Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns
Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns
复制标题
DOI：
10.1111/j.1651-2227.2004.tb03018.x
复制
发表时间：
2004-06-01
期刊：
影响因子：
3.8
通讯作者：
Fawcus, SR
中科院分区：
文献类型：
--
作者：
Bergman, NJ;Linley, LL;Fawcus, SR
目的：早产儿的常规护理包括延长母婴分离和保温箱护理。最近的研究表明，分离会产生不利影响。母婴皮肤接触（SSC）提供了一个替代孵化器的栖息地，证明了稳定的早产儿的好处;这还没有建立不稳定或新生儿低出生体重儿。因此，将出生时的SSC与出生时体重在1200至2199 g之间的婴儿的保温箱护理进行了比较。研究方法：这是一项前瞻性、非盲、随机对照临床试验;在分娩前确定潜在受试者，如果合格，则在5分钟时通过计算机最小化技术进行随机化。标准化护理和观察维持6小时。根据一组预先确定的生理参数和复合心肺稳定评分（SCRIP）测量稳定性。结果如下：在可比较的组中分析了34名婴儿：3/18名SSC与12/13名恒温箱婴儿相比超过了预定参数（p < 0.001）。SSC的稳定评分为77.11，培养箱为74.23（最大值为78），平均差异为2.88（95% CI：0.3-5.46，p = 0.031）。所有18名SSC受试者在第6小时内稳定，而6/13名保温箱婴儿稳定。八出13孵化器科目经历hypothermia.Conclusion：新生儿护理提供的皮肤对皮肤接触的母亲的胸部结果在更好的生理结果和稳定性比提供相同的护理在封闭的伺服控制的孵化器。在最初6小时内分离的婴儿中观察到的心肺不稳定性与哺乳动物的“抗议-绝望”生物学一致，并且与人类婴儿中描述的“过度觉醒和解离”反应模式一致：新生儿不应该与母亲分离。
Aim: Conventional care of prematurely born infants involves extended maternal-infant separation and incubator care. Recent research has shown that separation causes adverse effects. Maternal infant skin-to-skin contact (SSC) provides an alternative habitat to the incubator, with proven benefits for stable prematures; this has not been established for unstable or newborn low-birthweight infants. SSC from birth was therefore compared to incubator care for infants between 1200 and 2199 g at birth. Methods: This was a prospective, unblinded, randomized controlled clinical trial; potential subjects were identified before delivery and randomized by computerized minimization technique at 5 min if eligible. Standardized care and observations were maintained for 6 h. Stability was measured in terms of a set of pre-determined physiological parameters, and a composite cardio-respiratory stabilization score (SCRIP). Results: 34 infants were analysed in comparable groups: 3/18 SSC compared to 12/13 incubator babies exceeded the pre-determined parameters (p < 0.001). Stabilization scores were 77.11 for SSC versus 74.23 for incubator (maximum 78), mean difference 2.88 (95% CI: 0.3-5.46, p = 0.031). All 18 SSC subjects were stable in the sixth hour, compared to 6/13 incubator infants. Eight out of 13 incubator subjects experienced hypothermia.Conclusion: Newborn care provided by skin-to-skin contact on the mother's chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistent with mammalian "protest-despair" biology, and with "hyper-arousal and dissociation" response patterns described in human infants: newborns should not be separated from their mothers.