Increased Frequency of Skin-to-Skin Contact Is Associated with Enhanced Vagal Tone and Improved Health Outcomes in Preterm Neonates

Abstract

Objective An estimation of the individual's ability to cope with environmental adversity, that is, stress resiliency, can be extrapolated by measuring cardiac vagal tone, that is, high-frequency heart rate variability (HF-HRV); indeed, higher HF-HRV is associated with health and developmental advantages for preterm neonates. Previous studies show skin-to-skin contact (SSC) improves stress resiliency; however, linkages between SSC and HF-HRV on outcomes have not been assessed. We aimed to test the hypothesis that increased SSC frequency would enhance HF-HRV, reduce neonatal morbidity, and improve developmental outcomes.

Study Design Weekly electrocardiograms and clinical data were obtained from 101 preterm neonates. SSC frequency was determined from the electronic medical record.

Results At postnatal week 1, frequency of SSC and HF-HRV were positively correlated (p =.02); further, multiple stepwise regressions showed higher HF-HRV and SSC predicted reduced days on ventilation and oxygen, and shorter hospital stay (p < 0.001). Higher HF-HRV predicted lower postmenstrual age (PMA) at discharge (p < 0.01).

Conclusion Higher SSC frequency was associated with increased HF-HRV during the first postnatal week. SSC and HF-HRV uniquely predicted diminished neonatal morbidity throughout hospitalization. Additionally, HF-HRV uniquely predicted earlier PMA at discharge. Augmenting SSC early in life enhances stress resiliency and improves health outcomes.

Keywords

HF-HRV - preterm neonates - skin-to-skin contact - stress resiliency

Authors' Contributions

M.M.M. participated in the execution of the study, conducted data analysis, wrote the first draft of the article, and reviewed and revised the article. F.C.G. participated in execution of the study, assisted in data analysis, contributed to the writing of the article, and reviewed and revised the article. K.M.S. participated in the execution of the study, contributed to the writing of the article, and reviewed the article. A.T. made important scientific contributions to protocol development, interpretation of the findings, and reviewing and approving the article. K.K.D. had primary responsibility for scientific oversight and fidelity of the research study protocol development, data analysis, and writing and revising the article. All authors approved the final version of the article prior to submission and agree to be accountable for all aspects of the work.

• References

• 1 Doheny KK. Long-term consequences of pain and stress in neonates. In: Buonocore G, Bellieni CV. , eds. Neonatal Pain: Suffering, Pain, and Risk of Brain Damage in the Fetus and Newborn, 2nd ed. Cham, Switzerland: Springer International; 2017: 213-225
• 2 McEwen BS, Gray J, Nasca C. Recognizing resilience: Learning from the effects of stress on the brain. Neurobiol Stress 2015; 1: 1-11
• 3 Porges SW. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. New York: W.W. Norton & Company; 2011
• 4 Geisler FC, Kubiak T, Siewert K, Weber H. Cardiac vagal tone is associated with social engagement and self-regulation. Biol Psychol 2013; 93 (02) 279-286
• 5 Hastings PD, Nuselovici JN, Utendale WT, Coutya J, McShane KE, Sullivan C. Applying the polyvagal theory to children's emotion regulation: social context, socialization, and adjustment. Biol Psychol 2008; 79 (03) 299-306
• 6 Doussard-Roosevelt JA, McClenny BD, Porges SW. Neonatal cardiac vagal tone and school-age developmental outcome in very low birth weight infants. Dev Psychobiol 2001; 38 (01) 56-66
• 7 Patural H, Pichot V, Jaziri F. , et al. Autonomic cardiac control of very preterm newborns: a prolonged dysfunction. Early Hum Dev 2008; 84 (10) 681-687
• 8 Beckie TM. A systematic review of allostatic load, health, and health disparities. Biol Res Nurs 2012; 14 (04) 311-346
• 9 McEwen BS. Allostasis and the epigenetics of brain and body health over the life course: the brain on stress. JAMA Psychiatry 2017; 74 (06) 551-552
• 10 Cong X, Ludington-Hoe SM, McCain G, Fu P. Kangaroo care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early Hum Dev 2009; 85 (09) 561-567
• 11 Vittner D, McGrath J, Robinson J. , et al. Increase in oxytocin from skin-to-skin contact enhances development of parent-infant relationship. Biol Res Nurs 2018; 20 (01) 54-62
• 12 Feldman R. Sensitive periods in human social development: new insights from research on oxytocin, synchrony, and high-risk parenting. Dev Psychopathol 2015; 27 (02) 369-395
• 13 Boundy EO, Dastjerdi R, Spiegelman D. , et al. Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics 2016; 137 (01) 1-16
• 14 Hendricks-Muñoz KD, Xu J, Parikh HI. , et al. Skin-to-skin care and the development of the preterm infant oral microbiome. Am J Perinatol 2015; 32 (13) 1205-1216
• 15 Nyqvist KH, Anderson GC, Bergman N. , et al. Towards universal kangaroo mother care: recommendations and report from the first European conference and seventh international workshop on kangaroo mother care. Acta Paediatr 2010; 99 (06) 820-826
• 16 Conde-Agudelo A, Belizán JM, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2011; 3 (03) CD002771
• 17 Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol 2010; 39 (Suppl. 01) i144-i154
• 18 Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry 2014; 75 (01) 56-64
• 19 Schneider C, Charpak N, Ruiz-Peláez JG, Tessier R. Cerebral motor function in very premature-at-birth adolescents: a brain stimulation exploration of kangaroo mother care effects. Acta Paediatr 2012; 101 (10) 1045-1053
• 20 Nyqvist KH. Given the benefits of kangaroo mother care, why has its routine uptake been so slow?. Acta Paediatr 2016; 105 (04) 341-342
• 21 Feldman R, Eidelman AI. Skin-to-skin contact (kangaroo care) accelerates autonomic and neurobehavioural maturation in preterm infants. Dev Med Child Neurol 2003; 45 (04) 274-281
• 22 Richardson DK, Gray JE, McCormick MC, Workman K, Goldmann DA. Score for neonatal acute physiology: a physiologic severity index for neonatal intensive care. Pediatrics 1993; 91 (03) 617-623
• 23 Li Y, Yan J, Li M. , et al. Addition of SNAP to perinatal risk factors improves the prediction of bronchopulmonary dysplasia or death in critically ill preterm infants. BMC Pediatr 2013; 13: 138
• 24 Gardner FC, Adkins CS, Hart SE, Travagli RA, Doheny KK. Preterm stress behaviors, autonomic indices, and maternal perceptions of infant colic. Adv Neonatal Care 2018; 18 (01) 49-57
• 25 Verklan MT, Padhye NS. Spectral analysis of heart rate variability: an emerging tool for assessing stability during transition to extrauterine life. J Obstet Gynecol Neonatal Nurs 2004; 33 (02) 256-265
• 26 Porges SW. The polyvagal perspective. Biol Psychol 2007; 74 (02) 116-143
• 27 Dodd VL. Implications of kangaroo care for growth and development in preterm infants. J Obstet Gynecol Neonatal Nurs 2005; 34 (02) 218-232
• 28 Laborde S, Mosley E, Thayer JF. Heart rate variability and cardiac vagal tone in psychophysiological research - recommendations for experiment planning, data analysis, and data reporting. Front Psychol 2017; 8: 213