Preterm infants' biobehavioral responses to caregiving and positioning over 24 hours in a neonatal unit in Taiwan

Abstract

This prospective, descriptive study used a repeated‐measures design to explore preterm infants' biobehavioral responses to 24‐hour neonatal caregiving and positioning, and the factors associated with changes in their biobehavioral responses. Thirty preterm infants (gestational age 27.6–36.1 weeks) were observed for 3 days to record biobehavioral responses. Infants' disorganized behaviors increased as caregiving intrusiveness and supine positioning increased. Social interactions did not lead to increases in infants' disorganized behaviors, but to increased regulatory behaviors. Non‐nutritive sucking (NNS), and prone positioning reduced occurrences of infant disorganized behaviors. Routine caregiving increased instability of oxygen saturation, but lateral and prone positioning improved physiological stability. Clinicians can appropriately provide NNS, positioning, and social interactions to promote biobehavioral stability. © 2012 Wiley Periodicals, Inc. Res Nurs Health 35:634–646, 2012

Newborn Physiological Immaturity

“…At the same time, this environment may add stressors to the premature infant, because of the infant's lack of neurological and sensory maturity to modulate external environmental factors. 33 , 34 Immature integumentary and immune systems do not provide competent defense against microorganisms. 35 Lung immaturity and poor lung compliance from lack of surfactant limits the infant's capacity for gas exchange.…”

Development of atraumatic heel-stick procedures by combined treatment with non-nutritive sucking, oral sucrose, and facilitated tucking: A randomised, controlled trial

“…Infants were placed in one of three positions: (a) supine: chest towards the top of the incubator; (b) prone: chest on the incubator bed, head turned sidewise, or with small towel rolls for support or head and trunk slightly elevated; (c) lateral: right or left side of trunk on the bed, supported by towel rolls (for details, see Liaw et al, 2012a). Infant position was coded with kappa reliabilities of 0.94-0.97.…”

“…Preterm infants' behavioural responses have been suggested to occur more frequently with even routine caregiving procedures (Liaw et al, 2012a), let alone invasive caregiving procedures. During painful caregiving procedures, preterm infants lack the autonomic and functional maturity to regulate themselves (Liaw et al, 2012a;Gibbins et al, 2008), so they need more support and protection to comfort them and facilitate their behavioural stability (Liaw et al, 2010;Catelin et al, 2005).…”

“…During painful caregiving procedures, preterm infants lack the autonomic and functional maturity to regulate themselves (Liaw et al, 2012a;Gibbins et al, 2008), so they need more support and protection to comfort them and facilitate their behavioural stability (Liaw et al, 2010;Catelin et al, 2005). Such support and protection has been shown to relieve mild-tomoderate short-term pain and comfort infants in distress by nonpharmacological interventions such as NNS (Liaw et al, 2012b), oral sucrose (Cignacco et al, 2012;Stevens et al, 2010), and FT (holding an infant with warm hands to offer tactile and thermal sensory stimulation; Liaw et al, 2012b;Axelin et al, 2006).…”

Effects of Combined Use of Mother’s Breast Milk, Heartbeat Sounds, and Non‐Nutritive Sucking on Preterm Infants’ Behavioral Stress During Venipuncture: A Randomized Controlled Trial

“…Preterm infants in the NICU display stress behaviors when receiving routine caregiving procedures (Liaw et al, 2012), as well as during painful, invasive procedures such as venipuncture. Preterm infants usually express pain and stress through consistent crying and increasing volumes, and through their facial actions, which include brow bulging, eye squeezing, an open mouth, a taut tongue, and nasolabial furrow deepening (Collados‐Gόmez et al, 2018; Gibbins et al, 2014).…”