Maternal holding during therapeutic hypothermia for infants with neonatal encephalopathy is feasible

Abstract

Aim: Concerns for infant destabilisation often prohibit parental holding of infants during therapeutic hypothermia (TH). We assessed the feasibility of maternal holding during TH, as the inability to hold can impede bonding.

Methods: Vital signs were assessed in stable infants before, at two-minute intervals during and 30 minutes after a single 30-minute holding session. The infant remained on the blanket throughout holding, and both infant and blanket were placed into the mother's arms on top of a thin foam insulating barrier. Mothers and nurses were surveyed about their experience.

Results: Ten infants undergoing TH for neonatal encephalopathy had no equipment malfunctions or dislodgement. The mean temperature was 33.4°C prior to and 33.5°C (p = 0.18) after holding. There was no significant bradycardia (heart rate <80 beats per minute), hypotension (mean arterial pressure <40 mm Hg) or oxygen desaturation (<93%). Nurses either strongly agreed (75%) or agreed (25%) with the statement 'After assisting with the holding protocol, I feel that holding during cooling is safe'. Mothers (100%) strongly agreed that other parents would benefit from holding.

Conclusion: In a small sample of ten stable infants treated with TH for neonatal encephalopathy, holding resulted in no adverse events and positive feedback from mothers and nurses.

Trial registration: ClinicalTrials.gov NCT03079284.

Keywords: Bonding; Holding; Hypothermia; Neonatal intensive care unit; Warming.

Conflict of interest statement

Conflict of Interest

The authors declare no conflicts of interest.

©2019 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Figures

Figure 1:

Vital sign parameters for each individual case. Bold black line on each boxplot indicates median, box indicates interquartile range, whiskers indicate range and dots indicate potential outliers. A: Temperature (y-axis) by case (x-axis) with predominant electroencephalogram (EEG) background during the 24 hour period during which infant was held on x-axis below the case number. Discontinuous background indicated by abbreviation “DIS” and continuous background indicated by abbreviation “CONT”. B: Heart rate (y-axis) by case (x-axis) with the morphine dose in mcg/kg/hr identified below the case number. C: Arterial blood pressure (y-axis) by case (x-axis) with blood pressure measurement device indicated below the case number. “CUFF” used to indicate blood pressure cuff measurement and “UAC” used to indicate umbilical arterial catheter. D. Oxygen saturation (y-axis) by case (x-axis) with respiratory support under case number on x-axis. “None” designates no support, “NC” designates nasal cannula oxygen and “CPAP” designates continuous positive airway pressure.

Figure 1:

Vital sign parameters for each individual case. Bold black line on each boxplot indicates median, box indicates interquartile range, whiskers indicate range and dots indicate potential outliers. A: Temperature (y-axis) by case (x-axis) with predominant electroencephalogram (EEG) background during the 24 hour period during which infant was held on x-axis below the case number. Discontinuous background indicated by abbreviation “DIS” and continuous background indicated by abbreviation “CONT”. B: Heart rate (y-axis) by case (x-axis) with the morphine dose in mcg/kg/hr identified below the case number. C: Arterial blood pressure (y-axis) by case (x-axis) with blood pressure measurement device indicated below the case number. “CUFF” used to indicate blood pressure cuff measurement and “UAC” used to indicate umbilical arterial catheter. D. Oxygen saturation (y-axis) by case (x-axis) with respiratory support under case number on x-axis. “None” designates no support, “NC” designates nasal cannula oxygen and “CPAP” designates continuous positive airway pressure.

Figure 1:

Vital sign parameters for each individual case. Bold black line on each boxplot indicates median, box indicates interquartile range, whiskers indicate range and dots indicate potential outliers. A: Temperature (y-axis) by case (x-axis) with predominant electroencephalogram (EEG) background during the 24 hour period during which infant was held on x-axis below the case number. Discontinuous background indicated by abbreviation “DIS” and continuous background indicated by abbreviation “CONT”. B: Heart rate (y-axis) by case (x-axis) with the morphine dose in mcg/kg/hr identified below the case number. C: Arterial blood pressure (y-axis) by case (x-axis) with blood pressure measurement device indicated below the case number. “CUFF” used to indicate blood pressure cuff measurement and “UAC” used to indicate umbilical arterial catheter. D. Oxygen saturation (y-axis) by case (x-axis) with respiratory support under case number on x-axis. “None” designates no support, “NC” designates nasal cannula oxygen and “CPAP” designates continuous positive airway pressure.

Figure 1:

Vital sign parameters for each individual case. Bold black line on each boxplot indicates median, box indicates interquartile range, whiskers indicate range and dots indicate potential outliers. A: Temperature (y-axis) by case (x-axis) with predominant electroencephalogram (EEG) background during the 24 hour period during which infant was held on x-axis below the case number. Discontinuous background indicated by abbreviation “DIS” and continuous background indicated by abbreviation “CONT”. B: Heart rate (y-axis) by case (x-axis) with the morphine dose in mcg/kg/hr identified below the case number. C: Arterial blood pressure (y-axis) by case (x-axis) with blood pressure measurement device indicated below the case number. “CUFF” used to indicate blood pressure cuff measurement and “UAC” used to indicate umbilical arterial catheter. D. Oxygen saturation (y-axis) by case (x-axis) with respiratory support under case number on x-axis. “None” designates no support, “NC” designates nasal cannula oxygen and “CPAP” designates continuous positive airway pressure.

Figure 2:

Mean temperatures and standard deviations for each 2 minute time interval before, during and after holding. The goal temperature is between 33–34°C.