Gardner Fumiyuki C, Adkins Cherie S, Hart Sarah E, Travagli R Alberto, Doheny Kim Kopenhaver
Penn State Hershey Children's Hospital and Department of Pediatrics, Penn State Hershey, College of Medicine, Hershey, Pennsylvania (Drs Gardner and Doheny); Stabler Department of Nursing, York College of Pennsylvania, York (Dr Adkins); Department of Anesthesia, Critical Care and Pain Management, Deaconess Medical Center, Boston, Massachusetts (Dr Hart); and Department of Neural and Behavioral Sciences, Penn State Hershey, College of Medicine, Hershey, Pennsylvania (Drs Travagli and Doheny).
Adv Neonatal Care. 2018 Feb;18(1):49-57. doi: 10.1097/ANC.0000000000000451.
While biological and behavioral stress response systems are intact in early gestation, preterm infants' behaviors are often more subtle and difficult to interpret compared with full-term infants. They are also more vulnerable for regulatory issues (ie, colic) that are known to impact caregiver-infant interactions. Biobehavioral measures such as behavioral responsivity and heart rate variability (HRV), particularly cardiac vagal tone, may help elucidate preterm infants' stress/regulatory systems.
To test the hypotheses that preterm infants' consoling behaviors and high-frequency (HF) HRV in the first week of life are significantly associated and they are inverse correlates of future colic risk.
METHODS/SEARCH STRATEGY: Thirty preterm (mean ± SE = 32.7 ± 0.3 weeks postmenstrual age [PMA]) infants underwent direct NIDCAP (Newborn Individualized Development and Assessment Program) observation during routine care and had HRV measurements during their first week postbirth. Sixty-three percent of mothers completed the Infant Colic Scale at 6 to 8 weeks adjusted postnatal age. Nonparametric tests were used to determine associations among behaviors, HRV, and maternal perceptions of infant colic.
FINDINGS/RESULTS: Self-consoling behaviors were positively associated with HF-HRV (vagal tone). In addition, stress behaviors were positively associated with low-frequency/high-frequency HRV (sympathetic dominance). Infants who displayed more stress behaviors also demonstrated more self-consoling behaviors. No significant associations were found with colic.
HF-HRV provides information on the infant's capacity to modulate stress and is a useful, noninvasive measure when behaviors are more difficult to discern.
Further study in a larger sample is needed to determine whether behavioral stress measures and HF-HRV may be useful to determine colic risk.
虽然生物和行为应激反应系统在妊娠早期是完整的，但与足月儿相比，早产儿的行为往往更微妙且难以解读。他们在已知会影响照顾者与婴儿互动的调节问题（如腹绞痛）方面也更脆弱。行为反应性和心率变异性（HRV）等生物行为指标，尤其是心脏迷走神经张力，可能有助于阐明早产儿的应激/调节系统。
检验以下假设：早产儿出生后第一周的安抚行为与高频（HF）HRV显著相关，且它们与未来腹绞痛风险呈负相关。
方法/搜索策略：30名早产儿（平均±标准误 = 孕龄32.7±0.3周）在常规护理期间接受了新生儿个体化发育与评估计划（NIDCAP）的直接观察，并在出生后第一周进行了HRV测量。63%的母亲在调整后的出生后6至8周完成了婴儿腹绞痛量表。使用非参数检验来确定行为、HRV和母亲对婴儿腹绞痛的认知之间的关联。
自我安抚行为与HF-HRV（迷走神经张力）呈正相关。此外，应激行为与低频/高频HRV（交感神经优势）呈正相关。表现出更多应激行为的婴儿也表现出更多的自我安抚行为。未发现与腹绞痛有显著关联。
HF-HRV提供了有关婴儿调节应激能力的信息，当行为更难辨别时，它是一种有用的非侵入性测量方法。
需要在更大的样本中进行进一步研究，以确定行为应激指标和HF-HRV是否有助于确定腹绞痛风险。
