Debra H Brandon1, Daniel Hatch2, Angel Barnes3, Ashlee J Vance4, Jane Harney5, Barbara Voigtman6, Noelle Younge7. 1. Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America; Duke University School of Medicine, Department of Pediatrics, Duke University Hospital, DUMC 2739, Durham, NC 27710, United States of America. Electronic address: debra.brandon@duke.edu. 2. Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America. Electronic address: daniel.hatch@duke.edu. 3. Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America. Electronic address: angel.barnes@duke.edu. 4. Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America. Electronic address: ashleev@med.umich.edu. 5. Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America. Electronic address: jane.harney@wisc.edu. 6. Kimberly Clark Corporation South Office, 2001 Marathon Avenue, Neenah, WI 54956, United States of America. Electronic address: Barbara.Voigtman@kcc.com. 7. Duke University School of Medicine, Department of Pediatrics, Duke University Hospital, DUMC 2739, Durham, NC 27710, United States of America. Electronic address: noelle.younge@duke.edu.
Abstract
BACKGROUND: Bundling nurse caregiving interventions are promoted to minimize infant stress. PURPOSE: To evaluate impact of bundled nursing care and diaper change frequency on vital sign stability and skin health of preterm infants born ≤32 weeks gestation. METHOD: Stable preterm infants on a 3-hour feeding schedule were randomly assigned to 3- vs. 6-hour diaper changes. Diapers were changed prior to 6 h if stool was present. Direct observation of bundled care events (BCE) identify caregiving activities during each BCE. Skin pH, transepidermal water loss (TEWL), and neonatal skin condition scores (NSCS) were obtained. Vital sign data (HR, RR, O2 saturation) was downloaded from bedside monitors. RESULTS: Forty-six infants contributed to 605 BCEs. BCEs lasted on average 28 min and included nine different activities (e.g., vital signs, feeding). Significant increases in heart rate during BCEs occurred in approximately half of the observations. Among observations with a diaper change increases in heart rate during diapering occurred in over 74% of observations Infants who were awake at the beginning of BCEs had 48% lower odds of having a change in heart rate than infants who were sleeping (p = .02). There were no group differences (3- vs. 6-hour diaper change) in skin health outcomes (TEWL, pH, NSCS). CONCLUSION: Reducing diaper change frequency without stool present should be considered to minimize caregiving stress in preterm infants. Additional research should evaluate the intrusiveness and clusters of activities that significantly impact physiologic stability to better individualize the timing of routine yet intrusive activities. Clinicaltrials.gov registry # NCT03370757.
BACKGROUND: Bundling nurse caregiving interventions are promoted to minimize infant stress. PURPOSE: To evaluate impact of bundled nursing care and diaper change frequency on vital sign stability and skin health of preterm infants born ≤32 weeks gestation. METHOD: Stable preterm infants on a 3-hour feeding schedule were randomly assigned to 3- vs. 6-hour diaper changes. Diapers were changed prior to 6 h if stool was present. Direct observation of bundled care events (BCE) identify caregiving activities during each BCE. Skin pH, transepidermal water loss (TEWL), and neonatal skin condition scores (NSCS) were obtained. Vital sign data (HR, RR, O2 saturation) was downloaded from bedside monitors. RESULTS: Forty-six infants contributed to 605 BCEs. BCEs lasted on average 28 min and included nine different activities (e.g., vital signs, feeding). Significant increases in heart rate during BCEs occurred in approximately half of the observations. Among observations with a diaper change increases in heart rate during diapering occurred in over 74% of observations Infants who were awake at the beginning of BCEs had 48% lower odds of having a change in heart rate than infants who were sleeping (p = .02). There were no group differences (3- vs. 6-hour diaper change) in skin health outcomes (TEWL, pH, NSCS). CONCLUSION: Reducing diaper change frequency without stool present should be considered to minimize caregiving stress in preterm infants. Additional research should evaluate the intrusiveness and clusters of activities that significantly impact physiologic stability to better individualize the timing of routine yet intrusive activities. Clinicaltrials.gov registry # NCT03370757.
Authors: Rita Tuladhar; Richard Harding; Susan M Cranage; T Michael Adamson; Rosemary S C Horne Journal: Early Hum Dev Date: 2003-04 Impact factor: 2.079
Authors: Evalotte Mörelius; Lena Hellström-Westas; Catarina Carlén; Elisabeth Norman; Nina Nelson Journal: Early Hum Dev Date: 2006-02-28 Impact factor: 2.079
Authors: Rosemary C White-Traut; Michael N Nelson; Jean M Silvestri; Minu Patel; Michael Berbaum; Guo-Guang Gu; Patricia Meleedy Rey Journal: J Obstet Gynecol Neonatal Nurs Date: 2004 Mar-Apr
Authors: Leesa G Allinson; Linda Denehy; Lex W Doyle; Abbey L Eeles; Jennifer A Dawson; Katherine J Lee; Alicia J Spittle Journal: BMJ Paediatr Open Date: 2017-11-25