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Published on: January 7, 2020
Feasibility and Impact of a Pilot Neonatal Cuddler Program on Preterm Infants in the Neonatal Intensive Care Unit
Kylie Bushroe1, Brieann Lloyd1, Chonita McDaneld1
1Division of Newborn Medicine, Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Insights
A neonatal cuddler program (NCP) positively impacted preterm infants' growth in the NICU. Even limited volunteer interaction improved weight and head circumference, suggesting benefits for infant development.
Area of Science:
- Neonatal intensive care
- Infant development
- Pediatric nursing
Background:
- Preterm infants in the NICU experience significant daily stress.
- Parental presence can be limited due to external factors.
- Positive sensory experiences are crucial for mitigating infant stress.
Purpose of the Study:
- To evaluate the impact of a neonatal cuddler program (NCP) on the growth of preterm infants.
- To assess the feasibility of implementing an NCP in a NICU setting.
Main Methods:
- A multidisciplinary program trained volunteers to provide sensory experiences to NICU infants.
- Infants were prospectively followed, with intervention data recorded.
- Statistical analyses (t-test, chi-square) compared anthropometric measures between intervention and control groups.
Main Results:
- Infants in the NCP group showed increased weight and occipitofrontal circumference (OFC) at discharge.
- The change in weight z-scores from birth to discharge was significant for the intervention group.
- Group allocation was a significant factor for OFC z-scores and change in weight z-scores.
Conclusions:
- A neonatal cuddler program is feasible and can positively impact preterm infant growth parameters.
- Limited exposure to positive sensory experiences through an NCP can yield measurable growth benefits.
- Further research is needed to explore the program's effects on neurobehavioral and developmental outcomes.
Objective:
Preterm infants experience daily stress in the neonatal intensive care unit (NICU). Positive sensory experiences mitigate stress responses, but parental participation can be limited by external pressures. This study aimed to describe the impact of a neonatal cuddler program (NCP) on preterm infants' growth.
Study Design:
A multidisciplinary program trained volunteers to interact with NICU infants when family was not at bedside. Infants were followed prospectively throughout admission. Intervention data included frequency, type, and duration of activity throughout the study period. Student t-test and chi-square test were used to analyze the impact of volunteer interaction on anthropometric measures at discharge.
Results:
Forty-five infants interacted with a volunteer (intervention group, n = 45) compared with the control group (n = 56) following coronavirus disease 2019 restrictions. The median (range) time of interaction with a volunteer in the intervention group was 90.0 (5.0-705.0) minutes per infant. Infants in the two groups had similar gestational ages, birth weights, lengths, and occipitofrontal circumferences (OFC). Infants in the intervention group had higher rates of spontaneous intestinal perforation, bronchopulmonary dysplasia, and reached full enteral feeds later. However, rates of severe intraventricular hemorrhage, retinopathy of prematurity, and duration of mechanical ventilation were similar. Infants in the two groups did not differ in the NICU length of stay. At discharge, infants in the intervention group weighed more (p = 0.04) and had higher OFC's (p = 0.01) and OFC z-scores (p = 0.03). The change in z-scores from birth to discharge was significant for the weight (p = 0.02) but not length or OFC. In regression analyses, only group allocation was identified as a significant factor for OFC z-scores at discharge (β= 0.279, p = 0.011) and for change in weight z-scores from birth to discharge (β = 0.226, p = 0.041).
Conclusion:
Growth is positively impacted by an NCP despite limited interaction. Additional work is needed to demonstrate the impact on neurobehavioral and developmental outcomes.
Key Points:
· Establishing and implementing a neonatal cuddler program in a large, level IV NICU is feasible.. · Neonatal cuddler programs can provide positive sensory experiences when parents are not at bedside.. · Even limited exposure to these positive sensory experiences can positively impact growth parameters for preterm infants..
