初步研究表明，在新生儿重症监护病房中，与父母进行肌肤接触护理可改善早产儿的心率变异性。
Pilot study shows skin-to-skin care with parents improves heart rate variability in preterm infants in the neonatal intensive care unit.
作者信息
Swieter Erin, Gross Jessica M, Stephen Julia, Watterberg Kristi, Maxwell Jessie R
机构信息
Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States.
Clinical and Translational Science Center, University of New Mexico, Albuquerque, NM, United States.
出版信息
Front Pediatr. 2023 Sep 18;11:1269405. doi: 10.3389/fped.2023.1269405. eCollection 2023.
BACKGROUND
Skin-to-skin care in the newborn intensive care unit typically lasts for short periods of time and enhances breastfeeding, attachment, and parental self-esteem. Heart rate variability (HRV) increases with gestational age and is a measure of maturation of parasympathetic vs. sympathetic autonomic nervous system activity. HRV measurements may be useful in capturing changes in autonomic regulation in response to skin-to-skin care.
OBJECTIVE
To analyze the effects of skin-to-skin care on HRV in preterm infants receiving respiratory support. We hypothesized that skin-to-skin care would result in a more mature pattern of parasympathetic activity.
METHODS
In this prospective crossover study, infants <30 weeks' gestation and 1-6 weeks postnatal age had HRV recorded for 30 min before, during, and after skin-to-skin care sessions. HRV characteristics analyzed included the standard deviation of the normal-to-normal interval (SDNN), the root mean squared of successive differences of normal-to-normal intervals (RMSSD), and the standard deviation of decelerations (SDDec).
RESULTS
10 infants between 25 5/7-29 6/7 weeks gestational age and 7-41 days postnatal age completed 22 sessions while receiving respiratory support (positive pressure ventilation or nasal cannula oxygen). Two measures of HRV (SDNN and RMSSD) were significantly decreased by the end of the skin-to-skin sessions, compared to pre-session values. SDNN decreased from a median of 10.44 ms before the session to 6.70 ms after being placed back in bed ( < 0.05), with RMSSD decreasing from a median of 6.80 ms before the session to 4.32 ms while being held at the end of 30 min ( < 0.05).
DISCUSSION
Skin-to-skin care with a parent resulted in a more mature autonomic nervous system pattern in preterm infants receiving respiratory support, suggesting physiologic benefit for the infant. No adverse events were seen during any session.
背景
新生儿重症监护病房中的肌肤接触护理通常持续时间较短，可促进母乳喂养、亲子依恋并增强父母的自尊。心率变异性（HRV）随胎龄增加，是副交感神经与交感自主神经系统活动成熟度的一项指标。HRV测量可能有助于捕捉因肌肤接触护理而引起的自主调节变化。
目的
分析肌肤接触护理对接受呼吸支持的早产儿HRV的影响。我们假设肌肤接触护理会导致副交感神经活动模式更加成熟。
方法
在这项前瞻性交叉研究中，对胎龄小于30周且出生后1至6周的婴儿在肌肤接触护理前、护理期间和护理后记录30分钟的HRV。分析的HRV特征包括正常到正常间隔的标准差（SDNN）、正常到正常间隔连续差值的均方根（RMSSD）以及减速标准差（SDDec）。
结果
10名胎龄在25⁵/₇至29⁶/₇周、出生后7至41天的婴儿在接受呼吸支持（正压通气或鼻导管吸氧）期间完成了22次护理。与护理前的值相比，两项HRV指标（SDNN和RMSSD）在肌肤接触护理结束时显著降低。SDNN从护理前的中位数10.44毫秒降至放回床上后的6.70毫秒（P<0.05），RMSSD从护理前的中位数6.80毫秒降至30分钟结束时抱在怀中的4.32毫秒（P<0.05）。
讨论
与父母进行肌肤接触护理使接受呼吸支持的早产儿自主神经系统模式更加成熟，表明对婴儿有生理益处。在任何一次护理期间均未观察到不良事件。
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