Sudden Unexpected Postnatal Collapse: Review and Management.

Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.

An analysis of the kangaroo care intervention using neonatal EEG complexity: a preliminary study.

OBJECTIVE: Skin-to-skin contact (SSC) promotes physiological stability and interaction between parents and infants. Temporal analyses of predictability in EEG-sleep time series can elucidate functional brain maturation between SSC and non-SSC cohorts at similar post-menstrual ages (PMAs). METHODS: Sixteen EEG-sleep studies were performed on eight preterm infants who received 8 weeks of SSC, and compared with two non-SSC cohorts at term (N=126) that include a preterm group corrected to term age and a full term group. Two time series measures of predictability were used for comparisons. RESULTS: The SSC premature neonate group had increased complexity when compared to the non-SSC premature neonate group at the same PMA. Discriminant analysis shows that SSC neonates at 40 weeks PMA are closer to the full term neonate non-SSC group than to the premature non-SSC group at the same PMA; suggesting that the KC intervention accelerates neurophysiological maturation of premature neonates. CONCLUSIONS: Based on the hypothesis that EEG-derived complexity increases with neurophysiological maturation as supported by previously published research, SSC accelerates brain maturation in healthy preterm infants as quantified by time series measures of predictability when compared to a similar non-SSC group. SIGNIFICANCE: Times series methods that quantify predictability of EEG sleep in neonates can provide useful information about altered neural development after developmental care interventions such as SSC. Analyses of this type may be helpful in assessing other neuroprotection strategies.

Kangaroo mother care during phototherapy: effect on bilirubin profile.

PURPOSE: To determine the safety and efficacy of allowing kangaroo mother care (KMC) one hour per day during the course of phototherapy using a fiberoptic phototherapy panel. SAMPLE: Thirty premature infants, 30-35 weeks gestation, <2,500 gm, who required phototherapy. Infants were randomized into three groups: (1) infants who received traditional bank or spotlight phototherapy 24 hours per day, (2) infants who received traditional phototherapy 23 hours per day and for the 24th hour lay prone on a fiberoptic phototherapy panel, and (3) infants who received traditional phototherapy 23 hours per day and for the 24th hour were given KMC with a fiberoptic phototherapy panel held against their back. OUTCOME VARIABLES: Nonparametric statistics were used for between-group comparisons on number of days of phototherapy, daily bilirubin decrement, and bilirubin profiles over the course of phototherapy. RESULTS: Groups did not differ in the number of days of phototherapy or in daily mean bilirubin decrement. The bilirubin profile for the KMC group showed a more shallow descent than did the profiles for the other groups, but a significant difference in decline was present only on day 4 of treatment (p = .05). CONCLUSION: This pilot work suggests that KMC using a fiberoptic panel during phototherapy may be safe, but further study is needed.

Kangaroo care compared to incubators in maintaining body warmth in preterm infants.

Many preterm infants cared for in incubators do not experience Kangaroo Care (KC), skin-to-skin contact with their mothers, due to fear of body heat loss when being held outside the incubator. A randomized clinical trial of 16 KC and 13 control infants using a pretest-test-posttest design of three consecutive interfeeding intervals of 2.5 to 3.0 h duration each was conducted over 1 day. Infant abdominal and toe temperatures were measured in and out of the incubator; maternal breast temperature was measured during KC. Repeated measures ANOVA showed no change in abdominal temperature across all periods and between groups. Toe temperatures were significantly higher during KC than incubator periods, and maternal breast temperature met each infant's neutral thermal zone requirements within 5 min of onset of KC. Preterm infants similar to those studied here will maintain body warmth with up to 3 h of KC.

Birth-related fatigue in 34-36-week preterm neonates: rapid recovery with very early kangaroo (skin-to-skin) care.

OBJECTIVE: To test preterm neonates' physiologic and behavioral responses when placed skin-to-skin on their mother's chests, called kangaroo care (KC), for the first 6 hours after birth, instead of having the neonates go to an intensive care unit. DESIGN: Convenience sampling was used in this descriptive study to enroll neonates who were given continuous KC beginning soon after birth in the delivery room and continuing for 6 hours. Heart rate, respiratory rate, oxygen saturation, abdominal temperature, and behavioral state were recorded each minute. SETTING: Data were collected in the delivery room and in a private labor room in tropical Cali, Colombia. PARTICIPANTS: Six 34-36-week preterm neonates with 5-minute APGAR scores of 6 or more were enrolled. Two neonates had grunting respirations before KC was begun. RESULTS: Temperature rose rapidly to thermoneutral range. With few exceptions, heart rate, respiratory rate, and oxygen saturation remained within normal limits; grunting respirations in two neonates disappeared with warmed humidified oxygen and continuous KC. Sleep predominated, and neonates were discharged home by 48 hours being fully breastfed, suggesting that KC was an environment conducive to recovery from fatigue. CONCLUSIONS: These data suggest that KC beginning in the delivery room can be given safely and perhaps with benefit to 34-36-week gestation neonates who appear healthy at birth. Kangaroo care was conducive to recovery from birth-related fatigue.

Developmental aspects of kangaroo care.

Kangaroo care (skin-to-skin holding) is an intervention that meets development care criteria by fostering neurobehavioral development. The five dimensions of neurobehavioral development are autonomic, motor, state, attention/interaction, and self-regulation. Kangaroo care promotes stability of heart and respiratory function, minimizes purposeless movements, improves behavioral state profiles, offers maternal proximity for attention/interaction episodes, and permits self-regulatory behavior expression. Kangaroo care satisfies in part the handling, self-consoling/soothing, nonnutritive sucking, and parenting interventions recommended by the National Association of Neonatal Nurses' Infant and Family Centered Developmental Care Guidelines.

Kangaroo care: research results, and practice implications and guidelines.

Results of two studies of the effects of 2 to 3 hours of kangaroo care (KC), one a randomized trial of 25 premature infants in open-air cribs and the other a pilot of 6 premature infants who were at least 24 hours postextubation, who were cared for in incubators are reviewed. Both studies incorporated a pretest/posttest control group design. Heart rate and abdominal skin temperature rose for KC infants during KC. Heat loss did not occur during KC, and infants slept more during KC. Kangaroo care had a comforting effect on infants and their mothers. Apnea and periodic breathing episodes dropped during KC for incubator infants. Suggestions and guidelines for selection of infants and practice based on these studies are presented.

Skin-to-skin contact beginning in the delivery room for Colombian mothers and their preterm infants.

To determine if the transition to extrauterine life is facilitated by skin-to-skin contact, six relatively low risk preterm infants experienced six continuous hours of skin-to-skin contact on their mothers' chests beginning within 30 minutes of birth. Heart and respiratory rates and oxygen saturation remained within normal limits and all infant temperatures rose rapidly to thermoneutral range. Two infants developed grunting respirations by the time skin-to-skin contact began, but the grunting disappeared with warm, humidified oxygen and continuous skin-to-skin contact. All infants were fully breastfeeding and ready for discharge by 24-48 hours postbirth. Early skin-to-skin contact was safe and seemed beneficial for these relatively low risk preterm infants.

Selected physiologic measures and behavior during paternal skin contact with Colombian preterm infants.

A descriptive study of eleven healthy preterm infants was conducted in which cardiorespiratory (heart and respiratory rates, oxygen saturation), thermal (abdominal, toe and tympanic temperatures) and state behavior responses to two hours of paternal skin-to-skin contact within the first 17 hours of birth in Colombia, South America were evaluated. Infant physiologic and behavioral state measures were recorded each minute as was paternal skin temperature and behavior. Infant heart and respiratory rates increased during paternal contact as did abdominal and core temperatures. Fathers were able to keep their infants sufficiently warm, and five infants became hyperthermic (tympanic temperature greater than 37.5 degrees C) despite cooling measures while being held in this climate. Infants slept most of the time while being held and fathers seldom gazed at, spoke to, or touched their infants while holding them. When mothers are unavailable, fathers may be an alternate source of warmth and comfort to infants.

Physiologic responses to skin-to-skin contact in hospitalized premature infants.

Twelve stable premature infants in open-air cribs acted as their own controls in a study designed to evaluate the effect of skin-to-skin contact (SSC) with their mothers on infant heart rate, respiratory rate, oxygen saturation, and skin temperature. Measurements were taken every minute during three consecutive interfeeding periods (2 to 3 hours each): pre-SSC, SSC, and post-SSC. Skin-to-skin contact in the upright position between maternal breasts underneath a velour blouse occurred in the continuing care nursery of secondary level NICUs and was compared with infants lying in open-air cribs. All physiologic measures remained within normal limits, suggesting that SSC had no adverse effects. Statistically significant increases in heart rate and skin and rectal temperatures during SSC were also within normal limits. Skin-to-skin contact can occur between hospitalized stable premature infants and their mothers without physiologic compromise and heat loss to the infant. Practice implications are discussed.

Developmental and temperament outcomes of sensory stimulation in healthy infants.

Eighty-one healthy, full-term infants were randomly assigned to a control group or one of three experimental conditions: daily administration of a cephalocaudal stroking procedure; placement on a multisensory hammock that provided auditory, vestibular, and tactile stimulation during expected sleep cycles; and a combination of the prior two treatments. All interventions were given during the first 3 months of life. Infants in the control group received the natural stimulation provided in their home environments without additional supplementation. Four- and 8-month assessments were done using the Bayley Scales of Infant Development and the Revised Infant Temperament Questionnaire. There were no significant treatment effects on weight or psychomotor development. Although infants receiving unimodal stimulation obtained lower 8-month cognitive development scores than infants in other experimental and control groups, their scores were within normal range. Control group infants achieved the most optimum mood and distractibility scores at both 4 and 8 months.