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Promoting health in premature infants: with special focus on skin-to-skin contact and development of valid pain assesment
Örebro University, School of Medical Sciences.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Premature infants are at greater risk for both short- and long-term negative outcomes than infants born at full term. Premature infants have an immature nervous system and are not developmentally prepared to process the often excessive stimuli and frequent painful procedures of intensive care. Skin-to-skin contact between the infant and the parent is beneficial for both infant and parents and can also humanize the intense environment of the neonatal intensive care unit. The aim of the thesis, to promote health in premature infants had two parts: (1) to investigate aspects of skin-to-skin contact (SSC) within neonatal care, and (2) to contribute to the development of a valid method for pain assessment in premature infants. In Study I, questionnaires about the implementation of SSC and staff’s attitudes toward the method were sent to all neonatal units in the Nordic countries. SSC was offered in all 87% of the units that responded, but to different extents in different countries. Medical risks and the physical environment were considered barriers to SSC, and the infant’s general development was considered the primary benefit. In Study II, 20 fathers of premature infants were interviewed about their experiences with SSC. The fathers’ overall experiences were positive and SSC made them feel involvedin their infant’s care. They also described the  environment as an obstacle, but the experience as both gratifying and challenging. In Study III, SSC with their mothers was shown to have a pain-relieving effect on premature infants undergoing a blood test. This effect was examined through nearinfrared spectroscopy (NIRS) over the somatosensory cortex. In Study IV the Premature Infant Pain Profile - Revised was translated and culturally adapted into Finnish, Icelandic, Norwegian and Swedish. In summary, SSC was used to various degrees in the Nordic countries, fathers seemed to appreciate the method, which made them feel more involved, and SSC provided pain relief during a blood test.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2017. , 63 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 157
Keyword [en]
Near-infrared spectroscopy, Neonatal intensive care, Pain assessment, Premature infant, Skin-to-skin contact
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:oru:diva-54775ISBN: 978-91-7529-183-3 (print)OAI: oai:DiVA.org:oru-54775DiVA: diva2:1066219
Public defence
2017-04-07, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-01-17 Created: 2017-01-17 Last updated: 2017-03-15Bibliographically approved
List of papers
1. Skin-to-skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices
Open this publication in new window or tab >>Skin-to-skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices
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2012 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 10, 1140-1146 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate the application of skin-to-skin care (SSC) in the Nordic countries, the existence of guidelines for SSC and the attitudes of neonatal staff towards SSC.

Methods: One questionnaire was distributed at unit level and one at staff level in all Nordic neonatal intensive care units (n = 109).

Results: The unit questionnaire was answered by 95 (87%) units and the staff questionnaire by 1446 staff members (72%). All units offered SSC to various degrees, but guidelines only existed at 47% of them. Units in Denmark, Norway and Sweden seemed to use SSC earlier, longer and in more medically complicated situations than units in Finland and Iceland. Seventy-seven per cent of the units had private rooms where parents and infants could stay together, still the physical environment of the units limited the use of SSC. Medical risks were considered the main barrier for further implementation of SSC, while general development and early interaction were the most frequently mentioned benefits.

Conclusion: Skin-to-skin care is implemented in all Nordic neonatal units, but offered to various degrees, to various populations and to varying extents. Danish, Norwegian and Swedish units are offering SSC more extensively than units in Finland and Iceland.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2012
Keyword
Kangaroo mother care, neonatal care, newborn infant, skin-to-skin care
National Category
Nursing
Research subject
Medicine; Caring sciences
Identifiers
urn:nbn:se:oru:diva-25710 (URN)10.1111/j.1651-2227.2012.02802.x (DOI)000309408200022 ()22849363 (PubMedID)2-s2.0-84867101431 (Scopus ID)
Available from: 2012-09-04 Created: 2012-09-04 Last updated: 2017-03-15Bibliographically approved
2. Skin-to-skin contact facilitates a more equal parenthood: a qualitative study from fathers’ perspectives
Open this publication in new window or tab >>Skin-to-skin contact facilitates a more equal parenthood: a qualitative study from fathers’ perspectives
(English)Manuscript (preprint) (Other academic)
National Category
Family Medicine
Identifiers
urn:nbn:se:oru:diva-56354 (URN)
Available from: 2017-03-15 Created: 2017-03-15 Last updated: 2017-03-15Bibliographically approved
3. Skin-to-skin contact reduces near-infrared spectroscopy pain responses in premature infants during blood sampling
Open this publication in new window or tab >>Skin-to-skin contact reduces near-infrared spectroscopy pain responses in premature infants during blood sampling
2016 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 4, 376-380 p.Article in journal (Refereed) Published
Abstract [en]

Aim: This study investigated if skin-to-skin contact could provide pain relief, measured with near infrared spectroscopy (NIRS), during venepuncture in premature infants.

Methods: Ten infants born at 26-35 weeks of gestation were examined during a blood sampling procedure with venepuncture under two different conditions: in skin-to-skin contact with their mother or lying in their incubator or crib. A double-channel NIRS device was used and oxygen saturation and heart rate were measured using pulse oximetry. The infant's face and the pulse oximetry values were videotaped throughout the procedures, so that we could carry out a pain assessment using the Premature Infant Pain Profile - Revised (PIPP-R).

Results: We found a significantly smaller increase in oxygenated haemoglobin on the contralateral side during venepuncture when the infants were in skin-to-skin contact with their mothers, compared to when they were laying in their incubator or crib. When venepuncture was compared with a sham procedure, oxygenated haemoglobin increased significantly more with the infant in the incubator or crib than held skin-to-skin, but no significant differences could be seen in the PIPP-R results between the two groups.

Conclusion: This study showed that skin-to-skin contact between premature infants and their mothers during venepuncture had a pain-relieving effect.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keyword
Near infrared spectroscopy, newborn infant, pain, skin-to-skin contact
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:oru:diva-45724 (URN)10.1111/apa.13180 (DOI)000371892200018 ()26342142 (PubMedID)
Funder
Magnus Bergvall Foundation
Note

Funding Agencies:

Örebro University Hospital Research Foundation

Nils Svenningsens minnesfond

Stiftelsen Allmana BBs minnesfond

Research Committee at Region Örebro County 

Available from: 2015-09-07 Created: 2015-09-07 Last updated: 2017-03-15Bibliographically approved
4. Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R)
Open this publication in new window or tab >>Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R)
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(English)Manuscript (preprint) (Other academic)
National Category
Family Medicine
Identifiers
urn:nbn:se:oru:diva-56355 (URN)
Available from: 2017-03-15 Created: 2017-03-15 Last updated: 2017-03-15Bibliographically approved

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