vaccination and obtaining pain score of less than three during vaccination . RESULTS Pain scores during, one minute and two minutes after vaccination in group 1 were lower than in groups 2 and 3. Group 1 had higher success rate in painless vaccination and had lower crying duration in comparison to another groups (p < 0.05) Conclusion: Breastfeeding was more effective than KMC and swaddling in reduction of BCG vaccination pain in healthy term neonates.
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Affiliation(s)
- Razieh Fallah
- a Department of Pediatrics , Growth Disorders of Children Research Center, Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | | | - Farzad Ferdosian
- a Department of Pediatrics , Growth Disorders of Children Research Center, Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Fariba Binesh
- c Department of Pathology , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
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15
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Salivary Cortisol Reactivity in Preterm Infants in Neonatal Intensive Care: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13030337. [PMID: 26999185 PMCID: PMC4809000 DOI: 10.3390/ijerph13030337] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/05/2016] [Accepted: 03/14/2016] [Indexed: 12/11/2022]
Abstract
Recently, more and more researchers have been using salivary cortisol reactivity to evaluate stress in preterm infants in the neonatal intensive care unit (NICU). The aim of this integrative literature review was to summarize the evidence of interventions leading to a change in salivary cortisol from the baseline in preterm infants in the NICU. The electronic databases of PubMed, CINAHL, Web of Science, and Scopus were searched for relevant studies. The inclusion criteria were studies with preterm infants exposed to an intervention evaluated by salivary cortisol reactivity before discharge from the NICU, which were published in English. In total, 16 studies were included. Eye-screening examination and heel lance provoked an increase in the salivary cortisol level. Music, prone position, and co-bedding among twins decreased the salivary cortisol level. Several studies reported a low rate of successful saliva sampling or did not use control groups. Future studies need to focus on non-painful interventions in order to learn more about salivary cortisol regulation in preterm infants. Moreover, these studies should use study designs comprising homogenous gestational and postnatal age groups, control groups, and reliable analysis methods that are able to detect cortisol in small amounts of saliva.
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16
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Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU. Arch Womens Ment Health 2016; 19:51-61. [PMID: 25724391 DOI: 10.1007/s00737-015-0502-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 01/04/2015] [Indexed: 10/23/2022]
Abstract
Preterm delivery can precipitate maternal psychological morbidities. Family Nurture Intervention (FNI) was designed to minimize these by facilitating the emotional connection between mother and infant, beginning early in the infant's neonatal intensive care unit (NICU) stay. We examined depression and anxiety symptoms of mothers of preterm infants at 4 months infant corrected age (CA). One hundred fifteen mothers who delivered between 26 and 34 weeks gestational age were randomized to receive standard care (SC) or standard care plus FNI. Mothers' self-reported depressive symptoms (Center for Epidemiologic Studies Depression Scale: CES-D) and state anxiety (Spielberger State-Trait Anxiety Inventory: STAI) symptoms were assessed at enrollment, near to term age, and 4 months (CA). At 4 months CA, mean CES-D and STAI scores were significantly lower in FNI mothers compared to SC mothers. Effectiveness of FNI can only be evaluated as an integrated intervention strategy as it was not possible to control all aspects of FNI activities. Although there was considerable loss to follow-up, analyses suggest that resulting biases could have masked rather than inflated the measured effect size for depressive symptoms. FNI may be a feasible and practicable way to diminish the impact of premature delivery on maternal depressive and anxiety symptoms.
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17
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Koukounari A, Pickles A, Hill J, Sharp H. Psychometric Properties of the Parent-Infant Caregiving Touch Scale. Front Psychol 2015; 6:1887. [PMID: 26696945 PMCID: PMC4678235 DOI: 10.3389/fpsyg.2015.01887] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/22/2015] [Indexed: 12/05/2022] Open
Abstract
Recent work in animals suggests that the extent of early tactile stimulation by parents of offspring is an important element in early caregiving. We evaluate the psychometric properties of a new parent-report measure designed to assess frequency of tactile stimulation across multiple caregiving domains in infancy. We describe the full item set of the Parent-Infant Caregiving Touch Scale (PICTS) and, using data from a UK longitudinal Child Health and Development Study, the response frequencies and factor structure and whether it was invariant over two time points in early development (5 and 9 weeks). When their infant was 9 weeks old, 838 mothers responded on the PICTS while a stratified subsample of 268 mothers completed PICTS at an earlier 5 week old assessment (229 responded on both occasions). Three PICTS factors were identified reflecting stroking, holding and affective communication. These were moderately to strongly correlated at each of the two time points of interest and were unrelated to, and therefore distinct from, a traditional measure of maternal sensitivity at 7-months. A wholly stable psychometry over 5 and 9-week assessments was not identified which suggests that behavior profiles differ slightly for younger and older infants. Tests of measurement invariance demonstrated that all three factors are characterized by full configural and metric invariance, as well as a moderate degree of evidence of scalar invariance for the stroking factor. We propose the PICTS as a valuable new measure of important aspects of caregiving in infancy.
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Affiliation(s)
- Artemis Koukounari
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Andrew Pickles
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Jonathan Hill
- School of Psychology and Clinical Language Sciences, University of Reading Reading, UK
| | - Helen Sharp
- Department of Psychological Science, Institute of Psychology, Health and Society, University of Liverpool Liverpool, UK
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18
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Aldrete-Cortez V, Perapoch J, Poblano A. Skin to skin care and heart rate regulation. Early Hum Dev 2015; 91:705-6. [PMID: 26529176 DOI: 10.1016/j.earlhumdev.2015.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Vania Aldrete-Cortez
- School of Psychology, Panamerican University at Mexico City, Augusto Rodin 498, Benito Juárez, Insurgentes Mixcoac, 03920 México City, Mexico.
| | - Joseph Perapoch
- Neonatology Unit of Hospital Materno-Infantil del Vall d' Hebrón, Passeig de la Vall d'Hebrón, 119 CP08035, Barcelona, Spain
| | - Adrián Poblano
- Clinic of Sleep Disorders, National University of Mexico (UNAM), México City, Mexico; Laboratory of Cognitive Neurophysiology, National Institute of Rehabilitation, México City, Mexico
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19
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Harrison TM, Ludington-Hoe S. A Case Study of Infant Physiologic Response to Skin-to-Skin Contact After Surgery for Complex Congenital Heart Disease. J Cardiovasc Nurs 2015; 30:506-16. [PMID: 25325374 PMCID: PMC4400181 DOI: 10.1097/jcn.0000000000000202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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. 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. The 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 before 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 after surgery for complex congenital heart disease. Further research with a larger sample is needed to examine the 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.
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Affiliation(s)
- Tondi M Harrison
- Tondi M. Harrison, PhD, RN, CPNP Assistant Professor, School of Nursing, University of Minnesota, Minneapolis. Susan Ludington-Hoe, PhD, CNM, FAAN Carl W. and Margaret Davis Walter Professor of Pediatric Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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20
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Effect of Skin-to-Skin Holding on Stress in Mothers of Late-Preterm Infants: A Randomized Controlled Trial. Adv Neonatal Care 2015; 15:354-64. [PMID: 26356086 DOI: 10.1097/anc.0000000000000223] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the effect of skin-to-skin care (SSC) on stress perception between mothers who provided SSC to their late-preterm born infants and mothers who provided blanket holding. DESIGN AND METHODS This was a longitudinal 2-group randomized controlled trial of 40 infant-mother dyads recruited from a level 3 neonatal intensive care unit in the upper Midwest. OUTCOME MEASURE Maternal stress was measured using the Parental Stressor: Neonatal Intensive Care Unit (PSS: NICU) scale pre- and post-SSC intervention. Demographic and other mother and infant covariates were extracted from medical records. Physiologic stability was measured by the Stability of the Cardiorespiratory System in Preterm Infants (SCRIP) score. Study personnel used daily logs to track frequency and duration of SSC and holding sessions. RESULTS The intervention and the control groups had similar pre- (mean ± standard deviation, 2.34 ± 0.86 for SSC and 2.94 ± 0.87 for holding) and post-intervention (mean ± standard deviation, 2.55 ± 0.95 for SSC and 2.78 ± 0.90 for holding) overall stress scores. Hours of SSC holding positively correlated with the change in stress scores for the entire scale (r = 0.58; P = .001), and for infant appearance (r = 0.58; P = .001) and parent role alteration (r = 0.48; P = .02) subscales. This relationship remained significant after controlling for the infant's length of stay and SCRIP score. IMPLICATIONS FOR PRACTICE Mothers who provide SSC may experience more stress related to a more facilitated progression in the mother and infant relationship. IMPLICATIONS FOR RESEARCH The relationship between increased stress and the number of hours of SSC holding warrants further investigation.
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21
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Mörelius E, Anderson GC. Neonatal nurses’ beliefs about almost continuous parent-infant skin-to-skin contact in neonatal intensive care. J Clin Nurs 2015; 24:2620-7. [DOI: 10.1111/jocn.12877] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Evalotte Mörelius
- Department of Social and Welfare Studies; Division of Health, Activity, and Care; Linköping University; Linköping Sweden
| | - Gene Cranston Anderson
- Emeritus and Courtesy Faculty; University of Florida; Gainesville FL USA
- Case Western Reserve University; Cleveland OH USA
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22
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Mörelius E, Örtenstrand A, Theodorsson E, Frostell A. A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Hum Dev 2015; 91:63-70. [PMID: 25545453 DOI: 10.1016/j.earlhumdev.2014.12.005] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/25/2014] [Accepted: 12/09/2014] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the effects of almost continuous skin-to-skin contact (SSC) on salivary cortisol, parental stress, parental depression, and breastfeeding. STUDY DESIGN This is a randomised study engaging families of late preterm infants (32-35 weeks gestation). Salivary cortisol reactivity was measured in infants during a nappy change at one month corrected age, and in infants and mothers during still-face at four month corrected age. Both parents completed the Swedish Parenthood Stress Questionnaire (SPSQ) at one month and the Edinburgh Postnatal Depression Scale (EPDS) at one and four months. Ainsworth's sensitivity scale was used to control for parental sensitivity. SUBJECTS Thirty-seven families from two different neonatal care units in Sweden, randomised to either almost continuous SSC or standard care (SC). RESULTS Infants randomised to SSC had a lower salivary cortisol reactivity at one month (p=0.01). There was a correlation between the mothers' and the preterm infants' salivary cortisol levels at four months in the SSC group (ρ=0.65, p=0.005), but not in the SC group (ρ=0.14, p=0.63). Fathers in SSC scored lower on the SPSQ sub-scale spouse relationship problems compared to fathers in SC (p<0.05). CONCLUSIONS Almost continuous SSC decreases infants' cortisol reactivity in response to handling, improves the concordance between mothers' and infants' salivary cortisol levels, and decreases fathers' experiences of spouse relationship problems.
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Affiliation(s)
- Evalotte Mörelius
- Department of Social and Welfare Studies, Division of Health, Activity and Care, Linköping University, Norrköping, Sweden; Department of Pediatrics, County Council of Östergötland, Linköping, Sweden.
| | - Annika Örtenstrand
- Department of Woman and Child Health, Division of Neonatology, Karolinska Institutet, Stockholm, Sweden
| | - Elvar Theodorsson
- Department of Clinical and Experimental Medicine, Division of Clinical Chemistry, Linköping University, Linköping, Sweden
| | - Anneli Frostell
- Department of Behavioural Sciences and Learning, Division of Psychology, Linköping University, Linköping, Sweden
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