SKIN TO SKIN CONTACT FOR PRETERM INFANTS & THEIR MOTHERS

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The physical separation between mother and premature infant is associated with disturbed patterns of maternal-infant interaction. A relatively new intervention, skin-to-skin contact (SSC) (placement of the diaper-clad premature infant upright between mother's breasts, chest-to-chest), provides close maternal-infant contact. SSC has been associated with enhanced feelings of closeness to the infant, maternal comfort in caring for the premature infant, longer durations of lactation, decreased incidence of apnea, and decreased infant morbidity and mortality. Before SSC can be practiced, its safety in relation to the physical status of the premature infant must be known. The purpose of this study is to determine the cardiorespiratory, thermal, and state behavior effects on multiple SSC sessions occurring over 3-5 consecutive days on stable, continuing care prematures who are appropriate for gestation and greater than 32 weeks gestational age A pretest-posttest control group design with randomization by Zellen technique will be used. The skin temperature of the mother during SSC will be examined for its compliant with the neutral thermal environment needed by the infant. The impact of SSC on feeding behavior will be assessed using the Anderson Complex Feeding Scale. Cardiorespiratory and thermal measures will be continuously monitored on the first and last days of SSC by a physiograph recorder during three consecutive interfeeding intervals (pre-SSC, SSC and post-SSC) in infants on 3-hour feeding schedules. Oxygen saturation will be recorded by a pulse oximeter interfaced with the physiograph recorder. The frequency of behavioral states (especially quiet sleep) using the Anderson Behavioral State Scale will be recorded every minute during the pre-SSC, SSC, and post- SSC periods by observers on the first and last day of SSC. The data obtained every 60 seconds will be analyzed. Control and SSC infants will remain in their open air cribs, clothed in hats, t-shirts diapers, booties and two blankets in the continuing care nursery for the pre-SSC, baseline, and post-SSC periods. Hypotheses are that cardiorespiratory and thermal measures will remain within normal limits for all subjects in all three periods on the 1st and last day of treatment and that the SSC infants will demonstrate significantly greater frequency and duration of quiet, regular sleep than C infants during the SSC period. If these hypotheses are upheld, and the cardiorespiratory and thermal values do no exceed accepted ranges, then nursery personnel may choose to adopt SSC as an intervention for close maternal-infant contact.