Gail C. McCain

Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: Pilot study

BACKGROUND Heel stick is the most common painful procedure for preterm infants in neonatal intensive care units. Resultant pain causes adverse physiological effects in major organ systems. Kangaroo Care (KC), involving mother-infant skin-to-skin contact is a promising analgesic for infant pain; however, the effect of KC on the autonomic nervous systems response to pain is unknown. AIM To determine if KC results in improved balance in autonomic responses to heel stick pain than the standard method where infants remain in an incubator care (IC) for the heel stick. STUDY DESIGN A randomized cross-over trial. SUBJECTS Fourteen preterm infants, 30-32 weeks gestational age and less than 9 days postnatal age. OUTCOME MEASURES Infant behavioral state, heart rate, heart rate variability (HRV) indices including low frequency (LF) and high frequency (HF) power, and the LF/HF ratio measured over Baseline, Heel Warming, Heel Stick, and Recovery periods in KC and IC conditions. RESULTS HRV differences between KC and IC were that LF was higher in KC at Baseline (p<.01) and at Heel Stick (p<.001), and HF was higher in KC at Baseline than in the IC condition (p<.05). The LF/HF ratio had less fluctuation across the periods in KC than in IC condition and was significantly lower during Recovery in KC than in IC (p<.001). CONCLUSIONS Infants experienced better balance in response in KC than IC condition as shown by more autonomic stability during heel stick. KC may be helpful in mediating physiologic response to painful procedures in preterm infants.

Facilitating inactive awake states in preterm infants: a study of three interventions.

Inactive awake behavioral states have been associated with reduced heart rates and more successful feeding in preterm infants. The purpose of this study was to test the efficacy of three different interventions to facilitate these optimal feeding states. Twenty preterm infants (gestational ages 27–33 weeks, M = 31.6, SD = 1.7; birth weights 931–2,140 grams, M = 34, SD = 373) serving as their own controls were randomly administered nonnutritive sucking, nonnutritive sucking plus rocking, and stroking interventions; and a control condition. There were significantly more inactive awake states with the nonnutritive sucking and nonnutritive sucking plus rocking interventions than with the stroking intervention and the control conditions. The results suggest that there are interventions that can help preterm infants in the transition from gavage to oral feeding and potentially shorten their hospital stays.

The relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly hispanic sample of men who have sex with men

Despite public health campaigns and safer sex messages, many men who have sex with men (MSM) continue to participate in high-risk sexual behaviors, which may make them vulnerable to HIV infection and sexually transmitted infections. The purpose of this study was to determine the relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of MSM. This correlational study sampled 205 MSM (M = 37 years of age, SD = ±8) representing the diverse ethnic composition of South Florida. This sample consisted of ethnic minorities (79%) with a large number of foreign-born men (69%). Participants completed measures of depressive symptoms, self-esteem, and sexual behaviors. Results indicated that higher levels of depressive symptoms and higher levels of self-esteem had a statistically significant relationship to lower levels of safer sexual behaviors. Lower income, lower educational level, and preference for Spanish language were associated with higher levels of depressive symptoms; lower income was associated with lower levels of self-esteem; and foreign birth and a preference for Spanish language were associated with lower levels of safer sex behaviors. Higher levels of depressive symptoms and higher levels of self-esteem were associated with high-risk sexual behaviors in this sample of MSM. Further research needs to be directed at culturally specific mental health and HIV prevention strategies for these vulnerable MSM.

Heart Rate Variability Responses of a Preterm Infant to Kangaroo Care

OBJECTIVE To examine the effect of kangaroo care on heart rate variability in a healthy preterm infant. DESIGN Case study. SETTING Private room on a postpartum unit. PARTICIPANT A mother-preterm infant dyad. INTERVENTION Kangaroo (skin-to-skin) care. MAIN OUTCOME MEASURE Heart rate variability, a noninvasive measurement of the sympathetic and parasympathetic components of the autonomic nervous systems influence on heart rate. RESULTS Heart rate variability, especially the parasympathetic component, was high when the infant was fussy in the open crib, indicating increased autonomic nervous system activity. With kangaroo care, the infant fell asleep, and both sympathetic and parasympathetic components of heart rate variability decreased. CONCLUSIONS The wide fluctuations in the parasympathetic component of heart rate variability suggest immaturity of the sympathovagal response. Overall, kangaroo care produced changes in heart rate variability that illustrate decreasing stress.

Transition from gavage to nipple feeding for preterm infants with bronchopulmonary dysplasia.

Background:The transition from gavage to nipple feeding is difficult for preterm infants with bronchopulmonary dysplasia because of tachypnea and hypoxemia from chronic respiratory distress. Objective:The aim of this study was to test the hypothesis that preterm infants with bronchopulmonary dysplasia who transitioned from gavage to nipple feeding with the semidemand method would achieve nipple feeding sooner and be discharged from hospital sooner than control infants who received standard care. Methods:Forty-two infants were randomized to the control condition and 44 to the experimental protocol. Mean gestational ages and birth weights were 25 ± 1.5 weeks and 784 g for controls and 25 ± 1.4 weeks and 787 g for experimental infants. Control infants received standard care that included gradual increases in the number of nipple to gavage feedings per day. Experimental infants received the semidemand method that used infant behavioral and cardiorespiratory signs to regulate frequency, length, and volume of nipple feedings. General linear model procedures were used to compare study groups. Results:Experimental infants achieved nipple feeding at M = 5.9 ± 0.7 days compared with control infants, M = 12.3 ± 0.8 (p < .0001). Length of hospitalization was not significantly different between groups. Discussion:The semidemand method significantly shortened the time for infants to attain nipple feeding in a manner taking their respiratory distress into consideration.

Heart Rate Variability Responses to Nipple Feeding for Preterm Infants with Bronchopulmonary Dysplasia: Three Case Studies

Preterm infants with bronchopulmonary dysplasia (BPD) have cardiorespiratory compromise that prolongs the transition time from gavage to nipple feeding. Heart rate variability (HRV) provides an indirect measure of the autonomic nervous systems influence on heart rate and cardiorespiratory stability. The purpose of this case study was to describe HRV responses of three preterm infants with BPD during the transition from gavage to nipple feeding. The infants responded to nipple feeding with increases in sympathetic influence on heart rate, and the increase continued in the 10-minute postfeeding. The infants were capable of balancing sympathetic and parasympathetic influences on heart rate related to the work of feeding.

Abnormal physiological responses to touch among children with persistent feeding difficulties.

Pediatric feeding/swallowing specialists commonly observe infants and toddlers who present with gagging or significant behavior state changes as a result of touch to oral and body regions. To date, this behavior has not been fully characterized or documented experimentally. This paper describes an exploratory study aimed at filling in these lacunae and providing a possible explanation. The study compares the responses to firm tactile pressure of 40 children between the ages of 3 and 18 months. The experimental group consisted of 20 children (12 males, 8 females) with heterogeneous medical diagnoses, at least 2 weeks of alternative feedings during the first 3 months of life, and a common history of persistent feeding difficulties. The comparison group consisted of 20 children with an unremarkable medical history matched by age and sex to the experimental group. Firm, tactile pressure was applied in a predetermined sequence following dermatome regions from legs to mouth. Response was recorded in terms of presence/absence of gagging and/or behavior state changes. Fifteen of the 20 children in the experimental group showed gagging (14) or inconsolable crying (1) in response to touch. None of the matched comparison group demonstrated either gagging or behavior state changes. The experimental and comparison groups showed significant differences in response to tactile input. Further, the source of these abnormal responses must be sought in similarity of experience across heterogeneous medical diagnoses and interventions. One possible explanation is a history of oral deprivation due to alternative feedings.