Chakkarapani Ela, Ingram Jenny, Stocks Stephanie, Beasant Lucy, Odd David
Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.
St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Acta Paediatr. 2025 Mar;114(3):546-554. doi: 10.1111/apa.17466. Epub 2024 Oct 25.
CoolCuddle, enabling parents to cuddle their babies with neonatal encephalopathy (NE) during therapeutic hypothermia and intensive care (TH), was developed in research settings. To determine the impact of implementing CoolCuddle in usual care in six diverse neonatal intensive care units on the cooling process and intensive care.
This vital sign cohort study embedded within the CoolCuddle implementation study enrolled 36 infants receiving TH for NE. Nurses received training on CoolCuddle and a standard operating procedure using an instruction video. After consenting, parents experienced up to 2 h of CoolCuddle with 30 min of pre- and post-cuddle observation. We used multilevel, clustered linear modelling to assess the physiological stability in temperature, cardio-respiratory and neurophysiology across the CoolCuddle.
In 60 CoolCuddles over 93.12 h, respiratory parameters, heart rate or neurological function did not vary between the epochs (p > 0.05). During cuddle, sleep-wake cycling on amplitude-integrated EEG increased (p = 0.008) and there was weak evidence of lower pain scores (p = 0.08). No adverse effects were observed.
Implementing CoolCuddle with support in usual practice maintained physiological stability and did not significantly affect the cooling process or intensive care, and may improve infant comfort. Ongoing monitoring of adverse effects when implementing CoolCuddle is recommended.
CoolCuddle是在研究环境中开发的，可让患有新生儿脑病（NE）的婴儿在治疗性低温和重症监护（TH）期间与父母进行肌肤接触。本研究旨在确定在六个不同的新生儿重症监护病房将CoolCuddle应用于常规护理对降温过程和重症监护的影响。
本生命体征队列研究纳入了CoolCuddle实施研究，共招募了36名接受TH治疗NE的婴儿。护士通过教学视频接受了CoolCuddle及标准操作程序的培训。在获得同意后，父母与婴儿进行长达2小时的CoolCuddle，并在前后各观察30分钟。我们使用多层次聚类线性模型来评估CoolCuddle期间婴儿在体温、心肺和神经生理方面的生理稳定性。
在93.12小时内进行的60次CoolCuddle中，各阶段的呼吸参数、心率或神经功能均无变化（p>0.05）。在肌肤接触期间，振幅整合脑电图上的睡眠-觉醒周期增加（p=0.008）且有微弱证据表明疼痛评分较低（p=0.08）。未观察到不良反应。
在常规实践中给予支持实施CoolCuddle可维持生理稳定性，且不会显著影响降温过程或重症监护，还可能提高婴儿的舒适度。建议在实施CoolCuddle时持续监测不良反应。
