Lisanti Amy J, Demianczyk Abigail C, Costarino Andrew, Vogiatzi Maria G, Hoffman Rebecca, Quinn Ryan, Chittams Jesse L, Medoff-Cooper Barbara
Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA.
Pediatr Crit Care Med. 2020 Sep;21(9):e834-e841. doi: 10.1097/PCC.0000000000002493.
To determine the effect of skin-to-skin care on stress, pain, behavioral organization, and physiologic stability of infants with critical congenital heart disease before and after neonatal cardiac surgery.
A baseline response-paired design was used, with infants acting as their own controls before, during, and after skin-to-skin care at two distinct time points: once in the preoperative period (T1) and once in the postoperative period (T2).
Cardiac ICU and step-down unit in a large metropolitan freestanding children's hospital.
Convenience sample of 30 infants admitted preoperatively for critical congenital heart disease.
Eligible infants were placed into skin-to-skin care for 1 hour with their biological mothers once each at T1 and T2.
Measurements of stress (salivary cortisol), pain and behavior state (COMFORT scale), and physiologic stability (vital signs) were assessed immediately before skin-to-skin care, 30 minutes into skin-to-skin care, and 30 minutes after skin-to-skin care ended.At both T1 and T2, infant pain scores were significantly decreased (p < 0.0001) and infants moved into a calmer behavior state (p < 0.0001) during skin-to-skin care as compared to baseline. At T1, infants also had significantly reduced heart rate (p = 0.002) and respiratory rate (p < 0.0001) and increased systolic blood pressure (p = 0.033) during skin-to-skin care. At both T1 and T2, infant cortisol remained stable and unchanged from pre-skin-to-skin care to during skin-to-skin care (p = 0.096 and p = 0.356, respectively), and significantly increased from during skin-to-skin care to post-skin-to-skin care (p = 0.001 and p = 0.023, respectively). Exploratory analysis revealed differences in cortisol reactivity for infants with higher baseline cortisol (> 0.3 μg/dL) versus lower (≤ 0.3 μg/dL) prior to skin-to-skin care. Infants with higher baseline cortisol at T2 experienced significantly reduced cortisol during skin-to-skin care (p = 0.025). No significant differences in demographics or baseline variables were found between infants in either group.
Skin-to-skin care is a low-cost, low-risk intervention that promotes comfort and supports physiologic stability in infants before and after neonatal cardiac surgery.
确定肌肤接触护理对患有严重先天性心脏病的婴儿在新生儿心脏手术前后的应激、疼痛、行为组织和生理稳定性的影响。
采用基线反应配对设计，在两个不同时间点（术前一次，即T1；术后一次，即T2）对婴儿进行肌肤接触护理，在护理前、护理期间和护理后，婴儿自身作为对照。
一家大型独立儿童医院的心脏重症监护病房和逐步降级病房。
30名术前因严重先天性心脏病入院的婴儿的便利样本。
符合条件的婴儿在T1和T2各与亲生母亲进行1小时的肌肤接触护理。
在肌肤接触护理前、护理30分钟时和护理结束后30分钟，评估应激（唾液皮质醇）、疼痛和行为状态（舒适度量表）以及生理稳定性（生命体征）。在T1和T2时，与基线相比，婴儿在肌肤接触护理期间疼痛评分显著降低（p < 0.0001），且进入更平静的行为状态（p < 0.0001）。在T1时，婴儿在肌肤接触护理期间心率也显著降低（p = 0.002），呼吸频率降低（p < 0.0001），收缩压升高（p = 0.033）。在T1和T2时，婴儿皮质醇从护理前到护理期间保持稳定且无变化（分别为p = 0.096和p = 0.356），从护理期间到护理后显著升高（分别为p = 0.001和p = 0.023）。探索性分析显示，在肌肤接触护理前，基线皮质醇较高（> 0.3 μg/dL）与较低（≤ 0.3 μg/dL）的婴儿在皮质醇反应性上存在差异。在T2时，基线皮质醇较高的婴儿在肌肤接触护理期间皮质醇显著降低（p = 0.025）。两组婴儿在人口统计学或基线变量方面未发现显著差异。
肌肤接触护理是一种低成本、低风险的干预措施，可促进新生儿心脏手术前后婴儿的舒适度并维持生理稳定性。
