Feasibility and Impact of a Pilot Neonatal Cuddler Program on Preterm Infants in the Neonatal Intensive Care Unit

Kylie Bushroe; Brieann Lloyd; Chonita McDaneld; Amit Mathur; Rakesh Rao

doi:10.1055/s-0042-1758726

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(S 01): e870-e878
DOI: 10.1055/s-0042-1758726

Original Article

Feasibility and Impact of a Pilot Neonatal Cuddler Program on Preterm Infants in the Neonatal Intensive Care Unit

Kylie Bushroe

¹Division of Newborn Medicine, Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, Missouri

,

Brieann Lloyd

¹Division of Newborn Medicine, Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, Missouri

,

Chonita McDaneld

¹Division of Newborn Medicine, Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, Missouri

,

Amit Mathur

²Division of Newborn Medicine, Department of Pediatrics, Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, Missouri

,

Rakesh Rao

¹Division of Newborn Medicine, Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, Missouri

› Institutsangaben

Abstract

Objective Preterm infants experience daily stress in the neonatal intensive care unit (NICU). Positive sensory experiences mitigate stress responses, but parental participation can be limited by external pressures. This study aimed to describe the impact of a neonatal cuddler program (NCP) on preterm infants' growth.

Study Design A multidisciplinary program trained volunteers to interact with NICU infants when family was not at bedside. Infants were followed prospectively throughout admission. Intervention data included frequency, type, and duration of activity throughout the study period. Student t-test and chi-square test were used to analyze the impact of volunteer interaction on anthropometric measures at discharge.

Results Forty-five infants interacted with a volunteer (intervention group, n = 45) compared with the control group (n = 56) following coronavirus disease 2019 restrictions. The median (range) time of interaction with a volunteer in the intervention group was 90.0 (5.0–705.0) minutes per infant. Infants in the two groups had similar gestational ages, birth weights, lengths, and occipitofrontal circumferences (OFC). Infants in the intervention group had higher rates of spontaneous intestinal perforation, bronchopulmonary dysplasia, and reached full enteral feeds later. However, rates of severe intraventricular hemorrhage, retinopathy of prematurity, and duration of mechanical ventilation were similar. Infants in the two groups did not differ in the NICU length of stay. At discharge, infants in the intervention group weighed more (p = 0.04) and had higher OFC's (p = 0.01) and OFC z-scores (p = 0.03). The change in z-scores from birth to discharge was significant for the weight (p = 0.02) but not length or OFC. In regression analyses, only group allocation was identified as a significant factor for OFC z-scores at discharge (β= 0.279, p = 0.011) and for change in weight z-scores from birth to discharge (β = 0.226, p = 0.041).

Conclusion Growth is positively impacted by an NCP despite limited interaction. Additional work is needed to demonstrate the impact on neurobehavioral and developmental outcomes.

Key Points

Establishing and implementing a neonatal cuddler program in a large, level IV NICU is feasible.
Neonatal cuddler programs can provide positive sensory experiences when parents are not at bedside.
Even limited exposure to these positive sensory experiences can positively impact growth parameters for preterm infants.

Keywords

positive sensory experiences - neonatal cuddler program - preterm infants - anthropometric measures

Volltext

Referenzen

References
1 Smith GC, Gutovich J, Smyser C. et al. Neonatal intensive care unit stress is associated with brain development in preterm infants. Ann Neurol 2011; 70 (04) 541-549
2 Lavallée A, de Clifford-Faugère G, Garcia C, Fernandez Oviedo AN, Héon M, Aita M. Part 1: narrative overview of developmental care interventions for the preterm newborn. J Neonatal Nurs 2019; 25 (01) 3-8
3 Lavallée A, de Clifford-Faugère G, Garcia C, Fernandez Oviedo AN, Héon M, Aita M. PART 2: practice and research recommendations for quality developmental care in the NICU. J Neonatal Nurs 2019; 25 (04) 160-165
4 Painter L, Lewis S, Hamilton BK. Improving neurodevelopmental outcomes in NICU patients. Adv Neonatal Care 2019; 19 (03) 236-243
5 Vittner D, McGrath J, Robinson J. et al. Increase in oxytocin from skin-to-skin contact enhances development of parent-infant relationship. Biol Res Nurs 2018; 20 (01) 54-62
6 Casper C, Sarapuk I, Pavlyshyn H. Regular and prolonged skin-to-skin contact improves short-term outcomes for very preterm infants: a dose-dependent intervention. Arch Pediatr 2018; 25 (08) 469-475
7 Welch MG, Firestein MR, Austin J. et al. Family nurture intervention in the neonatal intensive care unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial. J Child Psychol Psychiatry 2015; 56 (11) 1202-1211
8 Powers SA, Taylor K, Tumin D, Kohler Sr JA. Measuring parental presence in the neonatal intensive care unit. Am J Perinatol 2022; 39 (02) 134-143
9 Pineda R, Bender J, Hall B, Shabosky L, Annecca A, Smith J. Parent participation in the neonatal intensive care unit: predictors and relationships to neurobehavior and developmental outcomes. Early Hum Dev 2018; 117: 32-38
10 Greene MM, Rossman B, Patra K, Kratovil A, Khan S, Meier PP. Maternal psychological distress and visitation to the neonatal intensive care unit. Acta Paediatr 2015; 104 (07) e306-e313
11 Lewis TP, Andrews KG, Shenberger E. et al. Caregiving can be costly: a qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy Childbirth 2019; 19 (01) 227
12 Gonya J, Harrison T, Feldman K, Stein M, Chawla N. Nursing networks in the NICU and their association with maternal stress: a pilot study. J Nurs Manag 2019; 27 (02) 442-449
13 Cho ES, Kim SJ, Kwon MS. et al. The effects of kangaroo care in the neonatal intensive care unit on the physiological functions of preterm infants, maternal-infant attachment, and maternal stress. J Pediatr Nurs 2016; 31 (04) 430-438
14 Caskey M, Stephens B, Tucker R, Vohr B. Importance of parent talk on the development of preterm infant vocalizations. Pediatrics 2011; 128 (05) 910-916
15 Pineda RG, Tjoeng TH, Vavasseur C, Kidokoro H, Neil JJ, Inder T. Patterns of altered neurobehavior in preterm infants within the neonatal intensive care unit. J Pediatr 2013; 162 (03) 470-476.e1
16 Vanderveen JA, Bassler D, Robertson CMT, Kirpalani H. Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis. J Perinatol 2009; 29 (05) 343-351
17 Hersey A, Hoffman L, Tucker R, Vohr B. Enhancing the NICU language environment with a neonatal cuddler program. J Perinatol 2021; 41 (08) 2063-2071
18 Pineda RG, Neil J, Dierker D. et al. Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. J Pediatr 2014; 164 (01) 52-60.e2
19 Latva R, Lehtonen L, Salmelin RK, Tamminen T. Visits by the family to the neonatal intensive care unit. Acta Paediatr 2007; 96 (02) 215-220