Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: a retrospective cohort study.
Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: a retrospective cohort study.
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DOI：
10.1136/bmjopen-2016-012985
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发表时间：
2017-03-20
期刊：
影响因子：
2.9
通讯作者：
Brock G
中科院分区：
文献类型：
--
作者：
Gonya J;Ray WC;Rumpf RW;Brock G
该研究的主要目的是调查皮肤接触护理模式如何影响婴儿早期认知和沟通表现。这是一项回顾性队列研究。这项研究在美国中西部的一家 IV 级转诊新生儿重症监护病房进行，专门从事极早产儿的护理。数据收集自 2010 年至 2011 年入住该病房并在随访诊所完成 6 个月和 12 个月发育评估的所有极早产儿（胎龄<27 周）的电子病历（n = 97）。结果测量包括贝利婴儿发育量表第三版（Bayley-III）的认知和沟通分量表；皮肤接触模式包括：住院期间母亲和父亲参与的总时间、总持续时间（以周为单位）和频率（每周小时数）。通过逻辑回归、t 检验、χ2 检验和 Fisher 精确检验等多步过程对提取的数据进行分析，然后使用新型视觉分析软件进行探索性网络分析。从母亲和父亲那里接受肌肤接触护理的总时间、每周频率和总时间高于样本中位数的婴儿更有可能在 Bayley-III 认知和沟通量表上得分≥80。然而，结果没有统计学意义（p>0.05）。无论极早产儿何时入院，母亲提供的大部分肌肤接触护理在 30 周校正年龄时都急剧下降。其他探索性网络分析表明，通过 Bayley-III 评估，医疗和皮肤接触因素在促进早期认知和沟通表现方面发挥着并行的、非协同的作用。这项研究表明，对极早产儿进行早期和频繁的皮肤接触护理与早期认知和沟通能力之间存在关联。
The primary objective of the study was to investigate how patterns of skin-to-skin care might impact infant early cognitive and communication performance. This was a retrospective cohort study. This study took place in a level-IV all-referral neonatal intensive care unit in the Midwest USA specialising in the care of extremely preterm infants. Data were collected from the electronic medical records of all extremely preterm infants (gestational age <27 weeks) admitted to the unit during 2010–2011 and who completed 6-month and 12-month developmental assessments in the follow-up clinic (n=97). Outcome measures included the cognitive and communication subscales of the Bayley Scales of Infant Development, Third Edition (Bayley-III); and skin-to-skin patterns including: total hours of maternal and paternal participation throughout hospitalisation, total duration in weeks and frequency (hours per week). Extracted data were analysed through a multistep process of logistic regressions, t-tests, χ2 tests and Fisher's exact tests followed with exploratory network analysis using novel visual analytic software. Infants who received above the sample median in total hours, weekly frequency and total hours from mothers and fathers of skin-to-skin care were more likely to score ≥80 on the cognitive and communication scales of the Bayley-III. However, the results were not statistically significant (p>0.05). Mothers provided the majority of skin-to-skin care with a sharp decline at 30 weeks corrected age, regardless of when extremely preterm infants were admitted. Additional exploratory network analysis suggests that medical and skin-to-skin factors play a parallel, non-synergistic role in contributing to early cognitive and communication performance as assessed through the Bayley-III. This study suggests an association between early and frequent skin-to-skin care with extremely preterm infants and early cognitive and communication performance.