The relation between maternal factors with preterm newborn pain and stress response while in maternal kangaroo care

Author(s)

Thaíla Corrêa Castral

• Document type: Doctoral Thesis
• Press: Ribeirão Preto.
• Institution: Universidade de São Paulo (USP). Escola de Enfermagem de Ribeirão Preto (PCARP/BC)
• Defense date: 2011-02-24

Examining board members

Carmen Gracinda Silvan Scochi; Sonir Roberto Rauber Antonini; Maria Vera Lúcia Moreira Leitão Cardoso; Maria Beatriz Martins Linhares; Fay Warnock

• Advisor: Carmen Gracinda Silvan Scochi; Fay Warnock

Abstract

Maternal kangaroo care (MKC) effectively reduces acute pain and stress in the preterm, but very little is known about the maternal role during MKC. The main purpose of the present non-controlled intervention study was to examine relationships between maternal factors (caregiving behaviour, depression and anxiety and maternal own stress) and preterm infant pain and stress response during heel lance (HL) for routine neonatal blood screening while in MKC. The study was carried out in a neonatal unit at a university hospital in Ribeirao Preto- SP and involved 42 consenting mothers and their stable preterm infants. Maternal and infant data were collected during three study phases: Baseline (10 minutes - before HL), HL procedure (during blood collection) and Recovery (10 minutes - post HL). On the day of the infant\'s scheduled HL, maternal and infant salivary cortisol samples were collected at baseline and 20 minutes post-HL. Two additional maternal salivary cortisol samples were collected (night and awakening). Continuous measures of infant heart rate (HR) were collected and maternal caregiving behaviour and infant pain behaviour (facial action, cry and infant state) were continuously videotaped during the three study phases. Within the following week of each infant\'s HL, the emotional state of study mothers was assessed using the Beck Depression and Anxiety Inventories. The Neonatal Facial Coding System (NFCS) and the Maternal Mood Infant Pain Behaviour Coding System were used to code infant and maternal behaviour, second-by-second, from which time based measures of behaviour were generated. Relationships between maternal and neonatal measures were initially analyzed using bivariate analyses and RM-ANOVA was used to examine change in maternal and infant measures. Multiple regression analyses were then used to test which maternal variables predicted neonatal responses. No statistical significant differences in infant mean NFCS score, cry percentage duration and HR were observed across the study phases when baseline percentage duration of infant sleep-awake state was controlled. Also, maternal and neonatal salivary cortisol pre-HL and post-HL did not differ statistically (p=0.731; p=1.000, respectively). However, mean NFCS score and percentage duration of infant cry during the HL procedure were found to be associated with maternal pre-HL salivary cortisol level (r=0.32; p=0.040 and r=-0.32; p=0.047, respectively). Associations were also observed between neonatal HR duration and maternal nocturne (r=-0.49; p=0.002), pre-HL (r=-0.34; p=0.025) and post-HL (r=-0.51; p=0.001) salivary cortisol levels. Further, neonatal HR post HL procedure was related with nocturne (r=-0.45; p=0.004), pre-HL (r=-0.41; p=0.007) and post-HL (r=-0.50; p=0.001) maternal salivary cortisol. In this study, maternal scores of depression and anxiety and percentage of time spent expressing typical and typically depressed behaviour were not found to predict preterm pain and stress response. However, mother salivary cortisol level pre-HL predicted preterm salivary cortisol post-HL [adjusted R2=0.092; F(1,36)=4.764; p=0.036]; and maternal nocturne salivary cortisol together with gestational age predicted neonatal HR [adjusted R2=0.282; F(2,35)=8.219; p=0.001]. Study findings support the effectiveness of the maternal regulatory role in MKC but do suggest that the stress regulatory ability (as reflected by maternal cortisol levels) of the studies mothers may be predictive of alteration in pain and stress response in preterm offspring. Similar studies are needed to substantiate and to build on study findings. (AU)

• FAPESP's process: 07/05051-1 - The relation between maternal factors and pre-term acute pain response during PKU test in the condition of skin-to-skin contact
• Grantee: Thaíla Corrêa Castral
• Support Opportunities: Scholarships in Brazil - Doctorate