Bauer K, Uhrig C, Sperling P, Pasel K, Wieland C, Versmold H T
Department of Paediatrics, Freie Universität Berlin, Klinikum Benjamin Franklin, Germany.
J Pediatr. 1997 Feb;130(2):240-4. doi: 10.1016/s0022-3476(97)70349-4.
More and progressively smaller preterm infants are taken out of the incubator and placed skin to skin on their mother's chest to promote bonding, despite concerns that the infants are exposed to cold during this intervention.
To test the hypothesis that skin-to-skin care is a cold stress for preterm infants weighing less than 1500 gm, with a decrease in rectal temperature, a decrease in peripheral skin temperature, or an increase in oxygen consumption compared with conditions monitored during incubator care.
We studied 22 stable, spontaneously breathing preterm infants weighing less than 1500 gm (appropriate in size for gestational age), who had their first skin-to-skin care in the first week of life. We continuously measured rectal temperature, peripheral skin temperature (foot), and oxygen consumption (indirect calorimetry) for 1 hour in a thermoneutral incubator, during 1 hour of skin-to-skin care, and for another hour in the incubator. Mean values for the three periods were compared by analysis of variance.
During skin-to-skin care the mean rectal temperature was 0.2 degree C (p < 0.01) and the peripheral skin temperature was 0.6 degree C (p < 0.01) higher than during the preceding hour in the incubator. Back in the incubator, body temperatures returned to values recorded before skin-to-skin care. Oxygen consumption during skin-to-skin care (6.1 +/- 0.9 ml/kg per minute) was not significantly higher than in the incubator (5.8 +/- 0.8 ml/kg per minute).
For stable preterm infants weighing less than 1500 gm and less than 1 week of age, 1 hour of skin-to-skin care is not a cold stress compared with care in a thermoneutral incubator.
越来越多的早产儿被抱出暖箱,与母亲进行肌肤接触,以促进母婴关系,尽管有人担心在此过程中婴儿会受冷。
验证以下假设:与暖箱护理时的监测情况相比,肌肤接触护理会给体重不足1500克的早产儿带来冷应激,导致直肠温度下降、外周皮肤温度下降或耗氧量增加。
我们研究了22名稳定、自主呼吸的早产儿,体重不足1500克(按孕周计算大小合适),他们在出生第一周接受了首次肌肤接触护理。我们在中性温度的暖箱中、肌肤接触护理1小时期间以及之后再回到暖箱的1小时内,连续测量直肠温度、外周皮肤温度(足部)和耗氧量(间接测热法)。通过方差分析比较三个时间段的平均值。
在肌肤接触护理期间,平均直肠温度比前一小时在暖箱中时高0.2摄氏度(p<0.01),外周皮肤温度高0.6摄氏度(p<0.01)。回到暖箱后,体温恢复到肌肤接触护理前记录的值。肌肤接触护理期间的耗氧量(6.1±0.9毫升/千克每分钟)并不显著高于暖箱中的耗氧量(5.8±0.8毫升/千克每分钟)。
对于体重不足1500克、年龄小于1周的稳定早产儿,与在中性温度暖箱中护理相比,1小时的肌肤接触护理不会带来冷应激。