liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Is a nappy change stressful to neonates?
Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-3256-5407
Department of Paediatrics, Lund University Hospital, Lund, Sweden.
Department of Paediatrics, Lund University Hospital, Lund, Sweden.
Department of Paediatrics, Lund University Hospital, Lund, Sweden.
Show others and affiliations
2006 (English)In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 82, no 10, 669-676 p.Article in journal (Refereed) Published
Abstract [en]

Objectives

Infants in neonatal intensive care (NICU infants) are often cared for in a stressful environment that includes potentially painful or stressful interventions. The aim was to investigate whether NICU infants have different pattern of stress and pain responses than healthy newborns when challenged by a non-painful everyday care routine.

Methods

NICU infants born at 23–38 weeks gestation (n = 39) were compared to healthy full-term newborns (n = 30). Cortisol concentrations in saliva were determined before and 30 min after a standardised nappy change. The premature infant pain profile (PIPP) and the neonatal infant pain scale (NIPS) were evaluated before, during, directly after, 3 min after, and 30 min after the nappy change. The investigation was performed on two different occasions, first between postnatal days 2–7 and then between postnatal days 10–18.

Results

NICU infants had higher median baseline salivary cortisol levels compared to full-term newborns on both occasions (17.1 nmol/L vs. 6.2 nmol/L p < 0.01 and 8.5 nmol/L vs. 2.4 nmol/L p < 0.01, respectively). Salivary cortisol decreased in response to the second nappy change in NICU infants (p = 0.01). NICU infants had higher PIPP scores during both nappy changes (p < 0.001 for both occasions) and more sustained increases in PIPP and NIPS up to 30 min after the nappy changes compared to full-term newborns.

Conclusions

NICU infants have higher baseline salivary cortisol than healthy full-term newborns. There is a change in baseline cortisol by age in both groups. Full-term infants as well as NICU infants show an increased pain response to a standardised nappy change.

Place, publisher, year, edition, pages
2006. Vol. 82, no 10, 669-676 p.
Keyword [en]
Cortisol; Infant; Newborn; Neonatal intensive care; Pain measurement; Stress
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13953DOI: 10.1016/j.earlhumdev.2005.12.013OAI: oai:DiVA.org:liu-13953DiVA: diva2:22315
Available from: 2006-09-07 Created: 2006-09-07 Last updated: 2016-05-04Bibliographically approved
In thesis
1. Stress in infants and parents: Studies of salivary cortisol, behaviour and psychometric measures
Open this publication in new window or tab >>Stress in infants and parents: Studies of salivary cortisol, behaviour and psychometric measures
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The life of a preterm infant admitted to a neonatal intensive care unit may be stressful from the moment of birth. Ever since Hans Selye’s initial characterisation of the biological stress response, cortisol has been frequently measured as an indicator of stress responsivity. However, research of the stress response and cortisol in infants, especially those who are preterm and/or ill, has been scarce basically because of methodological issues.

The first aim with this thesis was to investigate the acute stress response, as measured by salivary cortisol and behaviour, for preterm infants, healthy infants, and infants at high psychosocial risk in response to certain defined handling procedures. The second aim was to investigate the stress response, as measured by salivary cortisol and psychometric measures, for parents present during the handling procedure of their infants. The intention was to perform all investigations in an as naturally occurring situation as possible, which means that the studied procedures would have been performed irrespectively of the research.

The present thesis includes six original articles. The results of the first study demonstrate that it is feasible to collect sufficient amounts of saliva and to analyse salivary cortisol in neonates using the presented method of collection and analysis. The second study shows that preterm infants, usually cared for in incubators, show no signs of discomfort and have variable cortisol responses during skin-to-skin care with their mothers. The mothers, however, experience stress and low control before their first skin-to-skin care with their preterm infant and do not relax completely until after the session. In the third study we found that preterm infants have higher baseline salivary cortisol as compared to healthy full-term infants. Moreover, preterm infants have higher and sustained pain response during a nappy change as compared to healthy full-term infants. The results of the fourth study shows that infants younger than three months, living in psychosocial high-risk families, have increased cortisol responses during a nappy change, performed by the mother. However, support with the aim of improving mother-infant interaction, dampens the stress response. The results of the fifth study show that oral sweet-tasting solution in combination with a pacifier dampen the levels of the stress hormone cortisol in three months old infants during routine immunisation. Moreover, parents experience more self-rated emotional stress before immunisation if it is their first child who is being immunised. The sixth paper shows that the material used for saliva collection (cotton buds with wooden or plastic sticks) is of importance when saliva is collected but for practical reasons not centrifuged within 24 hours prior to cortisol analyse.

The present thesis shows that it is practically feasible to collect saliva and to analyse the stress hormone cortisol in infants. The interpretation of infants’ and parents’ salivary cortisol responses to different handling procedures are discussed in relation to shortand long-term consequences, neonatal intensive care, preterm birth, attachment, mood, and pain.

Place, publisher, year, edition, pages
Institutionen för molekylär och klinisk medicin, 2006
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 943
Keyword
Stress, Infants, Prematura childern, Intensive care, neonatal, saliva, Chemistry, Glucose, Hydrocortisone
National Category
Pediatrics
Identifiers
urn:nbn:se:liu:diva-7294 (URN)91-85497-78-9 (ISBN)
Public defence
2006-05-12, Berzeliussalen, Ingång 65, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2006-09-07 Created: 2006-09-07 Last updated: 2016-05-04

Open Access in DiVA

No full text

Other links

Publisher's full textLink to Ph.D. thesis

Authority records BETA

Mörelius, EvalotteNelson, Nina

Search in DiVA

By author/editor
Mörelius, EvalotteNelson, Nina
By organisation
PediatricsFaculty of Health Sciences
In the same journal
Early Human Development
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 256 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf