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Lin S, Li L, Ren X, Zhong C, Wu K, Fang X, Liang S, Chen X, Chen J, Yang L, Wang X, Wang B. Effects of White Noise on Pain Scores and Salivary Cortisol Levels in Surgical Neonates: A Randomized Controlled Trial. Adv Neonatal Care 2024; 24:291-300. [PMID: 38815280 DOI: 10.1097/anc.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Neonates experience varying intensities of pain after surgery. While white noise has been used for postoperative pain relief in infants, its effects on neonates after surgery need further exploration. PURPOSE This study aimed to evaluate the effects of white noise on pain scores and salivary cortisol levels in surgical neonates. METHODS In this randomized controlled trial, 64 neonates scheduled for surgery were recruited and assigned by block randomization into 2 groups. The intervention group listened to white noise at 50 dB, while the control group listened to white noise at 0 dB, for 30 minutes 6 times for 48 hours postoperatively. Pain scores, measured by the COMFORTneo Scale, and salivary cortisol levels were compared. RESULTS Although pain scores decreased after surgery in all subjects, no statistically significant difference was observed between the 2 groups (P = .937). There was a significant difference between pre- and postintervention pain scores in the intervention group only (P = .006). Salivary cortisol levels decreased after intervention in the intervention group, but there was no significant difference between pre- and postintervention levels in the 2 groups (P = .716). IMPLICATIONS FOR PRACTICE Given the reduction in pain scores and salivary cortisol concentrations after white noise intervention, white noise shows potential as an adjunctive soothing measure for neonates after surgery. IMPLICATIONS FOR RESEARCH Future studies are needed to confirm the efficacy and utility of white noise intervention in clinical settings.
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Affiliation(s)
- Siya Lin
- Clinical Nursing Education and Research Section (Ms Lin, Dr Li, and Mss Ren and J. Chen), Department of Nursing (Ms Lin), Department of Neonatology, Pediatrics Center (Mss Zhong and Fang, and Dr B. Wang), Department of Pediatric Surgery, Pediatrics Center (Drs Wu and Yang), Department of Laboratory Medicine (Messrs Liang and X. Chen), Department of Cardiovascular Surgery (Dr X. Wang), Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Rocha VAD, Cruz-Machado SDS, Silva IA, Fernandes PACM, Markus RP, Bueno M. Identification of Inflammatory Mediators in Saliva Samples From Hospitalized Newborns: Potential Biomarkers? Clin Nurs Res 2024; 33:207-219. [PMID: 38506123 DOI: 10.1177/10547738241238249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Saliva measurements serve as a noninvasive tool for clinically monitoring newborns (NB) and children, a vulnerable population with promising potential for both research and clinical practice. Saliva acts as a repository for various inflammatory biomarkers involved in diverse biological functions. Particularly for children, it offers numerous advantages when compared to plasma and urine sampling. Nevertheless, there is a significant knowledge gap regarding detectable levels of cytokines in the saliva of newborns and children, as well as studies aiming to assess the relationship of this content with physiological and pathological processes. OBJECTIVES To characterize the levels of 11 inflammatory mediators (IFNg, IL1b, IL2, IL4, IL6, IL8, IL10, IL12, IL17, TNF, and VEGF) in saliva samples from NB on the first and second day of hospitalization in the Neonatal Intensive Care Unit (NICU). METHOD Exploratory study, descriptive, nested within a primary clinical, observational, and prospective study, conducted in the NICU of a public hospital in São Paulo, Brazil. Demographic data and vital signs were recorded in the clinical records of 90 NB, and five saliva samples from 5 NB were collected between the first and second day of life (D1-D2) at approximately 8-hr intervals (8-9 am, 4-5 pm, and 11-12 pm). Saliva samples were used for the measurement of 11 cytokines (IFNg, IL1b, IL2, IL4, IL6, IL8, IL10, IL12, IL17, TNF, and VEGF). RESULTS Five NBs participated in this exploratory study, and the vital signs showed variability from the first (D1) to the second day (D2) of hospitalization, variability similar to that of the total population of the primary study. The presence and levels of the 11 cytokines were detected in the saliva samples, as well as a statistical correlation between 10 cytokines (IFNg, IL1b, IL2, IL4, IL6, IL10, IL12, IL17, TNF, and VEGF) and vital signs. CONCLUSIONS The novelty of measuring inflammatory mediators in saliva samples from hospitalized NBs in the NICU is highlighted, providing support and new perspectives for the development of clinical and experimental research and an opportunity for developing and implementing new salivary biomarkers in different population segments.
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Affiliation(s)
- Vanderlei Amadeu da Rocha
- Universidade de São Paulo, Hospital Universitário, Unidade de Terapia Intensiva Pediátrica e Neonatal, São Paulo, SP, Brasil
| | | | - Isília Aparecida Silva
- Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiatrica, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Regina Pekelmann Markus
- Universidade de São Paulo, Instituto de Biociências, Laboratório de Cronofarmacologia, São Paulo, SP, Brasil
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Baudat M, Simons SHP, Joosten EAJ. Repetitive neonatal procedural pain affects stress-induced plasma corticosterone increase in young adult females but not in male rats. Dev Psychobiol 2024; 66:e22478. [PMID: 38433425 DOI: 10.1002/dev.22478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
Exposure to repetitive painful procedures in the neonatal intensive care unit results in long-lasting effects, especially visible after a "second hit" in adulthood. As the nociceptive system and the hypothalamic-pituitary-adrenal (HPA) axis interact and are vulnerable in early life, repetitive painful procedures in neonates may affect later-life HPA axis reactivity. The first aim of the present study was to investigate the effects of repetitive neonatal procedural pain on plasma corticosterone levels after mild acute stress (MAS) in young adult rats. Second, the study examined if MAS acts as a "second hit" and affects mechanical sensitivity. Fifty-two rats were either needle pricked four times a day, disturbed, or left undisturbed during the first neonatal week. At 8 weeks, the animals were subjected to MAS, and plasma was collected before (t0), after MAS (t20), and at recovery (t60). Corticosterone levels were analyzed using an enzyme-linked immunosorbent assay, and mechanical sensitivity was assessed with von Frey filaments. Results demonstrate that repetitive neonatal procedural pain reduces stress-induced plasma corticosterone increase after MAS only in young adult females and not in males. Furthermore, MAS does not affect mechanical sensitivity in young adult rats. Altogether, the results suggest an age- and sex-dependent effect of repetitive neonatal procedural pain on HPA axis reprogramming.
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Affiliation(s)
- Mathilde Baudat
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sinno H P Simons
- Deptartment of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Centre Rotterdam - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elbert A J Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Zhang Q, Huo Q, Chen P, Yao W, Ni Z. Effects of white noise on preterm infants in the neonatal intensive care unit: A meta-analysis of randomised controlled trials. Nurs Open 2024; 11:e2094. [PMID: 38268285 PMCID: PMC10794858 DOI: 10.1002/nop2.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/14/2023] [Accepted: 12/25/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To critically assess the effects of white noise on the pain level, weight gain and vital signs (heart rate, respiratory rate and oxygen saturation) of preterm infants in neonatal intensive care units (NICUs). DESIGN A systematic review and meta-analysis of randomised controlled trials (RCTs). METHODS Ten databases (PubMed, Cochrane Library, Embase, Web of Science, CINAHL, PsycINFO, SinoMed, China National Knowledge Infrastructure, VIP and Wanfang Data) were systematically reviewed from inception to July 2022. Two reviewers evaluated the risk of bias separately using the Cochrane Collaboration criteria and extracted data using a predesigned information form. RESULTS The meta-analysis included eight eligible RCTs. According to statistical analysis, white noise significantly affected the pain level, weight gain, heart rate, respiratory rate and oxygen saturation in preterm infants. Regardless of the outcome measurement timing, gestational age and birth weight of preterm infants, subgroup analysis demonstrated that white noise reduced the pain level, heart rate and respiratory rate and promoted weight gain in preterm infants in NICUs. CONCLUSION White noise is a practical and potentially useful therapy for premature neonates in NICUs. No Patient or Public Contribution.
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Affiliation(s)
- Qing Zhang
- Department of NeonatologyChildren's Hospital of Soochow UniversitySoochowChina
| | - Qiugui Huo
- Department of NeonatologyChildren's Hospital of Soochow UniversitySoochowChina
| | - Peizhen Chen
- Department of NeonatologyChildren's Hospital of Soochow UniversitySoochowChina
| | - Wenying Yao
- Department of NursingChildren's Hospital of Soochow UniversitySoochowChina
| | - Zhihong Ni
- Department of NursingChildren's Hospital of Soochow UniversitySoochowChina
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Bousquet A, Sanderson K, O’Shea TM, Fry RC. Accelerated Aging and the Life Course of Individuals Born Preterm. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1683. [PMID: 37892346 PMCID: PMC10605448 DOI: 10.3390/children10101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Individuals born preterm have shorter lifespans and elevated rates of chronic illness that contribute to mortality risk when compared to individuals born at term. Emerging evidence suggests that individuals born preterm or of low birthweight also exhibit physiologic and cellular biomarkers of accelerated aging. It is unclear whether, and to what extent, accelerated aging contributes to a higher risk of chronic illness and mortality among individuals born preterm. Here, we review accelerated aging phenotypes in adults born preterm and biological pathways that appear to contribute to accelerated aging. We highlight biomarkers of accelerated aging and various resiliency factors, including both pharmacologic and non-pharmacologic factors, that might buffer the propensity for accelerated aging among individuals born preterm.
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Affiliation(s)
- Audrey Bousquet
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (A.B.); (R.C.F.)
| | - Keia Sanderson
- Department of Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - T. Michael O’Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (A.B.); (R.C.F.)
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Luo F, Zhu H, Mei L, Shu Q, Cheng X, Chen X, Zhao Y, Chen S, Pan Y. Evaluation of procedural pain for neonates in a neonatal intensive care unit: a single-centre study. BMJ Paediatr Open 2023; 7:e002107. [PMID: 37821124 PMCID: PMC10582867 DOI: 10.1136/bmjpo-2023-002107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/16/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND To evaluate the procedural pain experienced by neonates in a neonatal intensive care unit (NICU) setting and determine the corresponding pain grades. METHODS Two experienced nurses independently used the Neonatal Infant Pain Scale (NIPS) to evaluate the neonatal pain during procedures taking place in the tertiary NICU and two level-two neonatal care units in the Children's Hospital of Zhejiang University School of Medicine. The mean and distribution of NIPS pain scores and the corresponding pain grades of participants when experiencing clinical painful procedures were analysed. RESULTS A total of 957 neonates exposed to 15 common clinical painful procedures were included in the study. The clinical painful procedures experienced by 957 participants could be divided into three groups: severe pain (NIPS score 5-7: peripheral intravenous cannulation, arterial catheterisation, arterial blood sampling, peripherally inserted central catheter placement and nasopharyngeal suctioning), mild to moderate pain (NIPS score 3-4: finger prick, intramuscular injection, adhesive removal, endotracheal intubation suctioning, heel prick, lumbar puncture and subcutaneous injection) and no pain to mild pain (NIPS score 0-2: gastric tube insertion, enema and intravenous injection). CONCLUSIONS The neonatal pain response to clinical procedures in NICU had certain pattern and preintervention drug analgesia could be taken for painful procedures with clustered high NIPS pain scores. Meanwhile, full coverage non-drug pain relief measures could be taken for procedures that are with scattered pain scores, and real-time pain evaluation should be provided to determine whether further drug analgesia is required.
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Affiliation(s)
- Feixiang Luo
- Neonatal Intensive Care Unit, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Huaiyu Zhu
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lingli Mei
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qi Shu
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaoying Cheng
- Quality Improvement Office, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaofei Chen
- Gastroenterology Department, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yisheng Zhao
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shuohui Chen
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yun Pan
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
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Ulmer-Yaniv A, Yirmiya K, Peleg I, Zagoory-Sharon O, Feldman R. Developmental Cascades Link Maternal-Newborn Skin-to-Skin Contact with Young Adults' Psychological Symptoms, Oxytocin, and Immunity; Charting Mechanisms of Developmental Continuity from Birth to Adulthood. BIOLOGY 2023; 12:847. [PMID: 37372132 DOI: 10.3390/biology12060847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
Premature birth disrupts the continuity of maternal-newborn bodily contact, which underpins the development of physiological and behavioral support systems. Utilizing a unique cohort of mother-preterm dyads who received skin-to-skin contact (Kangaroo Care, KC) versus controls, and following them to adulthood, we examined how a touch-based neonatal intervention impacts three adult outcomes; anxiety/depressive symptoms, oxytocin, and secretory immunoglobulin A (s-IgA), a biomarker of the immune system. Consistent with dynamic systems' theory, we found that links from KC to adult outcomes were indirect, mediated by its effects on maternal mood, child attention and executive functions, and mother-child synchrony across development. These improvements shaped adult outcomes via three mechanisms; (a) "sensitive periods", where the infancy improvement directly links with an outcome, for instance, infant attention linked with higher oxytocin and lower s-IgA; (b) "step-by-step continuity", where the infancy improvement triggers iterative changes across development, gradually shaping an outcome; for instance, mother-infant synchrony was stable across development and predicted lower anxiety/depressive symptoms; and (c) "inclusive mutual-influences", describing cross-time associations between maternal, child, and dyadic factors; for instance, from maternal mood to child executive functions and back. Findings highlight the long-term impact of a birth intervention across development and provide valuable insights on the mechanisms of "developmental continuity", among the key topics in developmental research.
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Affiliation(s)
- Adi Ulmer-Yaniv
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
| | - Karen Yirmiya
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
| | - Itai Peleg
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
| | - Orna Zagoory-Sharon
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
| | - Ruth Feldman
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
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Li W, Zhang H, Huang X, Ye R, Lin Y. Effects of routine procedures on salivary cortisol in mechanically ventilated neonates. Sci Rep 2023; 13:4622. [PMID: 36944698 PMCID: PMC10030645 DOI: 10.1038/s41598-023-29913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/13/2023] [Indexed: 03/23/2023] Open
Abstract
Even though the stress secondary to invasive procedures has been investigated, less attention has been paid to the stimulation or pain caused by routine procedures on neonates. The changes in salivary cortisol concentration in mechanically ventilated NICU patients during routine procedures were monitored to provide reference and guidance for pain management. 80 mechanically ventilated neonates in the hospital from Sep 2021 to Mar 2022 were selected. The salivary cortisol levels of the neonates were monitored during nursing procedures and were categorized by their risk levels to the following groups: high-risk (endotracheal suctioning and arterial blood sampling), moderate-risk (gastric tube insertion, venipuncture), and low-risk (bedside bathing and diaper changes). The changes in heart rate were also recorded and compared. The concentration of cortisol in the saliva of the neonates was 1.5 ± 0.8 nmol/L during the sleeping state, 6.2 ± 1.3 nmol/L during endotracheal suctioning, 6.4 ± 1.4 nmol/L during arterial blood sampling, 6.1 ± 1.2 nmol/L during venipuncture, 4.4 ± 1.1 nmol/L during gastric tube insertion, 3.5 ± 0.8 nmol/L during bedside bathing, and 3.3 ± 0.9 nmol/L during a diaper change. The results revealed a statistically significant effect between routine procedures on salivary cortisol levels. Compared with the neonates in the control sleep state, there was a significant (P < 0.05) change in salivary cortisol concentration of infants undergoing high and moderate-risk nursing procedures. There was a small but significant (P < 0.05) change in salivary cortisol levels in infants who underwent low-risk procedures compared to infants in the control sleep state. Further, the fluctuation of salivary cortisol levels in routine procedures was more frequent compared with routine handling at night. The fluctuations of salivary cortisol concentration in high-risk procedures were larger than that of infants who underwent low-risk procedures, with the difference being statistically significant (P < 0.05). It was also determined that the top four influencing factors on the infants' heart rate were arterial blood sampling venipuncture, intubation, endotracheal suctioning, and gastric tube insertion (P < 0.05). Monitoring the saliva cortisol concentration index and heart rates can reflect the impact of different routine procedures on newborns and can be used to manage neonatal pain in the future.
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Affiliation(s)
- Wanting Li
- Fujian Provincial key Laboratory of Neonatal Diseases, Xiamen, China
- Xiamen Children's Hospital, Xiamen, China
| | | | - Xianghui Huang
- Fujian Provincial key Laboratory of Neonatal Diseases, Xiamen, China.
- Xiamen Children's Hospital, Xiamen, China.
| | - Ruming Ye
- Xiamen Children's Hospital, Xiamen, China
| | - Ying Lin
- Fujian Provincial key Laboratory of Neonatal Diseases, Xiamen, China
- Xiamen Children's Hospital, Xiamen, China
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Cortisol reactivity and negative affect among preterm infants at 12 months during a mother-infant interaction task. Infant Behav Dev 2023; 70:101784. [PMID: 36401957 DOI: 10.1016/j.infbeh.2022.101784] [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: 05/05/2022] [Revised: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to investigate correlates of preterm (PT) infant's cortisol reactivity and the association to infant negative affect, during a mother-infant interaction procedure. Participants included 48 infants born prematurely (gestational age < 37 weeks) and their mothers, assessed when infants were 12 months old corrected for prematurity. The examined variables comprised both neonatal and environmental dimensions including maternal interactive behavior. Infant negative affect and maternal interactive behavior were assessed with a standardized mother-infant interaction task. A baseline infant saliva sample was collected before the interaction began, and a second sample after the interaction episodes ended. Results revealed that decrease of infant's cortisol concentration was significantly associated with the exposure to more sensitive, and less intrusive maternal behaviors. However, once controlled for neonatal risk, family SES and maternal psychological distress, the associations were rendered non-significant. Although the association between cortisol reactivity and negative affect trended toward significance, maternal intrusiveness was the only significant predictor of observed infant negative affect. Findings suggest the importance of primary relational experiences on PT infants' early regulatory competencies.
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Vulnerability of the Neonatal Connectome following Postnatal Stress. J Neurosci 2022; 42:8948-8959. [PMID: 36376077 PMCID: PMC9732827 DOI: 10.1523/jneurosci.0176-22.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Stress following preterm birth can disrupt the emerging foundation of the neonatal brain. The current study examined how structural brain development is affected by a stressful early environment and whether changes in topological architecture at term-equivalent age could explain the increased vulnerability for behavioral symptoms during early childhood. Longitudinal changes in structural brain connectivity were quantified using diffusion-weighted imaging (DWI) and tractography in preterm born infants (gestational age <28 weeks), imaged at 30 and/or 40 weeks of gestation (N = 145, 43.5% female). A global index of postnatal stress was determined based on the number of invasive procedures during hospitalization (e.g., heel lance). Higher stress levels impaired structural connectivity growth in a subnetwork of 48 connections (p = 0.003), including the amygdala, insula, hippocampus, and posterior cingulate cortex. Findings were replicated in an independent validation sample (N = 123, 39.8% female, n = 91 with follow-up). Classifying infants into vulnerable and resilient based on having more or less internalizing symptoms at two to five years of age (n = 71) revealed lower connectivity in the hippocampus and amygdala for vulnerable relative to resilient infants (p < 0.001). Our findings suggest that higher stress exposure during hospital admission is associated with slower growth of structural connectivity. The preservation of global connectivity of the amygdala and hippocampus might reflect a stress-buffering or resilience-enhancing factor against a stressful early environment and early-childhood internalizing symptoms.SIGNIFICANCE STATEMENT The preterm brain is exposed to various external stimuli following birth. The effects of early chronic stress on neonatal brain networks and the remarkable degree of resilience are not well understood. The current study aims to provide an increased understanding of the impact of postnatal stress on third-trimester brain development and describe the topological architecture of a resilient brain. We observed a sparser neonatal brain network in infants exposed to higher postnatal stress. Limbic regulatory regions, including the hippocampus and amygdala, may play a key role as crucial convergence sites of protective factors. Understanding how stress-induced alterations in early brain development might lead to brain (re)organization may provide essential insights into resilient functioning.
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Olszewska M, Pointinger-Tomasik S, Kwinta P. Assessment of salivary cortisol concentrations for procedural pain monitoring in newborns. J Perinat Med 2022; 51:564-572. [PMID: 36282969 DOI: 10.1515/jpm-2022-0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study aimed to evaluate the usefulness of salivary cortisol (SC) for the assessment of procedural pain intensity in preterm and term newborns. METHODS Three groups of neonates (term, 370-416 weeks; moderate to late preterm, 320-366; and very preterm, <320) hospitalized in neonatal intensive care unit were assessed for the study. Response to nappy change, lung ultrasound (LUS), and blood sampling was analyzed. The intensity of pain was evaluated using continuous heart rate and blood oxygen saturation (SpO2) monitoring, Neonatal Infant Pain Scale (NIPS), and SC concentrations. Saliva samples were collected before and 20 min after the procedure's end. RESULTS Seventy-one infants were examined: 30 term, 21 moderate to late preterm, and 20 very preterm. SC has increased significantly in response to nappy change only in very preterm newborns (2.13 ng/mL [1.55-3.68] vs. 2.84 ng/mL [1.93-9.06], p = 0.01). LUS did not affect concentrations of SC in any group. Significant increase in SC was observed after blood sampling in term and very preterm infants (2.2 ng/mL [1.45-2.92] vs. 4.29 ng/mL [3.88-5.73], p = 0.002, and 1.88 ng/mL [1.47-4.13] vs. 5.3 ng/mL [3.42-8.02], p = 0.002, respectively). A significant correlation between values of SC increase and NIPS scores was found (Spearman's rank correlation coefficient [rs] = 0.31, p = 0.001). CONCLUSIONS We observed the increase in SC concentrations in response to painful stimulus. The presence of a correlation between NIPS scores and SC increase suggests that SC can be used as an objective parameter to assess pain in neonates.
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Affiliation(s)
- Marta Olszewska
- Department of Pediatrics, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Przemko Kwinta
- Department of Pediatrics, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Kolomboy F, Fatmawati A, Hadriani H, Lisnawati L, Elisanti AD. What Did the Neonatal Integrative Developmental Care Model and Routine Developmental Care Affect on Stress of Premature Babies? Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Neonatal integrative developmental care model (NIDCM) is a holistic model of premature baby care referring to seven basic neuroprotective developmental cares (DCs) by involving the family.
AIM: This study aimed to assess the effect of the application of NIDCM on the stress response of premature babies.
METHODS: The research design used was quasi-experimental with a non-equivalent control group pre- and post-test. The study was conducted in the neonatal care room of Dr. Wahidin Sudirohusodo Makassar Hospital from January 2020 to April 2021. The sample was 76 subjects consisting of 38 premature babies (19 controls and 19 interventions) and 38 mothers (19 controls and 19 interventions). The collected samples were taken to the Medical Research Laboratory of Universitas Hasanuddin (HUMRC) for testing. Furthermore, baby stress was assessed from salivary cortisol levels by enzyme linked immunosorbent assay. In addition, the effect of initial cortisol, final cortisol, and birth weight on changes in salivary cortisol in premature babies was determined using the Chi-square test.
RESULTS: Neither NIDCM intervention nor routine DC has been shown to descriptive statistically decrease the stress response of premature babies in the neonatal care room, some of which are even increased. However, specifically in premature babies with a birth weight of <1800 g, NIDCM showed a better effect in lowering cortisol after treatment than regular DC.
CONCLUSIONS: The application of NIDCM intervention reduces the stressor felt by the babies in the neonatal care room, besides the condition of babies with a birth weight of fewer than 1800 g needs special attention with the NIDCM intervention.
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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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van Dokkum NH, de Kroon MLA, Dijk PH, Kraft KE, Reijneveld SA, Bos AF. Course of Stress during the Neonatal Intensive Care Unit Stay in Preterm Infants. Neonatology 2022; 119:84-92. [PMID: 34883490 DOI: 10.1159/000520513] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Understanding the course of stress during the neonatal intensive care unit stay may provide targets for interventions. Our aim was to describe the course of stress in preterm infants during the first 28 days of life, the influence of gestational age, and associations with clinical characteristics. METHODS In a single centre prospective cohort study, we included infants with a gestational age <30 weeks and/or birth weight <1,000 g. We measured stress over the first 28 days using the Neonatal Infant Stressor Scale (NISS). We plotted daily NISS total and subcategory scores by gestational age. The subcategories were (1) nursing, (2) skin-breaking, (3) monitoring and imaging, and (4) medical morbidity-related scores. We assessed associations of cumulative NISS scores over the first 7, 14, and 28 days with clinical characteristics using regression analyses. RESULTS We included 45 infants, with a median gestational age of 27 weeks. The mean daily NISS score was 66.5 (SD 8.7), with highest scores in the first 7 days of life. Scores decreased the slowest for the lowest gestational ages, in particular for nursing scores, rather than skin-breaking, monitoring and imaging, and medical morbidity-related scores. Adjusted for gestational age, infants with lower Apgar scores, sepsis, intraventricular haemorrhages, and on mechanical ventilation had significantly higher cumulative NISS scores at 7, 14, and 28 days. CONCLUSION NISS scores varied greatly within infants and over time, with the highest mean scores in the first week after birth. The course of declining NISS scores in the first 28 days depended on gestational age at birth.
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Affiliation(s)
- Nienke H van Dokkum
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlou L A de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter H Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karianne E Kraft
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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Yin T, Liaw JJ, Tien CH, Wu HP, Chang YC, Lan HY. Effects of a tripartite intervention on biological stress in preterm infants during heel pricks for newborn screening: A randomized controlled trial. Res Nurs Health 2021; 45:34-45. [PMID: 34914128 DOI: 10.1002/nur.22204] [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: 11/13/2020] [Revised: 10/11/2021] [Accepted: 11/25/2021] [Indexed: 11/07/2022]
Abstract
This prospective randomized trial examined the effects of a tripartite intervention (behavioral state modulation + nonnutritive sucking + tucking) on stress from procedural pain during heel pricks. Blood samples for routine screening were collected by heel pricks 48 h after birth (Stage 1) and at ≥37 weeks' gestation (Stage 2); salivary cortisol levels (SCLs) pre-prick (T0) and 20 min post-prick (T1) assessed stress. Preterm infants (n = 64) sampled by convenience at Level III neonatal care units were randomly assigned to the control condition (usual care) or intervention condition (tripartite intervention). Generalized estimating equations examined differences in salivary cortisol between conditions. After adjusting for effects of gestational age, postmenstrual age, and baseline SCLs, (1) at Stage 1, the change in salivary cortisol from T0 to T1 in preterm infants who received the tripartite intervention was, on average, significantly lower by 0.431 units (log scale) than the change in preterm infants who received the control condition (p < 0.001); (2) in the tripartite intervention condition, the difference between the change in mean SCLs from T0 to T1 at Stages 1 and 2 was significantly lower by 0.287 units (log scale), on average than between the change at Stages 1 and 2 in the control condition (p = 0.026). The provision of a tripartite intervention during heel prick significantly decreased the raise of SCLs compared with infants receiving usual care, suggesting lower stress. Clinicians could easily implement the tripartite intervention for heel-stick support; however, replication is needed before recommending its incorporation into routine heel stick and other stressful procedures.
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Affiliation(s)
- Ti Yin
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Chiung-Hsi Tien
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Hsiang-Ping Wu
- Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chia-Yi City, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan
| | - Hsiang-Yun Lan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
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16
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Benoit B, Cassidy C, van Wijlen J, Correll Q, Campbell-Yeo M, Hendra S, Martin-Misener R, MacDougall J, Cameron A. CO-DEVELOPMENT OF IMPLEMENTATION INTERVENTIONS TO SUPPORT PARENT-LED INFANT PAIN CARE: A QUALITATIVE DESCRIPTIVE STUDY PROTOCOL (Preprint). JMIR Res Protoc 2021; 11:e33770. [PMID: 35930339 PMCID: PMC9391977 DOI: 10.2196/33770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Untreated pain in infants is associated with adverse health outcomes. Despite strong evidence for accessible, effective, and low-cost parent-led pain-relieving interventions such as breastfeeding or chestfeeding and skin-to-skin contact, these interventions are not routinely used. Objective The objective of this study is to support the implementation of parent-led pain interventions by identifying barriers to and facilitators of parent-led, evidence-informed pain care in infants during acute procedures. In addition, this study aims to develop theory-informed, contextually relevant implementation interventions for supporting the use of parent-led pain care for infants in hospital and community contexts. Methods This study will consist of 2 phases that follow a systematic, theoretically informed approach guided by the Theoretical Domains Framework and Behavior Change Wheel. In phase 1, we will use a qualitative descriptive design to explore barriers and facilitators to using parent-led pain care in infants from the perspectives of hospital and community-based clinicians, clinical leaders, and families. In phase 2, we will use the Behavior Change Wheel to design tailored implementation interventions that have evidence for effectively addressing identified barriers in collaboration with an advisory committee of administrative, clinical, and family leaders. Results Ethics approval for this study was obtained in December 2020. As of May 2022, a total of 15 participants have been enrolled in phase 1. The results from all phases will be reported in 2023. Conclusions Following the completion of this study, we will have co-designed theoretically informed implementation interventions that can be pilot-tested and experimentally applied. The findings will be used to implement parent-led interventions that improve patient safety and health outcomes for diverse families. International Registered Report Identifier (IRRID) DERR1-10.2196/33770
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Affiliation(s)
- Britney Benoit
- Rankin School of Nursing, St Francis Xavier University, Antigonish, NS, Canada
| | | | | | - Quinn Correll
- Rankin School of Nursing, St Francis Xavier University, Antigonish, NS, Canada
| | | | - Sionnach Hendra
- Rankin School of Nursing, St Francis Xavier University, Antigonish, NS, Canada
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17
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Souza-Vogler SRD, Lima GMDS. The effect of kangaroo care on modulate chronic stress response in preterm infants and mothers. Stress 2021; 24:742-752. [PMID: 33843436 DOI: 10.1080/10253890.2021.1900107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To assess stress experienced during Neonatal Intensive Care Unit (NICU) stay, we analyzed fingernail Cortisol (CORT) and Dehydroepiandrosterone (DHEA) levels and ratios in mothers and preterm infants (PI); compared hormones levels/ratio (CORT and DHEA) in kangaroo care (KC) versus standard care (SC) groups and examined relationships between PI hormone levels total days spent in the NICU. Mothers and their infants were recruited in the NICU, included levels I-IV and kangaroo care unit, within one week of infant birth in hospitals in Brazil. At 3 months after birth, mothers provided 3-month growth clippings from all ten digits of their own and their infants' fingernails. CORT and DHEA were measured using enzyme immunoassays (mothers) and high-performance-liquid-chromatography-with-mass-spectrometry (infants). Sample: n = 59 mothers (KC = 30/SC = 29) and 63 infants (KC = 32/SC = 31). Data were analyzed using non-parametric/parametric comparative statistics. NICU stay ranged from 3-103 days. For mothers in Kangaroo and Standard Care the CORT, DHEA levels and DHEA:CORT ratio (DC) ratio did not differ. Infants in KC had higher DHEA (p = 0.003) and a higher DC ratio (p = 0.011) than SC infants. Even though KC infants stayed in the NICU for a greater number of days than infants in SC, they had higher mean level of DHEA, and DC ratio, suggesting that KC played a role in promoting their stress regulatory capacities and may mitigate toxic effects of chronic hypercortisolemia. However, for mothers, KC did not reduce chronic stress compared to that in women in the SC condition. Further research warranted.
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Affiliation(s)
| | - Geisy Maria de Souza Lima
- Institute of Integral Medicine Professor Fernando Figueira (IMIP), Department of Neonatology, Recife, Brazil
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18
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Metallinou D, Lazarou E, Lykeridou A. Pharmacological and Non-Pharmacological Brain-Focused Clinical Practices for Premature Neonates at High Risk of Neuronal Injury. MÆDICA 2021; 16:281-290. [PMID: 34621352 DOI: 10.26574/maedica.2020.16.2.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective:Disruption of smooth intrauterine brain development is a significant consequence of premature birth that may lead to adverse neurological outcomes. Although noteworthy progress has been made in the management of prematurity, the rates of neonatal morbidity and neurodevelopmental disorders remain high, underlining the need to find clinical practices that particularly protect the central nervous system. Aim:To identify recent articles regarding pharmacological and non-pharmacological brain-focused clinical practices (BFCP) for premature neonates at high risk of neuronal injury. Material and methods:We did an extensive search of PubMed and Google Scholar for relevant research published between 2000 and 2020. Results:Nineteen full-length original research papers fulfilled the inclusion criteria and were selected for the purpose of the present review. Non-pharmacological BFCP intend to improve the neonate's experience in the NICU environment and can be applied by a multidisciplinary team, while pharmacological ones are related to novel molecules that aim to quell apoptosis and inflammation or promote neurogenesis. Conclusion:In the future, a combination of pharmacological and non-pharmacological BFCP might be considered as the most promising protection and/or treatment provided in clinical practice to premature neonates at high risk of neuronal injury.
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Affiliation(s)
- Dimitra Metallinou
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Greece
| | | | - Aikaterini Lykeridou
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Greece
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19
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Upadhyaya S, Sourander A, Luntamo T, Matinolli HM, Chudal R, Hinkka-Yli-Salomäki S, Filatova S, Cheslack-Postava K, Sucksdorff M, Gissler M, Brown AS, Lehtonen L. Preterm Birth Is Associated With Depression From Childhood to Early Adulthood. J Am Acad Child Adolesc Psychiatry 2021; 60:1127-1136. [PMID: 33068750 DOI: 10.1016/j.jaac.2020.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 09/14/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There have been inconsistent findings on the associations among prematurity, poor fetal growth, and depression. We examined the associations among gestational age, poor fetal growth, and depression in individuals aged 5 to 25 years. METHOD We identified 37,682 case subjects based on International Classification of Diseases, Ninth Revision code 2961 and International Classification of Diseases, Tenth Revision codes F32.0-F32.9 and F33.0-F33.9 from the Care Register for Health Care, and 148,795 matched controls from the Finnish Central Population Register. Conditional logistic regression examined the associations between gestational age by each gestational week, poor fetal growth, and depression. The associations were adjusted for parental age and psychopathology, paternal immigrant status, maternal substance abuse, depression, number of previous births, marital status, socio-economic status, smoking during pregnancy, and the infant's birthplace. RESULTS In the adjusted models, increased risk of depression was found in children born ≤25 weeks (adjusted odds ratio [aOR] 1.89, 95% CI 1.08-3.31), at 26 weeks (aOR 2.62, 95% CI 1.49-4.61), at 27 weeks (aOR 1.93, 95% CI 1.05-3.53), and ≥42 weeks (aOR 1.11, 95% CI 1.05-1.19). In girls, extremely preterm birth was associated with depression diagnosed at 5 to 12 years (aOR 2.70, 95% CI 1.83-3.98) and 13 to 18 years (aOR 2.97, 95% CI 1.84-4.78). In boys, postterm birth (≥42 weeks) was associated with depression diagnosed at 19 to 25 years (aOR 1.28, 95% CI 1.07-1.54). Poor fetal growth was associated with an increased risk of depression in full-term infants (aOR 1.06, 95% CI 1.03-1.10) and postterm infants (aOR 1.24, 95% CI 1.08-1.43). CONCLUSION Preterm birth before 28 weeks of gestation appeared to play a role in the development of childhood depression. Smaller effects were also seen in postterm births, especially in boys.
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Affiliation(s)
| | - Andre Sourander
- University of Turku, Finland; Turku University Hospital, Finland; Columbia University, New York.
| | | | - Hanna-Maria Matinolli
- University of Turku, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | | | - Mika Gissler
- University of Turku, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland; Karolinska Institute, Stockholm, Sweden
| | | | - Liisa Lehtonen
- University of Turku, Finland; Turku University Hospital, Finland
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20
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Stoye DQ, Sullivan G, Galdi P, Kirschbaum C, Lamb GJ, Black GS, Evans MJ, Boardman JP, Reynolds RM. Perinatal determinants of neonatal hair glucocorticoid concentrations. Psychoneuroendocrinology 2021; 128:105223. [PMID: 33878601 PMCID: PMC8155393 DOI: 10.1016/j.psyneuen.2021.105223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/21/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022]
Abstract
Adult hair glucocorticoid concentrations reflect months of hypothalamic-pituitary-adrenal axis activity. However, little is known about the determinants of neonatal hair glucocorticoids. We tested associations between perinatal exposures and neonatal hair glucocorticoids. Cortisol and cortisone were measured by LC-MS/MS in paired maternal and infant hair samples collected within 10 days of birth (n = 49 term, n = 47 preterm), with neonatal samples collected at 6-weeks in n = 54 preterm infants. We demonstrate cortisol accumulation in hair increases with fetal maturity, with hair cortisol being higher in term than preterm born infants after delivery (median 401 vs 106 pg/mg; p < 0.001). In term born infants, neonatal hair cortisol is positively associated with maternal hair cortisol concentration (β = 0.240, p = 0.045) and negatively associated with birthweight z-score (β = -0.340, p = 0.006). Additionally, being born without maternal labour is associated with lower hair cortisol concentrations (β = -0.489, p < 0.001) and a lower ratio of cortisol to cortisone (β = -0.484, p = 0.001). In preterm infants, histological chorioamnionitis is associated with a higher cortisol to cortisone ratio in hair (β = 0.459, p = 0.001). In samples collected 6 weeks after preterm birth, hair cortisol concentration is associated with cortisol hair concentrations measured after birth (β = 0.523, p < 0.001), chorioamnionitis (β = 0.250, p = 0.049) and postnatal exposures including intravenous hydrocortisone therapy (β = 0.343, p < 0.007) and neonatal sepsis (β = 0.290, p = 0.017). In summary, neonatal hair cortisol is associated with birth gestation, maternal hair cortisol concentration and fetal growth. Additionally, exposures at delivery are important determinants of hair cortisol, and should be considered in the design of future research investigating how neonatal hair cortisol relates to prenatal exposures or fetal development.
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Affiliation(s)
- David Q Stoye
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Paola Galdi
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Gillian J Lamb
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Gill S Black
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Margaret J Evans
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK; Centre for Cardiovascular Science, University of Edinburgh, UK.
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21
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Liao J, Liu G, Xie N, Wang S, Wu T, Lin Y, Hu R, He HG. Mothers' voices and white noise on premature infants' physiological reactions in a neonatal intensive care unit: A multi-arm randomized controlled trial. Int J Nurs Stud 2021; 119:103934. [PMID: 33975075 DOI: 10.1016/j.ijnurstu.2021.103934] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND A few positive effects of mothers' voice on physiological outcomes have been studied and limited studies have focused on the level of cortisol. In addition, white noise has recently been found to be beneficial for human sleep, but studies in premature infants were limited and no study has compared the effects of mothers' voice and white noise on premature infants. OBJECTIVE To examine the effects of mothers' voice and white noise on sleep-wake patterns, salivary cortisol levels, weight gain, heart rate, and oxygen saturation of premature infants in a neonatal intensive care unit (NICU). METHODS This was a three-group randomized controlled trial. A total of 103 medically stable premature infants in incubators were recruited from the NICU of a women's and children's hospital in China between March and December 2017 and were randomized into three groups: the mothers' voice group (n = 34), the white noise group (n = 34), and the routine care group (n = 35). Mothers' voice, white noise, and no voice were provided to the three groups for 20 min at a time, three times a day for four consecutive days. The sound levels of the mothers' voice and white noise were controlled between 50 and 55 dB. Sleep-wake patterns, salivary cortisol level, and weight were measured at pre-test and post-test whereas heart rate and oxygen saturation were measured every five-minute at 11am, 2pm, 5pm for four-consecutive days. RESULTS A group difference was found only in weight gain (p = 0.003), with weight gain in the white noise group being significantly higher than the mothers' voice group (Z=-3.447, p = 0.001). Significant declines in total sleep time and sleep efficiency and increases in wake time after sleep onset and average awakening time were only found in the routine-care group between the pre-test and post-test (p<0.05). No significant differences were found in the salivary cortisol levels, heart rates, and oxygen saturation levels among the three groups (p>0.05). A significant increase in oxygen saturation during the 20-min intervention was found in white noise group. Non-significant decreases in the heart rate during the 20-min intervention and salivary cortisol levels at post test were noted in all the three groups. CONCLUSION White noise is more useful for encouraging weight gain in preterm infants compared with mothers' voices. White noise might be introduced for use in the care of premature infants in NICUs, and more high-quality randomized controlled trials are needed to confirm these findings. Trial Registration No: ChiCTR-INR-17012755.
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Affiliation(s)
- Jinhua Liao
- Experimentalist Assistant, School of Nursing, Fujian Medical University, Fuzhou, China
| | - Guihua Liu
- Research Assistant, School of Nursing, Fujian Medical University, Fuzhou, China
| | - Namei Xie
- Graduate Student, School of Nursing, Fujian Medical University, Fuzhou, China
| | - Shuo Wang
- Teacher Assistant, School of Nursing, Fujian Medical University, Fuzhou, China
| | - Taohong Wu
- Graduate Student, School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ying Lin
- Associate Professor of Nursing, Neonatology Department, Women's and Children's Hospital in Fujian province, China
| | - Rongfang Hu
- Professor, School of Nursing, Fujian Medical University, Fuzhou, China.
| | - Hong-Gu He
- Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
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22
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Benoit B, Newman A, Martin-Misener R, Latimer M, Campbell-Yeo M. The influence of breastfeeding on cortical and bio-behavioural indicators of procedural pain in newborns: Findings of a randomized controlled trial. Early Hum Dev 2021; 154:105308. [PMID: 33513546 DOI: 10.1016/j.earlhumdev.2021.105308] [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: 10/20/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022]
Abstract
AIMS The objective of this study was to compare the influence of breastfeeding and 24% oral sucrose on pain-related electrophysiologic activity, bio-behavioural pain scores, physiologic recovery, and adverse events during heel lance. STUDY DESIGN Single-blind randomized controlled trial. SUBJECTS 39 full-term infants were randomized to receive breastfeeding or 0.24 mL of 24% oral sucrose plus offered non-nutritive sucking 2 min prior to heel lance. OUTCOME MEASURES The primary outcome of pain-related potential was recorded on electroencephalogram. Secondary outcomes included Premature Infant Pain Profile - Revised (PIPP-R) score, physiologic recovery, and adverse events. Data were analyzed per protocol (ClinicalTrials.gov: NCT03272594). RESULTS Between November 2017 and January 2019, 20 infants were randomized to breastfeeding and 19 infants to receive oral sucrose. Infants who were breastfeeding had an appreciably smaller, yet not statistically different (F[1,15.9] = 0.58, p = 0.64, SE = 11.79), amplitude pain-related potential (peak amplitude 0.29 μV) following heel lance compared to infants who received oral sucrose (peak amplitude 8.97 μV). Mean PIPP-R scores were not statistically significantly different between groups following heel lance, however, they were indicative of low pain across groups. Mean time in seconds to physiologic recovery was faster in breastfeeding infants (M = 17.5, SD = 31.1) compared to oral sucrose (M = 70.8, SD = 144.3). There were no safety concerns. DISCUSSION Breastfeeding and oral sucrose both reduce bio-behavioural responses to pain, however, may differentially modulate pain response in the infant brain. Further research to understand the neurophysiologic effects of these interventions during acute painful procedures is needed.
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Affiliation(s)
- Britney Benoit
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada.
| | - Aaron Newman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Margot Latimer
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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23
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Hale JE, Platt CD, Bonilla FA, Hay BN, Sullivan JL, Johnston AM, Pasternack MS, Hesterberg PE, Meissner HC, Cooper ER, Barmettler S, Farmer JR, Fisher D, Walter JE, Yang NJ, Sahai I, Eaton RB, DeMaria A, Notarangelo LD, Pai SY, Comeau AM. Ten Years of Newborn Screening for Severe Combined Immunodeficiency (SCID) in Massachusetts. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2060-2067.e2. [PMID: 33607339 DOI: 10.1016/j.jaip.2021.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Massachusetts began newborn screening (NBS) for severe combined immunodeficiency (SCID) using measurement of T-cell receptor excision circles (TRECs) from dried blood spots. OBJECTIVE We describe developments and outcomes from the first 10 years of this program (February 1, 2009, to January 31, 2019). METHODS TREC values, diagnostic, and outcome data from all patients screened for SCID were evaluated. RESULTS NBS of 720,038 infants prompted immunologic evaluation of 237 (0.03%). Of 237, 9 were diagnosed with SCID/leaky SCID (4% of referrals vs 0.001% general population). Another 7 were diagnosed with other combined immunodeficiencies, and 3 with athymia. SCID/leaky SCID incidence was approximately 1 in 80,000, whereas approximately 1 in 51,000 had severe T-cell lymphopenia for which definitive treatment was indicated. All patients with SCID/leaky SCID underwent hematopoietic cell transplant or gene therapy with 100% survival. One patient with athymia underwent successful thymus transplant. No known cases of SCID were missed. Compared with outcomes from the 10 years before SCID NBS, survival trended higher (9 of 9 vs 4 of 7), likely due to a lower rate of infection before treatment. CONCLUSIONS Our data support a single NBS testing-and-referral algorithm for all gestational ages. Despite lower median TREC values in premature infants, the majority for all ages are well above the TREC cutoff and the algorithm, which selects urgent (undetectable TREC) and repeatedly abnormal TREC values, minimizes referral. We also found that low naïve T-cell percentage is associated with a higher risk of SCID/CID, demonstrating the utility of memory/naïve T-cell phenotyping as part of follow-up flow cytometry.
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Affiliation(s)
- Jaime E Hale
- New England Newborn Screening Program, Commonwealth Medicine, University of Massachusetts Medical School, Worcester, Mass
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Francisco A Bonilla
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Northeast Allergy, Asthma & Immunology, Leominster, Mass
| | - Beverly N Hay
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Mass
| | - John L Sullivan
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Mass
| | - Alicia M Johnston
- Harvard Medical School, Boston, Mass; Division of Infectious Disease, Boston Children's Hospital, Boston, Mass
| | - Mark S Pasternack
- Harvard Medical School, Boston, Mass; Pediatric Infectious Disease Unit, MassGeneral Hospital for Children, Boston, Mass
| | - Paul E Hesterberg
- Division of Allergy and Immunology, MassGeneral Hospital for Children, Boston, Mass
| | - H Cody Meissner
- Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, Mass
| | - Ellen R Cooper
- Division of Pediatric Infectious Diseases, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Sara Barmettler
- Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Boston, Mass
| | - Jocelyn R Farmer
- Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Boston, Mass
| | - Donna Fisher
- Division of Pediatric Infectious Diseases, Baystate Children's Hospital, University of Massachusetts Medical School-Baystate, Springfield, Mass
| | - Jolan E Walter
- Division of Allergy and Immunology, MassGeneral Hospital for Children, Boston, Mass; Division of Allergy & Immunology, Department of Pediatrics, University of South Florida at Johns Hopkins All Children's Hospital, St. Petersburg, Fla
| | - Nancy J Yang
- Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Boston, Mass
| | - Inderneel Sahai
- New England Newborn Screening Program, Commonwealth Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Mass
| | - Roger B Eaton
- New England Newborn Screening Program, Commonwealth Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Mass
| | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Mass
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology & Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Sung-Yun Pai
- Harvard Medical School, Boston, Mass; Division of Hematology-Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Mass.
| | - Anne Marie Comeau
- New England Newborn Screening Program, Commonwealth Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Mass.
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Vogl JL, Dunne EC, Liu C, Bradley A, Rwei A, Lonergan EK, Hopkins BS, Kwak SS, Simon CD, Rand CM, Rogers JA, Weese-Mayer DE, Garfield CF. Kangaroo father care: A pilot feasibility study of physiologic, biologic, and psychosocial measures to capture the effects of father-infant and mother-infant skin-to-skin contact in the Neonatal Intensive Care Unit. Dev Psychobiol 2021; 63:1521-1533. [PMID: 33521969 DOI: 10.1002/dev.22100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 01/01/2023]
Abstract
Robust literature supports the positive effects of kangaroo mother care (KMC) on infant physiologic stability and parent-infant bonding in the Neonatal Intensive Care Unit (NICU). Comparatively little is known about kangaroo father care (KFC) in the NICU, and KFC implementation has been limited. Our pilot feasibility study objective was to examine KFC effects on premature infants and fathers as compared to KMC. Parents of preterm NICU infants independently completed a 90-min Kangaroo Care (KC) session on consecutive days. Infant heart rate variability (HRV) and apnea/periodicity measures were compared (pre-KC to KC; KFC to KMC). Additionally, we assessed the feasibility of administering three psychosocial questionnaires to fathers and mothers in the NICU and after discharge. Ten preterm infants completed 20 KC sessions (334/7 -374/7 weeks post-menstrual age). Results demonstrated similar infant physiologic responses between KMC and KFC, including significant differences in measures of HRV (p < .05) between KC and non-KC periods. Eighty-eight percentage of questionnaires administered were completed, supporting the utilization of these instruments in future research of this population. If confirmed, these preliminary results identify an opportunity to objectively assess KFC effects, supporting the development of empirically based KFC programs benefitting NICU families.
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Affiliation(s)
- Jamie L Vogl
- Division of Pediatric Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Emma C Dunne
- Division of Pediatric Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Claire Liu
- Simpson Querrey Institute, Center for Bio-integrated Electronics, Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Allison Bradley
- Division of Pediatric Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Alina Rwei
- Simpson Querrey Institute, Center for Bio-integrated Electronics, Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Erin K Lonergan
- Division of Pediatric Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Bradley S Hopkins
- Division of Pediatric Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Sung Soo Kwak
- Simpson Querrey Institute, Center for Bio-integrated Electronics, Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Clarissa D Simon
- Family and Child Health Innovations Program, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Casey M Rand
- Division of Pediatric Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - John A Rogers
- Simpson Querrey Institute, Center for Bio-integrated Electronics, Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Debra E Weese-Mayer
- Division of Pediatric Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Craig F Garfield
- Family and Child Health Innovations Program, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Hospital Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
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Datla S, Kitchanan S, Sethuraman G. Diagnostic Reliability of Salivary C-Reactive Protein as an Alternative Noninvasive Biomarker of Neonatal Sepsis. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2284-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Lammertink F, Vinkers CH, Tataranno ML, Benders MJNL. Premature Birth and Developmental Programming: Mechanisms of Resilience and Vulnerability. Front Psychiatry 2021; 11:531571. [PMID: 33488409 PMCID: PMC7820177 DOI: 10.3389/fpsyt.2020.531571] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
The third trimester of pregnancy represents a sensitive phase for infant brain plasticity when a series of fast-developing cellular events (synaptogenesis, neuronal migration, and myelination) regulates the development of neural circuits. Throughout this dynamic period of growth and development, the human brain is susceptible to stress. Preterm infants are born with an immature brain and are, while admitted to the neonatal intensive care unit, precociously exposed to stressful procedures. Postnatal stress may contribute to altered programming of the brain, including key systems such as the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. These neurobiological systems are promising markers for the etiology of several affective and social psychopathologies. As preterm birth interferes with early development of stress-regulatory systems, early interventions might strengthen resilience factors and might help reduce the detrimental effects of chronic stress exposure. Here we will review the impact of stress following premature birth on the programming of neurobiological systems and discuss possible stress-related neural circuits and pathways involved in resilience and vulnerability. Finally, we discuss opportunities for early intervention and future studies.
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Affiliation(s)
- Femke Lammertink
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Christiaan H. Vinkers
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Maria L. Tataranno
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Manon J. N. L. Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Griffith T, White-Traut R, Janusek LW. A Behavioral Epigenetics Model to Predict Oral Feeding Skills in Preterm Infants. Adv Neonatal Care 2020; 20:392-400. [PMID: 32868589 DOI: 10.1097/anc.0000000000000720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Preterm infants experience a multitude of prenatal and postnatal stressors, resulting in cumulative stress exposure, which may jeopardize the timely attainment of developmental milestones, such as achieving oral feeding. Up to 70% of preterm infants admitted to the neonatal intensive care unit experience challenges while initiating oral feeding. Oral feeding skills require intact neurobehavioral development. Evolving evidence demonstrates that cumulative stress exposure results in epigenetic modification of glucocorticoid-related genes. Epigenetics is a field of study that focuses on phenotypic changes that do not involve alterations in the DNA sequence. Epigenetic modification of glucocorticoid-related genes alters cortisol reactivity to environmental stimuli, which may influence neurobehavioral development, and is the essence of the evolving field of Preterm Behavioral Epigenetics. It is plausible that early-life cumulative stress exposure and the ensuing epigenetic modification of glucocorticoid-related genes impair neurobehavioral development required for achievement of oral feeding skills in preterm infants. PURPOSE The purpose of this article is to build upon the evolving science of Preterm Behavioral Epigenetics and present a conceptual model that explicates how cumulative stress exposure affects neurobehavioral development and achievement of oral feeding skills through epigenetic modification of glucocorticoid-related genes. METHODS/RESULTS Using the Preterm Behavioral Epigenetics framework and supporting literature, we present a conceptual model in which early-life cumulative stress exposure, reflected by DNA methylation of glucocorticoid-related genes and altered cortisol reactivity, disrupts neurobehavioral development critical for achievement of oral feeding skills. IMPLICATIONS FOR PRACTICE AND RESEARCH Future investigations guided by the proposed conceptual model will benefit preterm infant outcomes by introducing epigenetic-based approaches to assess and monitor preterm infant oral feeding skills. Furthermore, the proposed model can guide future investigations that develop and test epigenetic protective interventions to improve clinical outcomes, representing an innovation in neonatal care.
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Affiliation(s)
- Thao Griffith
- Department of Health Promotion, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois (Drs Griffith and Janusek); Nursing Research, Children's Hospital of Wisconsin, Milwaukee (Dr White-Traut); and Department of Women, Children, and Family Health Science, College of Nursing, University of Illinois at Chicago (Dr White-Traut)
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Clinical validation of the Neonatal Infant Stressor Scale with preterm infant salivary cortisol. Pediatr Res 2020; 87:1237-1243. [PMID: 31847006 PMCID: PMC7255933 DOI: 10.1038/s41390-019-0713-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/30/2019] [Accepted: 11/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Preterm infants face unique stress states in early life. Early-life stress has been associated with changes in cortisol reactivity and behavioral abnormalities later in childhood in non-preterm populations. The Neonatal Infant Stressor Scale (NISS) has been used to estimate infant stress in the neonatal intensive care unit (NICU) but has not been biomarker validated. The relationship between NISS scores and salivary cortisol is unknown. The aim of this study is to test the association between NISS scores and salivary cortisol in the NICU Hospital Exposures and Long-Term Health (NICU-HEALTH) preterm birth cohort. METHODS Three hundred and eighty-six salivary cortisol specimens were collected from 125 NICU-HEALTH participants during the NICU hospitalization. NISS scores were calculated to represent the infant's experience in the 6 hours prior to specimen collection. Adjusted mixed-effect regression models were used to assess the association between each NISS score and salivary cortisol. RESULTS Acute and total NISS scores were significantly associated with salivary cortisol level (P = 0.002 and 0.05, respectively). The chronic NISS score was not associated with salivary cortisol levels. Caffeine treatment and postmenstrual age of the infant were important covariates in all models. CONCLUSION Acute and total NISS score are associated with salivary cortisol level in hospitalized moderately preterm infants.
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Howard C, Powell AS, Pavlidis E, Pavel A, Finn D, Allen A, Olavarria‐Ramirez L, Clarke G, Livingstone V, Boylan GB, Dempsey EM. No effect of a musical intervention on stress response to venepuncture in a neonatal population. Acta Paediatr 2020; 109:511-517. [PMID: 31532835 DOI: 10.1111/apa.15018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/04/2019] [Accepted: 09/16/2019] [Indexed: 11/29/2022]
Abstract
AIM To investigate the effect of a musical intervention on neonatal stress response to venepuncture as measured by salivary cortisol levels and pain profile scores. METHODS In a randomised control crossover trial, participants were randomised to both a control arm (sucrose) and intervention arm (sucrose and music) for routine venepuncture procedures. Salivary swabs were collected at baseline, 20 minutes post-venepuncture and 4 hours post-venepuncture. Pain levels were assessed using the Premature Infant Pain Profile (PIPP). A total of 16 preterm neonates participated in both arms to complete the study. RESULTS Cortisol values were elevated at all timepoints in the intervention arm (baseline, 20 minutes, and 4 hours post-procedure) but not significantly so (P = .056, P = .3, and P = .575, respectively). Median change in cortisol values from baseline was +128.48 pg/mL (-47.66 to 517.02) at 20 minutes and +393.52 pg/mL (47.88-1221.34) at 4 hours post-procedure in the control arm compared to -69.564 pg/mL (-860.96 to 397.289) and +100.48 pg/mL (-560.46 to 842.99) at 20 minutes and 4 hours post-procedure in the intervention arm. There was no statistically significant difference observed between groups (P = .311 at 20 minutes, and P = .203 at 4 hours post-procedure). PIPP scores were not significantly different between study arms. CONCLUSION Our findings did not support the additional benefit of music intervention on neonatal stress response to venepuncture in preterm infants.
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Affiliation(s)
- Caoimhe Howard
- Department of Paediatrics and Child Health Neonatal Intensive Care Unit Cork University Maternity Hospital Cork Ireland
| | - Anna S. Powell
- Department of Paediatrics and Child Health Neonatal Intensive Care Unit Cork University Maternity Hospital Cork Ireland
| | - Elena Pavlidis
- INFANT Irish Centre for Fetal and Neonatal Translational Research University College Cork Cork Ireland
| | - Andreea Pavel
- Department of Paediatrics and Child Health Neonatal Intensive Care Unit Cork University Maternity Hospital Cork Ireland
- INFANT Irish Centre for Fetal and Neonatal Translational Research University College Cork Cork Ireland
| | - Daragh Finn
- INFANT Irish Centre for Fetal and Neonatal Translational Research University College Cork Cork Ireland
| | - Andrew Allen
- APC Microbiome Ireland Biosciences Institute University College Cork Cork Ireland
| | | | - Gerard Clarke
- INFANT Irish Centre for Fetal and Neonatal Translational Research University College Cork Cork Ireland
- APC Microbiome Ireland Biosciences Institute University College Cork Cork Ireland
- Department of Psychiatry and Neurobehavioural Science University College Cork Cork Ireland
| | - Vicki Livingstone
- INFANT Irish Centre for Fetal and Neonatal Translational Research University College Cork Cork Ireland
| | - Geraldine B. Boylan
- Department of Paediatrics and Child Health Neonatal Intensive Care Unit Cork University Maternity Hospital Cork Ireland
- INFANT Irish Centre for Fetal and Neonatal Translational Research University College Cork Cork Ireland
| | - Eugene M. Dempsey
- Department of Paediatrics and Child Health Neonatal Intensive Care Unit Cork University Maternity Hospital Cork Ireland
- INFANT Irish Centre for Fetal and Neonatal Translational Research University College Cork Cork Ireland
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Mehler K, Hucklenbruch‐Rother E, Trautmann‐Villalba P, Becker I, Roth B, Kribs A. Delivery room skin-to-skin contact for preterm infants-A randomized clinical trial. Acta Paediatr 2020; 109:518-526. [PMID: 31423649 DOI: 10.1111/apa.14975] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/25/2019] [Accepted: 08/16/2019] [Indexed: 01/21/2023]
Abstract
AIM To investigate the effects of 60 minutes delivery room skin-to-skin contact (DR-SSC) compared with 5 minutes visual contact (VC) on mother-child interaction (MCI), salivary cortisol, maternal depression, stress and bonding at 6 months corrected age. METHODS A single-centre randomized controlled trial conducted in a German level III NICU. Eighty-eight preterm infants (25-32 weeks of gestational age) were randomized after initial stabilization to either 60 minutes DR-SSC or 5 minutes VC. Forty-five infants were allocated to DR-SSC, 43 to VC. RESULTS Delivery room skin-to-skin contact dyads showed a higher quantity of maternal motoric (18 vs 15, P = .030), infant's vocal (7 vs 5, P = .044) and motoric (20 vs 15, P = .032) responses. Moreover, the combined score of maternal and infant responsive behaviour was higher (86 vs 71, P = .041) in DR-SSC dyads. DR-SSC mothers had lower risk of both, early postpartum depression (15% vs 45%, P = .003) and impaired bonding (Score 3 vs 5, P = .031). CONCLUSION In addition to regular intermittent kangaroo mother care, DR-SSC promotes MCI and decreases risk of maternal depression and bonding problems. Thus, DR-SSC may have positive effects on preterm development.
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Affiliation(s)
- Katrin Mehler
- Division of Neonatology Children's Hospital University of Cologne Cologne Germany
| | - Eva Hucklenbruch‐Rother
- Research group of Metabolism and Perinatal Programming Children's Hospital University of Cologne Cologne Germany
| | | | - Ingrid Becker
- Institute of Medical Statistics, Informatics, and Epidemiology University of Cologne Cologne Germany
| | - Bernhard Roth
- Division of Neonatology Children's Hospital University of Cologne Cologne Germany
| | - Angela Kribs
- Division of Neonatology Children's Hospital University of Cologne Cologne Germany
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Low dose fentanyl infusion versus 24% oral sucrose for pain management during laser treatment for retinopathy of prematurity-an open label randomized clinical trial. Eur J Pediatr 2020; 179:285-292. [PMID: 31729550 DOI: 10.1007/s00431-019-03514-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
To compare the efficacy of low dose fentanyl infusion and 24% oral sucrose in providing optimal pain relief during laser for retinopathy of prematurity (ROP), we enrolled fifty-eight spontaneously breathing preterm infants undergoing laser. The preterm infants were randomized to either fentanyl infusion (1 mcg/kg/hr) or 24% oral sucrose (2 ml). We evaluated and compared the proportion of time spent crying during the procedure, salivary cortisol before and after the procedure, premature infant pain profile- revised (PIPP-R) scores during the procedure, apnoea during and after the procedure, need for mechanical ventilation, and feed intolerance and urinary retention 24 h after the procedure between the two groups. We found that the proportion of time spent crying during the procedure was significantly less in the fentanyl group [62.5% (50.7-74.2) vs 73.8% (55.6-83.4); P = 0.02]. Average PIPP-R score during the procedure was significantly less in the fentanyl group [7.2 vs 9.0; (mean difference of - 1.8; P = 0.01)]. There was no difference in other outcomes between the two groups.Conclusion: During laser for ROP, low dose fentanyl infusion was found to be efficacious in reducing pain as compared with 24% sucrose.What is Known:• Preterm infants undergoing laser photocoagulation for ROP suffer significant amount of pain.• Standard of care for pain relief in infants undergoing laser therapy in developed countries is general anesthesia (GA) or combination of sedation, analgesia, and paralysis (SAP).What is New:• During laser photocoagulation for ROP, fentanyl infusion at low dose (1 mcg/kg/hr) is efficacious in reducing pain as compared to 24% oral sucrose.
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Stroustrup A, Bragg JB, Spear EA, Aguiar A, Zimmerman E, Isler JR, Busgang SA, Curtin PC, Gennings C, Andra SS, Arora M. Cohort profile: the Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) cohort, a prospective preterm birth cohort in New York City. BMJ Open 2019; 9:e032758. [PMID: 31772104 PMCID: PMC6887035 DOI: 10.1136/bmjopen-2019-032758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) longitudinal preterm birth cohort studies the impact of the NICU exposome on early-life development. NICU-HEALTH collects multiple biospecimens, complex observational and survey data and comprehensive multisystem outcome assessments to allow measurement of the impact of modifiable environmental exposures during the preterm period on neurodevelopmental, pulmonary and growth outcomes. PARTICIPANTS Moderately preterm infants without genetic or congenital anomalies and their mothers are recruited from an urban academic medical centre level IV NICU in New York City, New York, USA. Recruitment began in 2011 and continues through multiple enrolment phases to the present with goal enrolment of 400 infants. Follow-up includes daily data collection throughout the NICU stay and six follow-up visits in the first 2 years. Study retention is 77% to date, with the oldest patients turning age 8 in 2019. FINDINGS TO DATE NICU-HEALTH has already contributed significantly to our understanding of phthalate exposure in the NICU. Phase I produced the first evidence of the clinical impact of phthalate exposure in the NICU population. Further study identified specific sources of exposure to clinically relevant phthalate mixtures in the NICU. FUTURE PLANS Follow-up from age 3 to 12 is co-ordinated through integration with the Environmental Influences on Child Health Outcomes (ECHO) programme. The NICU-HEALTH cohort will generate a wealth of biomarker, clinical and outcome data from which future studies of the impact of early-life chemical and non-chemical environmental exposures can benefit. Findings from study of this cohort and other collaborating environmental health cohorts will likely translate into improvements in the hospital environment for infant development. TRIAL REGISTRATION NUMBERS This observational cohort is registered with ClinicalTrials.gov (NCT01420029 and NCT01963065).
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Affiliation(s)
- Annemarie Stroustrup
- Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jennifer B Bragg
- Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Emily A Spear
- Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Andrea Aguiar
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Emily Zimmerman
- Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - Joseph R Isler
- Pediatrics, Columbia University, New York City, New York, USA
| | - Stefanie A Busgang
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Paul C Curtin
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Chris Gennings
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Syam S Andra
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Manish Arora
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Fitri SYR, Lusmilasari L, Juffrie M, Rakhmawati W. Pain in Neonates: A Concept Analysis. Anesth Pain Med 2019; 9:e92455. [PMID: 31750094 PMCID: PMC6820293 DOI: 10.5812/aapm.92455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/11/2019] [Accepted: 06/29/2019] [Indexed: 11/16/2022] Open
Abstract
Context The term pain in neonates is emerged in recent decades. However, studies on pain in neonates are still limited and have various indicators. In addition, the term pain still often overlaps with stress in various studies and clinical circumstances. The concepts of pain and stress in the neonates need to be clarified to be better understood and then applied to improve neonates’ quality of life. Therefore, the current study aimed at clarifying the concept of pain in neonates. Evidence Acquisition The current study employed the concept analysis approach developed by Walker and Avant. The authors reviewed articles from JSTOR, ScienceDirect, Proquest, Sage, Cochrane, and Springer databases from 1980 to 2016 using keywords pain, stress, neonatal, neonates, and quality of life. Results Pain had attributes such as tissue damage, physiological changes, metabolic changes, and behavioral changes. Stress had attributes such as physiological changes, metabolic changes, and behavioral changes. Conclusions Attributes of pain and stress have similarities and differences. The main difference is the stimulus that induces a response. Pain has an attribute of tissue damage, whereas stress is not always due to tissue damage. The attributes of physical, metabolic, and behavioral changes between pain and stress are similar.
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Affiliation(s)
- Siti Yuyun Rahayu Fitri
- Faculty of Nursing Universitas Padjadjaran, Bandung, Indonesia
- Corresponding Author: Faculty of Nursing Universitas Padjadjaran, Bandung, Indonesia.
| | - Lely Lusmilasari
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohammad Juffrie
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Provenzi L, Giorda R, Fumagalli M, Brambilla M, Mosca F, Borgatti R, Montirosso R. Telomere length and salivary cortisol stress reactivity in very preterm infants. Early Hum Dev 2019; 129:1-4. [PMID: 30530269 DOI: 10.1016/j.earlhumdev.2018.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/29/2018] [Accepted: 12/02/2018] [Indexed: 11/15/2022]
Abstract
During the Neonatal Intensive Care Unit (NICU) stay, very preterm (VPT) infants are exposed to life-saving yet pain-inducing skin-breaking procedures (i.e., NICU pain-related stress) which contribute to the programming of hypo-responsive HPA axis development during the first months of life. Unfortunately, to date the mechanisms linking NICU pain-related stress and altered HPA axis regulation are only limitedly known. Telomere length (TL) regulation is an epigenetic mechanism previously shown to be affected by early stress exposures and capable of associating with HPA axis reactivity in children. In VPT infants, NICU pain-related stress was found to associate with decreased TL from birth to discharge, but there is no evidence for the association between TL and HPA axis in these infants. In this study, we prospectively examined the relationship between NICU pain-related stress and HPA axis reactivity to an age-appropriate socio-emotional condition (i.e., the Still-Face Procedure, SFP) in healthy VPT infants at 3-month corrected age. NICU pain-related stress was computed as the ratio between the number of skin-breaking procedures and length of NICU stay. A differential score (i.e., ∆TL) was obtained subtracting TL at birth from TL at discharge. A normalized (log10) cortisol reactivity index (CRI) was obtained by averaging post-stress (20 min after SFP) salivary cortisol sample on baseline value. A regression model controlling for neonatal and socio-demographic confounders showed that ∆TL was the only significant predictor of CRI. Although preliminary, these findings contribute to our knowledge of the mechanisms linking early exposures to adversity and later in life regulation of the HPA axis in VPT infants.
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Affiliation(s)
- Livio Provenzi
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842 Bosisio Parini, Lecco, Italy.
| | - Roberto Giorda
- Molecular Biology Lab, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842 Bosisio Parini, Lecco, Italy
| | - Monica Fumagalli
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, 20122 Milan, Italy
| | - Maddalena Brambilla
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842 Bosisio Parini, Lecco, Italy
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, 20122 Milan, Italy
| | - Renato Borgatti
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842 Bosisio Parini, Lecco, Italy
| | - Rosario Montirosso
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842 Bosisio Parini, Lecco, Italy
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Kinoshita M, Iwata S, Okamura H, Tsuda K, Saikusa M, Harada E, Yamashita Y, Saitoh S, Iwata O. Feeding-Induced Cortisol Response in Newborn Infants. J Clin Endocrinol Metab 2018; 103:4450-4455. [PMID: 30085188 DOI: 10.1210/jc.2018-01052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/31/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Understanding the biological rhythms and stress response in sick newborns is important to minimize the negative effects of intensive care. Salivary cortisol has been used as a noninvasive surrogate marker of adrenal function; however, understanding of its control variables is insufficient. OBJECTIVE To investigate the presence of feeding-induced cortisol response and its control variables in newborns. DESIGN, SETTING, AND PATIENTS Fifty-three newborn infants, who were between 30 and 40 weeks' corrected age and were on 3-hourly regular oral/enteral feeding, were recruited between January 2013 and June 2014. MAIN OUTCOME MEASURE Saliva samples were collected before and 1 hour after regular feeding. Dependence of cortisol levels (adjusted for postnatal age) and their feeding-related elevation on clinical variables was assessed by using generalized estimating equations. RESULTS Higher cortisol levels were associated with corrected age ≥37 weeks and saliva samples collected after feeding (both P < 0.001). Oral feeding was associated with a greater feeding-induced cortisol response compared with exclusive enteral feeding (P = 0.034), whereas a prolonged feeding duration (≥30 minutes) was associated with a reduced cortisol response compared with brief feeding (<30 minutes) (P < 0.001). Gestational age, corrected age, antenatal/postnatal glucocorticoids, type of milk, and daily feeding volume had no effect on cortisol response. CONCLUSIONS Feeding-induced cortisol response was observed in newborns. The cortisol response was more prominent following oral feeding and was reduced with prolonged feeding. Future studies may investigate whether feeding-induced cortisol response plays a role in the acquisition of adrenal ultradian and diurnal rhythms.
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Affiliation(s)
- Masahiro Kinoshita
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Sachiko Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Hisayoshi Okamura
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Kennosuke Tsuda
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Mamoru Saikusa
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Eimei Harada
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Yushiro Yamashita
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Shinji Saitoh
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Osuke Iwata
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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Roué JM, Rioualen S, Gendras J, Misery L, Gouillou M, Sizun J. Multi-modal pain assessment: are near-infrared spectroscopy, skin conductance, salivary cortisol, physiologic parameters, and Neonatal Facial Coding System interrelated during venepuncture in healthy, term neonates? J Pain Res 2018; 11:2257-2267. [PMID: 30349352 PMCID: PMC6188070 DOI: 10.2147/jpr.s165810] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Improving pain and stress assessments in neonates remains important in preventing the short- and long-term consequences. We aimed to identify the relationships between different pain assessment parameters by simultaneously measuring changes in cortical, autonomic, hormonal, physiological, and behavioral evoked responses to venepuncture in healthy, full-term neonates. Methods This observational, prospective study (ancillary to the ACTISUCROSE trial) included 113 healthy, 3-day old, full-term neonates who underwent venepuncture for systematic neonatal screening, from July to October 2013, in a tertiary-level maternity ward of a university hospital. During venepuncture, we simultaneously measured the cortical single-channel near-infrared spectroscopy (NIRS) signals, foot skin conductance, salivary cortisol, physiological responses, and behavioral (Neonatal Facial Coding System [NFCS]) evoked responses. Results Regarding the NIRS analysis, the highest correlation was between the NFCS at venepuncture and the change in NIRS integrated values of total hemoglobin (r=0.41, P<0.001) or oxygenated hemoglobin (r=0.27, P<0.001). The NFCS at venepuncture was moderately positively correlated with changes in salivary cortisol (r=0.42, P<0.001) and skin conductance (r=0.29, P<0.001). Salivary cortisol and skin conductance changes were not correlated; the latter parameters were not correlated with heart rate, respiratory rate, or SpO2. Conclusion During venepuncture, NFCS was mildly or moderately correlated with salivary cortisol, skin conductance, and cortical NIRS changes.
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Affiliation(s)
- Jean-Michel Roué
- Department of Neonatal Medicine, Brest University Hospital, Brest, France, .,Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
| | - Stéphane Rioualen
- Department of Neonatal Medicine, Brest University Hospital, Brest, France, .,Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
| | - Julie Gendras
- Department of Neonatal Medicine, Brest University Hospital, Brest, France, .,Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
| | - Laurent Misery
- Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
| | - Maëlenn Gouillou
- Inserm CIC 1412, Centre for Clinical Investigation, Brest University Hospital, Brest, France
| | - Jacques Sizun
- Department of Neonatal Medicine, Brest University Hospital, Brest, France, .,Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
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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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Basal and reactivity levels of cortisol in one-month-old infants born to overweight or obese mothers from an ethnically and racially diverse, low-income community sample. Psychoneuroendocrinology 2018; 88:115-120. [PMID: 29223002 PMCID: PMC6031312 DOI: 10.1016/j.psyneuen.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 01/04/2023]
Abstract
Establishing typical values of the steroid hormone cortisol at rest and after challenge is critical for understanding how environmental factors impact stress regulation and overall development, beginning at birth. Yet most extant samples are small or based upon low-risk populations, and few studies address the potential role of maternal weight during pregnancy in their study designs or sampling strategy. Here we report basal and reactivity levels of salivary cortisol within a racially and ethnically diverse sample of 132 infants approximately one month of age (Age in days: M=37.61, SD=7.27) born to lower income overweight or obese mothers. Reactivity was assessed in response to a multi-domain infant stressor paradigm, which included assessment via the Newborn Behavioral Observation (NBO) system and extensive anthropometric measurements. Sample means for basal, post stressors, and reactivity to the NBO were significantly lower than those reported in reviews of low-risk samples. Parity was associated with cortisol levels such that first-born infants had lower resting cortisol and higher reactivity than infants born to multiparous women. Latino infants had lower basal cortisol. No other demographic characteristics significantly predicted cortisol. The variability in cortisol levels present in this sample suggests that considerable psychophysiological diversity may exist in samples of low-SES or high-risk participants. Findings provide useful ranges for samples of racially and ethnically diverse newborns from low-income families.
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Biobehavioral Responses of Preterm Infants to Conventional and Swaddled Tub Baths: A Randomized Crossover Trial. J Perinat Neonatal Nurs 2018; 32:358-365. [PMID: 29782435 DOI: 10.1097/jpn.0000000000000336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bathing is a routine care procedure that exposes preterm infants to prolonged handling, which could cause stress and potentially disrupt infants' biobehavioral responses. The aim of this double-blind randomized crossover trial was to compare the preterm infant's body temperature, heart rate (HR), peripheral capillary oxygen saturation (SpO2), salivary cortisol levels, and sleep-wake states during and after swaddled and conventional tub baths. Forty-three infants born at 32 to 36 weeks postmenstrual age, weighing 2225 g or less, were enrolled in the study. Infants were videotaped before and after each type of baths. The time interval between baths ranged from 24 to 72 hours to allow a washout period. Physiological, hormonal, and behavioral responses were collected at baseline and during recovery from baths. No significant differences in the mean body temperature, HR, SpO2, salivary cortisol levels, and sleep-wake states between the bath types were observed in the baseline or recovery responses during the first 20 minutes after bath. Regardless of bath type, salivary cortisol levels showed a nonstatistical significant increase.
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40
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Araújo FM, Pedreira MDLG, Avelar AFM, Pradella-Hallinan MLDC, Tsunemi MH, Pinheiro EM. Sleep and salivary cortisol in preterm neonates: a clinical, randomized, controlled, crossover study. Rev Bras Enferm 2018; 71:1358-1365. [DOI: 10.1590/0034-7167-2017-0546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/07/2017] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: Analyze the influence of ear protectors on the baseline levels of salivary cortisol and response and total sleep time of preterm neonates during two periods of environmental management of a neonatal intermediate care unit. Method: A clinical, randomized, controlled and crossover study conducted with 12 preterm neonates. The use of ear protectors was randomized in two periods. Sleep evaluation was performed using one Alice 5 Polysomnography System and unstructured observation. Results: No significant difference was observed between the baseline levels of salivary cortisol and response in preterm neonates from the control and experimental groups, and no statistical significance was observed between the total sleep time of both groups. No relationship was observed between the baseline levels of cortisol and response and total sleep time. Conclusion: Ear protectors in preterm neonates did not influence the salivary cortisol level and total sleep time in the studied periods.
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Andersen RD, Munsters JMA, Vederhus BJ, Gradin M. Pain assessment practices in Swedish and Norwegian neonatal care units. Scand J Caring Sci 2017; 32:1074-1082. [PMID: 29282767 DOI: 10.1111/scs.12553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice. AIM The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units. METHODS A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded. RESULTS A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren's Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau-Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues. CONCLUSION The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates.
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Affiliation(s)
- Randi Dovland Andersen
- Department of Child and Adolescent Health Services, Telemark Hospital, Skien, Norway.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Josanne M A Munsters
- Department of Women's and Children's Health, University Children's Hospital Uppsala, Uppsala, Sweden
| | | | - Maria Gradin
- Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Whitehead K, Jones L, Laudiano Dray P, Meek J, Fabrizi L. Full 10-20 EEG application in hospitalised neonates is not associated with an increase in stress hormone levels. Clin Neurophysiol Pract 2017; 3:20-21. [PMID: 30215001 PMCID: PMC6133781 DOI: 10.1016/j.cnp.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom
| | - Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom
| | - Pureza Laudiano Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, London WC1E 6BD, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom
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Jones L, Fabrizi L, Laudiano-Dray M, Whitehead K, Meek J, Verriotis M, Fitzgerald M. Nociceptive Cortical Activity Is Dissociated from Nociceptive Behavior in Newborn Human Infants under Stress. Curr Biol 2017; 27:3846-3851.e3. [PMID: 29199079 PMCID: PMC5742634 DOI: 10.1016/j.cub.2017.10.063] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/20/2017] [Accepted: 10/25/2017] [Indexed: 12/31/2022]
Abstract
Newborn infants display strong nociceptive behavior in response to tissue damaging stimuli, and this is accompanied by nociceptive activity generated in subcortical and cortical areas of the brain [1, 2]. In the absence of verbal report, these nociceptive responses are used as measures of pain sensation in newborn humans, as they are in animals [3, 4]. However, many infants are raised in a physiologically stressful environment, and little is known about the effect of background levels of stress upon their pain responses. In adults, acute physiological stress causes hyperalgesia [5, 6, 7], and increased background stress increases pain [8, 9, 10], but these data cannot necessarily be extrapolated to infants. Here we have simultaneously measured nociceptive behavior, brain activity, and levels of physiological stress in a sample of 56 newborn human infants aged 36–42 weeks. Salivary cortisol (hypothalamic pituitary axis), heart rate variability (sympathetic adrenal medullary system), EEG event-related potentials (nociceptive cortical activity), and facial expression (behavior) were acquired in individual infants following a clinically required heel lance. We show that infants with higher levels of stress exhibit larger amplitude cortical nociceptive responses, but this is not reflected in their behavior. Furthermore, while nociceptive behavior and cortical activity are normally correlated, this relationship is disrupted in infants with high levels of physiological stress. Brain activity evoked by noxious stimulation is therefore enhanced by stress, but this cannot be deduced from observation of pain behavior. This may be important in the prevention of adverse effects of early repetitive pain on brain development. Infant pain behavior and nociceptive brain activity are generally correlated Stress disrupts the relationship between infant pain brain activity and behavior Stress is associated with increased nociceptive brain activity, but not behavior Stress is an important factor when assessing infant pain experience
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Affiliation(s)
- Laura Jones
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Maria Laudiano-Dray
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Kimberley Whitehead
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, London WC1E6DB, UK
| | - Madeleine Verriotis
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London WC1E6BT, UK.
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Vangeel EB, Pishva E, Hompes T, van den Hove D, Lambrechts D, Allegaert K, Freson K, Izzi B, Claes S. Newborn genome-wide DNA methylation in association with pregnancy anxiety reveals a potential role for GABBR1. Clin Epigenetics 2017; 9:107. [PMID: 29026448 PMCID: PMC5627482 DOI: 10.1186/s13148-017-0408-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 09/24/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is increasing evidence for the role of prenatal stress in shaping offspring DNA methylation and disease susceptibility. In the current study, we aimed to identify genes and pathways associated with pregnancy anxiety using a genome-wide DNA methylation approach. METHODS We selected 22 versus 23 newborns from our Prenatal Early Life Stress (PELS) cohort, exposed to the lowest or highest degree of maternal pregnancy anxiety, respectively. Cord blood genome-wide DNA methylation was assayed using the HumanMethylation450 BeadChip (HM450, n = 45) and candidate gene methylation using EpiTYPER (n = 80). Cortisol levels were measured at 2, 4, and 12 months of age to test infant stress system (re)activity. RESULTS Data showed ten differentially methylated regions (DMR) when comparing newborns exposed to low versus high pregnancy anxiety scores. We validated a top DMR in the GABA-B receptor subunit 1 gene (GABBR1) revealing the association with pregnancy anxiety particularly in male newborns (most significant CpG Pearson R = 0.517, p = 0.002; average methylation Pearson R = 0.332, p = 0.039). Cord blood GABBR1 methylation was associated with infant cortisol levels in response to a routine vaccination at 4 months old. CONCLUSIONS In conclusion, our results show that pregnancy anxiety is associated with differential DNA methylation patterns in newborns and that our candidate gene GABBR1 is associated with infant hypothalamic-pituitary-adrenal axis response to a stressor. Our findings reveal a potential role for GABBR1 methylation in association with stress and provide grounds for further research.
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Affiliation(s)
- Elise Beau Vangeel
- Department of Neurosciences, Genetic Research About Stress and Psychiatry (GRASP), KU Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (CMVB), KU Leuven, Leuven, Belgium
| | - Ehsan Pishva
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Titia Hompes
- Department of Neurosciences, Genetic Research About Stress and Psychiatry (GRASP), KU Leuven, Leuven, Belgium
- University Psychiatric Center, Leuven, Belgium
| | - Daniel van den Hove
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Psychosomatics and Psychotherapy, Laboratory of Translational Neuroscience, University of Wuerzburg, Wuerzburg, Germany
| | - Diether Lambrechts
- Department of Oncology, Laboratory of Translational Genetics, KU Leuven, Leuven, Belgium
- Vesalius Research Center (VRC), VIB, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Intensive Care and Department of Pediatric Surgery, Erasmus MC—Sophia’s Children’s Hospital, Rotterdam, The Netherlands
| | - Kathleen Freson
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology (CMVB), KU Leuven, Leuven, Belgium
| | - Benedetta Izzi
- Department of Epidemiology and Prevention, IRCCS Instituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Stephan Claes
- Department of Neurosciences, Genetic Research About Stress and Psychiatry (GRASP), KU Leuven, Leuven, Belgium
- University Psychiatric Center, Leuven, Belgium
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45
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Carlson NS. Current Resources for Evidence-Based Practice, January/February 2017. J Obstet Gynecol Neonatal Nurs 2016; 46:91-99. [PMID: 27840207 DOI: 10.1016/j.jogn.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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