04/19/23

Soothability and Promotion of Growth in Preterm Infants

2012 State of the Science Congress on Nursing Research

Holly J. Diesel, PhD, RN

Patrick M. Ercole, PhD, MPH

Purpose & Hypotheses

To examine the effects of a flax seed pillow on premature infant soothability, weight gain and hospital length of stay Infants receiving the intervention will be more

soothed Infants who are soothed will gain more weight Infants who gain more weight will have

shorter hospital length of stays

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Background & Significance

Prematurity is a local and global problem

Premature infants have poorer outcomes

Prematurity is costly

Review of the Literature

Touch

Developmental Care Model

Massage

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Model

NurseNurse

ParentParent

Preterm Infant

Input

Input

Input Input

GrowthGrowth

No No GrowthGrowth

Interaction

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Power Analyses Power analysis

á = .05Effect size of 10Standard deviation of 10Group size of 1483% power80% retention total sample size of 36Final n = 46

Methods

Design

Setting

Inclusion/exclusion

Variables

XOX

R

X X

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Recruitment & Enrollment

IRB approval

Staff in-services

Pilot study

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Protocol Enrollment Stabilization Actiwatch Pre-intervention Intervention Post-intervention

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Statistical Procedures

SPSS 17.0

Examination for outliers

Detection of demographic differences

DemographicsIntervention n=23 Control n=24 t(p)

Infant Ethnicity

Caucasian/white n= 5 (22%) n= 12 (52%) 0.075

African American n=17 (74%) n= 11 (48%)

Hispanic/Latino n= 0 n= 0

Asian/Pacific Islander n=1 (4%) n= 0

Other n= 0 n= 0

Gestational Age

Mean 33.8 (1.77) 33.2 (1.74) 1.13 (.265)

Range 30-36 31-36

Gender

Female 8 (35%) 14 (61%) 1.79 (.080)

Male 15 (65%) 9 (39%)

Birth weight 2120 (473) 2100 (439) .143 (.887)

Birth length 45.1 (2.6) 45.1 (2.6) .028 (.978)

Apgar scores

1 minute 8 (1.77) 8 (1.07) -1.41 (.17)

5 minute 9 (.66) 9 (.66) .000 (1.0)

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Research Question #1

Do infants who receive the flax seed pillow intervention demonstrate greater soothability than the infants in the control group?

Pre/Post Intervention HRIntervention Control

HR Pre

Mean(sd)

HR Post

Mean(sd)

t(p) HR Pre

Mean(sd)

HR Post Mean(sd)

t(p)

Day 2 T1 148(8.8) 137(11.7) -2.46(.018)* 149(12.0) 151(13.5) -2.94(.770)

Day 2 T2 154(10.0) 139(11.9) -3.18(.003)* 150(15.7) 152(15.1) .916(.366)

Day 3 T1 152(12.2) 139(9.5) -5.02(.000)* 152(9.6) 154(11.9) -.040(.968)

Day 3 T2 153(12.2) 141(9.4) -4.73(.000)* 148(9.7) 157(13.2) 1.61(.114)

Day 4 T1 153(12.8) 138(12.1) -4.02(.000)* 146(12.0) 151(10.6) 1.77(.084)

Day 4 T2 159(10.3) 143(11.3) -2.91(.005)* 152(12.1) 155(15.7) 2.21(.033)

* Statistically significant

Pre/Post Intervention RRIntervention Control

RR Pre Mean(sd)

RR PostMean(sd)

t (p) RR Pre Mean(sd)

RR PostMean(sd)

t (p)

Day 2 T1 57 (14.9) 43 (12.5) -3.419 (.001)* 58 (11.2) 56 (13.6) -.167(.868)

Day 2 T2 58 (13.6) 53(9.33) -3.014 (.004)* 53 (12.4) 53 (13.0) 1.399(.169)

Day 3 T1 57 (13.1) 40 (10.3) -3.995 (.000)* 53 (8.9) 52 (9.7) .579(.566)

Day 3 T2 56 (13.7) 40 (8.3) -5.135 (.000)* 52 (8.6) 56 (12.9) 1.160(.252)

Day 4 T1 58 (13.5) 42 (10.1) -3.111 (.003)* 54 (12.1) 53 (13.5) .932(.356)

Day 4 T2 62 (10.2) 44 (10.6) -2.863 (.006)* 54 (11.7) 55 (14.9) 2.379(.022)

* Statistically significant

Pre/Post Intervention NIPSIntervention Control

NIPS Pre Mean(sd)

NIPS PostMean(sd)

t (p) NIPS Pre Mean(sd)

NIPS PostMean(sd)

t (p)

Day 2 T1 1.5 (1.31) .65 (1.02) -2.46 (.018)* 1.2 (1.16) 1.4 (1.12) .713(.479)

Day 2 T2 1.8 (1.67) .30 (.559) -3.285 (.003)* 1.0 (.953) 1.48 (1.60) 1.945(.060)

Day 3 T1 1.1 (1.13) .22 (.518) -3.726 (.001)* .91 (.900) 1.0 (.928) 1.260(.214)

Day 3 T2 1.4 (1.37) .17 (.385) -5.581 (.000)* 1.0 (1.19) 1.9 (1.44) .919(.363)

Day 4 T1 1.3 (1.42) .22 (.846) -2.782 (.008)* .96 (1.43) 1.1 (1.32) .724(.473)

Day 4 T2 2.3 (1.33) .48 (.788) -2.390 (.023)* .78 (.902) 1.4 (1.55) 4.543(.000)*

* Statistically significant

Pre/Post Intervention Activity

Wake Time Mean (sd) Sleep Time Mean (sd)

Day Intervention Control t (p) Intervention Control t (p)

2 440 (152) 361 (152) 1.77 (.084) 918 (290) 1079 (152) -2.37 (.022)*

3 475 (258) 365 (181) 1.68 (.100) 919 (309) 1077 (182) -2.11 (.042)*

4 380 (181) 320 (124) 1.32 (.195) 1069 (180) 1119 (125) -1.09 (.283)

* Statistically significant

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Research Question #2

Do infants who are soothed gain more weight?

Comparison of Weight Gain

Intervention

Mean(sd)

Control

Mean(sd)

t(p)

Weight at discharge

(grams)

2379.8 (323.6) 2373.0 (333.4) .070 (.945)

Extended Daily Mean Weight by Study Group

1900

1950

2000

2050

2100

2150

2200

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Study Day

Mea

n D

aily

Wei

ght (

gram

s)

Intervention-Weight Control-Weight

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Research Question #3

Do infants who gain more weight have shorter hospital length of stay?

Comparison of Weight Gain & Hospital Length of Stay

Intervention

Mean(sd)

Control

Mean(sd)

t(p)

Weight gain 2379.8 (323.6) 2373.0 (333.4) .070 (.945)

Length of stay 16.5 (9.50) 16.4 (12.4) .013 (.989)

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Discussion Exploratory research

Confirms previous research

Multiple measures with reliability/validity

No adverse effects

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Limitations

Generalizability

Nursery relocation

Parental involvement

Care delivery variation

Implications

For ResearchLarger sample sizeAdditional populationsAdditional variables

For NursingAdditional intervention optionOpportunity for increased parental involvement

Conclusion

Flax seed pillow and soothabilitySafe, simple intervention to assist premature

infants with transition to extra-uterine environment

Well received by nursing and parents Increased opportunity for parental involvement

References

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Anderson, G.C., Chiu, S., Dombrowski, M.A., Swinth, J.Y., Albert, J.M., & Wada, N. (2003). Mother-newborn contact in a randomized trail of kangaroo (skin-to-skin) care. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32 (5), 604-611.

Axelin, A., Salantera, S, & Lehtonen, L. (2006). Facilitated tucking by parents’ in pain management of preterm infants – a randomized crossover trial. Early Human Development, 82, 241-247.

Beachy, J. (2003). Premature infant massage in the NICU. Neonatal Network, 22(3), 39- 45.

References Byers, J.F. (2003). Components of developmental care and the evidence

for their use in the NICU. The American Journal of Maternal/Child Nursing, 28(3), 174-180.

Dieter, J.N.I, Field, T., Hernandez-Reif, M., Emory, E.K., & Redzepi, M. (2003) . Stable preterm infants gain more weight and sleep less after five days of massage therapy. Journal of Pediatric Psychology, 28(6), 403-411.

Field, T., Hernandez-Reif, M., Feijo, L., & Freedman, J. (2006). Prenatal, perinatal and neonatal stimulation: A survey of neonatal nurseries. Infant Behavior and Development, 29, 24-31.

Grenier, I.R., Bigsby, R., Vergara, E.R., & Lester, B.M. (2003). Comparison of motor self-regulatory and stress behaviors of preterm infants across body positions. American Journal of Occupational Therapy, 57(3), 289-287.

References Grunau, R., Linhares, M., Holsti, L., Oberlander, T., & Whitfield, M.F.

(2004). Does prone or supine position influence pain response in preterm infants at 32 weeks gestational age? Clinical Journal of Pain, 20(2), 76-82.

Harrison, L.L. (2001). The use of comforting touch and massage to reduce stress for preterm infants in the neonatal intensive care unit. Newborn and Infant Nursing Reviews, 1(4), 235-241.

Liaw, J.J. (2000). Tactile stimulation and preterm infants. Journal of Perinatal & Neonatal Nursing, 14(1), 84-103.

Ream, E., & Richardson, A. (1996). Fatigue: Aconcept analysis. International Journal of Nursing Studies, 33(5), 519-529.

White-Traut, R.C., Nelson, M.N., Silverstri, J.M., Patel, M., Berbaum, M., & Gu, G.G. (2004).