ResultsBackground Results

ClinicalRelevance

Purpose

Methods

PhysiologicStabilityofIntubatedPretermInfantsReceivingKangarooCareintheNeonatalIntensiveCareUnit:ASystematicReview

MaggieHolland,SPT,CourtneyMatthews,SPT,AnneMcGinty,SPT,MeredithRamsey,SPT,AdamGoode,PT,DPT,PhD,LeilaLedbetter,MLIS &LauraCase,PT,DPT,MS,PCS,C/NDT

DoctorofPhysicalTherapyDivision,DukeUniversity,Durham,NCandDukeUniversityMedicalCenterLibrary,Durham,NC

Conclusions

Kangaroocareorskin-to-skincare(SSC)hasbeenshowntobebeneficialforstablepreterminfants.Benefitsofthisinterventionincludereducedmortality,increasedgrowth,enhancedparent-childbonding,anddecreasedlengthofhospitalstay.SSChasbeenusedwithlessstableinfants,butSSCwithveryprematuremechanicallyventilatedinfantsremainscontroversial.

ReviewtheeffectofSSConmeasuresofphysiologicstabilityandreportanypotentiallydestabilizingeventsinprematuremechanicallyventilatedinfants

Alibrarian-assistedcomputerizedsearchofdatabaseswasperformedincluding:PubMed,CumulativeIndextoNursingAlliedHealthLiterature(CINAHL),andEMBASE.

Datawasabstractedandqualitativelysynthesizedtoassess:• SSCprocedure• Outcomesofphysiologicstability• Destabilizingevents– accidentalextubation,apnea,and

hypothermia

PhysiologicstabilitymaybemaintainedorimprovedduringSSCinsomepreterminfantsonventilatorsthoughwithlessstabilityreportedininfants<1000to1200g.Thehighest-levelstudydesignshowedincreasedtemperaturevariabilityandFiO2demandduringSSC,reinforcingtheneedforcontinuousmonitoringofindividualinfantresponse.Continuedresearchisneededespeciallyrandomizedcontrolledtrials.

SSCmaybesafelyincludedindevelopmentalcareforsomeintubated,preterminfantswithcarefulmonitoringofphysiologicstabilityandavoidanceofincreaseindistress.PhysicaltherapistscancontributetotheNICUmultidisciplinaryteaminprovidingsafetransfers,positioning,support,andmonitoringduringSSC.

Author, Year Study Design PopulationAzevedo,2011 Quasi-experimental 43infants,GA29.1wks,meanwt.1096g

Carbasse, 2013 Prospectivecohort 96infants,meanGA28wks,meanwt.1069g

Clifford,2001 Caseseries Chartsof7infants,meanGA25.5wks,meanwt.752g

Gale,1993 Case series 25infants,meanGA30.5wks,meanwt.1100g

Karlsson,2012 Cohort design 26infants,GArange22-26wks,meanwt. 600g

Neu,2000 Crossoverdesign 15infants,meanGA 30.2wks,meanwt.1094g

Parker,2002 Casestudy 1female infant,born 27wksGA,917gSmith,2001/2003

Crossoverdesign 14infants,meanGA25.7wks,meanwt.990g

Swinth,2003 Casestudy 1female infant,33wksGA,2024gVanZantan,2007 Casecontrolwithrepeated

measuresGroup 1:18infants,GA<28wks,meanwt.834gGroup2:16infants,GA28-30wks,meanwt.1244g

LevelofEvidence: GRADEC

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HeartRate OxygenSaturation

Fi02 Temperature

Num

bero

fStudies

PhysiologicVariable

SummaryofStabilityConclusions

MaintainStabilityImproveStabilityDecreaseStability

Articlesidentifiedthroughdatabasesearching(n=174)

Articlesafterduplicatesremoved(n=115)

Title/Abstractscreened(n=115)

Articlesexcluded(n=67)

Full-textarticlesassessedforeligibility(n=48)

Full-textarticlesexcluded(n=37)

ExclusionReasons:• Notmechanicallyventilated• SSCnotprimaryintervention• Infantsnotpremature

(gestationalage(GA)>37wks)

• Outcomedoesn’tmeasurestability

• Onlyabstractavailable• Commentaries/recommenda

tions• NotinEnglish

Studiesincludedinsynthesis(n=11)

Screen

ing

Includ

edEligibility

Iden

tificatio

n

Author,Year Potentially DestabilizingEventsCarbasse,2013 Apneaorbradycardia in13%ofSSCepisodes,noextubations

Clifford,2001 1accidentalextubation duringtransferduetolooseendotrachealtube

Gale, 1993 1accidentalextubationduringSSC

Karlsson,2012 1episode ofhypothermiceventduetofailureofventilatorgashumidifier/warmer

Smith, 2001/2003 1accidentalextubation onawashoutday(notduringSSC)

Noneoftheseevents requiredterminationofSSC.

DescriptionofIncludedStudies PotentiallyDestabilizingEvents

References

RangeofDatafromKeyOutcomesOutcome Normal

RangeStudies

ReportingOutcome

RangeofDataValuesDuringSSC

Heart rate 120-180bpm 5 • Maxvariationrangedfrom-3.5bpmto+7.8bpmO2saturation

adjustFiO2ifSaO2orSpO2<85%or>96%

9 • 0.19%increase – 1.46%increase• 1.3-2.5%decreaseduringtransferwhichincreasedtonormalwithin1min.

• 1studyreportsmoredesaturationafter20min.ifinfant<1.2kg

• 1studyreportsgreaterdecreaseinsupplementalO2needsforintubatedvs.non-intubatedinfants

FiO2 adjustFiO2ifSaO2orSpO2<85%or >96%

4 • 5.36% decrease– 4%increase• Only1studyreportsincreasedFiO2duringSSC,greaterincreaseinthesecondhour

Temperature 36.5– 37.5°C 9 • 0.29°Cdecrease – 0.2°Cincrease inaxillarytemperature(n=4)

• 1studyshowedincreasedperipheraltemperatureleadingto0.8°Cchangeincentral-peripheraltemp.

• 4studiesshowstatisticallysignificantchange• More changeininfants<1000g

Themost variationforallvariablesoccurredduringthetransferandthenquicklystabilized.

1.Azevedo,VívianMaraGonçalvesdeOliveira,CésarCoelhoXavier,andFernandadeOliveiraGontijo.“SafetyofKangarooMother CareinIntubatedNeonatesunder1500G.”JournalofTropicalPediatrics 58,no.1(February2012):38–42.doi:10.1093/tropej/fmr033.2.Bohnhorst,Bettina.“SkintoSkinCareintheNeonatalIntensiveCareUnit:MoreDataRegardingSeriouslyIllInfantsAreBadlyNeeded.”Neonatology97,no.4(2010):318–20.doi:10.1159/000255164.3.Carbasse,Aurélia,SylvieKracher,MartineHausser,ClaireLanglet,BenoîtEscande,LionelDonato,DominiqueAstruc,andPierreKuhn.“SafetyandEffectivenessofSkin-to-SkinContactintheNICUtoSupport Neurodevelopment inVulnerablePretermInfants.”TheJournalofPerinatal&NeonatalNursing 27,no.3(September2013):255–62.doi:10.1097/JPN.0b013e31829dc349.4.Conde-Agudelo,Agustin,andJoséL.Díaz-Rossello.“KangarooMotherCaretoReduceMorbidityandMortalityinLowBirthweight Infants.”TheCochraneDatabaseofSystematicReviews 4(2014):CD002771.doi:10.1002/14651858.CD002771.pub3.5.Karlsson,Victoria,Ann-BrittHeinemann,GunnarSjörs,KerstinHedbergNykvist,andJohanAgren.“EarlySkin-to-SkinCareinExtremelyPretermInfants:ThermalBalanceandCareEnvironment.”TheJournalofPediatrics 161,no.3(September2012):422–26.doi:10.1016/j.jpeds.2012.02.034.