Preterm infant heart rate is lowered after Family Nurture Intervention in the NICU: Evidence in support of autonomic conditioning. (October 2021)

• Record Type: Journal Article
• Authors: Ludwig, Robert J.; Grunau, Ruth E.; Chafkin, Julia E.; Hane, Amie A.; Isler, Joseph R.; Chau, Cecil M.Y.; Welch, Martha G.; Myers, Michael
• Is Part Of: Early human development. Volume 161(2021)
• Publication Date: 2021-10
• Subjects: ANS autonomic nervous system -- FNI Family Nurture Intervention -- GA gestational age -- GEE generalized estimating equation modeling -- HR heart rate -- NICU Neonatal Intensive Care Unit -- NS nurture specialist -- RCT randomized controlled trial -- RSA respiratory sinus arrhythmia -- SSC skin-to-skin care -- SC standard care; Autonomic stability -- Autonomic nervous system -- Cardiac function -- Kangaroo care -- Skin-to-skin care -- Preterm infant -- Stress; Fetus -- Periodicals; Neonatology -- Periodicals; Prenatal influences -- Periodicals; 612.65
• DOI: 10.1016/j.earlhumdev.2021.105455
• Languages: English
• ISSNs: 0378-3782

Abstract

Abstract: Background: Cardiac complications after premature birth are associated with negative long-term consequences to health. The Family Nurture Intervention (FNI) has been designed to support mother-infant parasympathetic calming sessions in the neonatal intensive care unit (NICU). FNI has shown neurodevelopmental and autonomic benefit across infant development. Aims: We tested the hypothesis that heart rate (HR) will decrease after FNI over the course of the NICU stay, compared to matched controls. Study design: We used a case-matched design. The intervention included on average four ~1-hour facilitated mother-infant 'calming' sessions per week. We collected 24/7 real time heart rate data from a central monitoring system and analyzed data from two time-periods. Subjects: The intervention group comprised 37 infants born ~30 weeks gestational age (GA) in a level IV NICU, treated with FNI. From the same NICU and time-period, we created a contemporaneous comparison group of 32 infants who were case-matched to each intervention infant for sex, age-at-birth, singleton or twin status, month of admission and length of stay. Outcome measures: Using generalized estimating equation (GEE) modeling, we analyzed 24/7 HR data during a 1-hour period between 4:30 and 5:30 am each day in the NICU, when all infants were least disturbed. Using repeated measures ANOVA, we analyzed 24/7 HR data during a 6-week period starting 1 week prior to the start of FNI and ending 5 weeks after start. Results: GEE modeling of the 1-hour data from all subjects showed significant lower HR in the FNI group, compared with controls. ANOVA modeling on a subset of subjects over the five-week period showed that FNI infant HR decreased in a dose-response manner relative to SC HR. Conclusion: This study suggests FNI may condition lower infant HR in a dose-response manner during the NICU stay. Highlights: Preterm delivery adversely affects cardiac function during the early postnatal period. The Family Nurture Intervention (FNI) facilitates mother/infant calming sessions in the NICU. FNI is designed to condition an adaptive autonomic socioemotional reflex between mother and infant. FNI may condition lower infant HR in a dose-response manner during the NICU stay.