Preterm infants’ behaviors and skin conductance responses to nurse handling in the NICU

Abstract

Stress response patterns are indicative of the neonate's unique ability to cope with environmental demands and can be evaluated through autonomic and behavioral response parameters.

Objective: To characterize stress responses during tactile stimulation to standard nurse handling in the NICU, and their association with severity of illness in preterm infants.

Methods: Thirty preterm neonates were studied at postnatal day 4–5 during standard nurse caregiving. Heart rate (HR), respiratory rate (RR), skin conductance responses per second (SCR/s), and NIDCAP® stress behaviors were recorded before and during care. Non-parametric tests were used to assess differences from before to during care. Pearson’s correlations were used to determine the association of biological and behavioral variables to the score for neonatal acute physiology (SNAP), a severity of illness index.

Results: HR, RR, SCR/s and NIDCAP® behaviors (motor and attentional cues, and ability to self-console) increased from before to during the care (p < 0.01). NIDCAP® behaviors showed a significant negative association to the SNAP score (R = −0.45, p < 0.05).

Conclusions: HR, RR, SCR/s and NIDCAP® behaviors significantly increased during care. NIDCAP® stress behaviors were influenced by the severity of illness of the infant, while SCR/s was not influenced by severity of illness.

Keywords:

• Behavioral responses
• preterm infants
• skin conductance responses

Acknowledgements

The authors acknowledge the medical/nursing staff of Penn State Hershey NICU for assistance with subject recruitment and the parents who gave consent for their infants to participate in the study.

Declaration of interest

This work was supported by The Children’s Miracle Network and Johnson & Johnson Health Behaviors and Quality of Life (KKD). Dr. Doheny receives financial support for research by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under award number 1R01DK099350. None of the funding sources had any role in the design of the study, in the analysis and interpretation of the data, in the decision to submit the article, or in the preparation, review or approval of the article. V. Z. and K. K. D. attest to not having any potential conflict-of-interests to disclose. Hanne Storm discloses that she is the founder and co-owner of Med-Storm Innovation that owns the patents for the skin conductance technology to assess pain which was used in this study.