Archives of disease in childhood. Fetal and neonatal edition · 2024
Kangaroo mother care improves cardiorespiratory physiology in preterm infants: an observational study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Sehgal Arvind, Yeomans Emma J, Nixon Gillian M
Аннотация
OBJECTIVES: To evaluate whether kangaroo mother care (KMC) in preterm infants on non-invasive respiratory support improves indices of cardiorespiratory wellbeing.
STUDY DESIGN: Prospective quasi-experimental observational study.
SETTING: Tertiary perinatal neonatal unit.
PATIENTS: 50 very preterm infants being managed with nasal continuous positive airway pressure.
INTERVENTIONS: Continuous high-resolution preductal pulse-oximetry recordings using Masimo Radical-7 oximeter for 1 hour (incubator care) followed by 1 hour during KMC performed on the same day.
MAIN OUTCOME MEASURES: Measures of cardiorespiratory stability (dips in oxygen saturations (SpO2)) of ≥5% less than baseline, % time spent with oxygen saturations <90%, SpO2 variability and heart rate fluctuation and incidence of bradycardias.
RESULTS: The gestational age and birth weight of the cohort were 28.4±2.1 weeks and 1137±301 g, respectively. Dips in SpO2 of ≥5% less than baseline were significantly fewer with KMC, median (IQR) 24 (12 to 42) vs 13 (3 to 25), p=0.001. SpO2 variability (Delta 12 s and 2 s), (1.24±0.6 vs 0.9±0.4, p=0.005 and 4.1±1.7 vs 2.8±1.2, p<0.0001) and rapid resaturation and desaturation indices were significantly lower during KMC, compared with incubator care. Percentage time spent in oxygen saturations <90% was less with KMC (7.5% vs 2.7%, p=0.04). Mean heart rate was comparable although fluctuations in heart rate (rise by >8 bpm) were lower with KMC (43±22 vs 33±20, p=0.03). Seven (14%) infants had bradycardias during incubator care and none during KMC, p=0.012.
CONCLUSIONS: KMC improves cardiorespiratory stability in ventilated preterm infants. Regular KMC has the potential to improve clinical outcomes in this vulnerable cohort.
STUDY DESIGN: Prospective quasi-experimental observational study.
SETTING: Tertiary perinatal neonatal unit.
PATIENTS: 50 very preterm infants being managed with nasal continuous positive airway pressure.
INTERVENTIONS: Continuous high-resolution preductal pulse-oximetry recordings using Masimo Radical-7 oximeter for 1 hour (incubator care) followed by 1 hour during KMC performed on the same day.
MAIN OUTCOME MEASURES: Measures of cardiorespiratory stability (dips in oxygen saturations (SpO2)) of ≥5% less than baseline, % time spent with oxygen saturations <90%, SpO2 variability and heart rate fluctuation and incidence of bradycardias.
RESULTS: The gestational age and birth weight of the cohort were 28.4±2.1 weeks and 1137±301 g, respectively. Dips in SpO2 of ≥5% less than baseline were significantly fewer with KMC, median (IQR) 24 (12 to 42) vs 13 (3 to 25), p=0.001. SpO2 variability (Delta 12 s and 2 s), (1.24±0.6 vs 0.9±0.4, p=0.005 and 4.1±1.7 vs 2.8±1.2, p<0.0001) and rapid resaturation and desaturation indices were significantly lower during KMC, compared with incubator care. Percentage time spent in oxygen saturations <90% was less with KMC (7.5% vs 2.7%, p=0.04). Mean heart rate was comparable although fluctuations in heart rate (rise by >8 bpm) were lower with KMC (43±22 vs 33±20, p=0.03). Seven (14%) infants had bradycardias during incubator care and none during KMC, p=0.012.
CONCLUSIONS: KMC improves cardiorespiratory stability in ventilated preterm infants. Regular KMC has the potential to improve clinical outcomes in this vulnerable cohort.