NOVEL METHODS EXAMINING STRESS, REST AND GROWTH IN NICU VULNERABLE INFANT POPULATIONS

2.50
Hdl Handle:
http://hdl.handle.net/10755/211741
Type:
Research Study
Title:
NOVEL METHODS EXAMINING STRESS, REST AND GROWTH IN NICU VULNERABLE INFANT POPULATIONS
Abstract:
Purpose: To describe novel methods used to investigate stress reactivity, growth and rest in preterm infants randomized to a music intervention while quantifying noise levels in the neonatal intensive care unit (NICU). Background: Innovative techniques are available to study the sensitive balance of the hypothalamic-pituitary-adrenal axis and neuroendocrine system function among infants in NICU who are at risk for increased stress, poor rest and decreased growth. Music has the unique ability to reduce stress, enhance rest and promote growth. Due to characteristic challenges of these babies, minimal research has been conducted in these areas as it is impractical to obtain large quantities of blood commonly needed to test biomarkers for stress and growth. Further, equipment for evaluating rest and noise is often cumbersome around the tubes, wires and monitors attached to tiny babies. Methods: We conducted a randomized controlled blinded multi-center pilot study to examine a structured music intervention over a seven day period. Using Urn Randomization, eligible preterm infants (N=19) were randomized to: 1) a music or 2) sham intervention based on high versus low degree of perinatal stress identified on standardized instruments, namely, the Perceived Stress Scale (PSS) reported by mothers and the Clinical Risk Index for Babies (CRIB). The Neurobiologic Risk Score (NBRS) was used to score infant biophysiologic stress over the NICU stay. Growth variables of weight gain in grams and serum insulin and IGF-1 were obtained before and after the one week study period. Hours of rest were quantified by actigraphy and validated with the Newborn Behavioral Observation (NBO) tool.  NICU environmental noise decibels and frequencies were analyzed with portable noise dosimeters. Stress reactivity was examined at timed intervals before and after a stressor blood stick with salivary cortisol strips collected pre and post the one week intervention. Analyses: Descriptive statistics and two-sample independent t-tests were used to examine the data and determine group differences in stress, weight gain, rest, Insulin, and IGF-1. Results: The data suggests that stress scores (PSS, CRIB, and NBRS) were similar between the two groups. Compared to the controls, the music group was found to have lower salivary cortisol levels during the stress reactivity tests, a higher number of sleep bouts, lower activity counts, increased Insulin and IGF-1, and lower lengths of stay. Implications: Lingual cortisol strips offered a non-invasive method of obtaining cortisol levels to examine stress reactivity. Actigraphy provided a means of quantifying rest that was validated by the NBO tool and nurses notes. Noise dosimeters were shown to be useful for assessing NICU noise. In sum, clinical scientists need innovative ways to examine variables that impact health outcomes of at-risk infants cared for in the NICU. Funding: 1) NIH/NINR-T32 NR007077 Health Disparities and Vulnerable Populations Research Training Program. 2) Oppenheimer Complimentary Alternative, Integrative Medicine Grant. 3) American Association of Critical Care Nurses Clinical Care Grant. 
Keywords:
Neonatal intensive care unit; Stress reactivity; Music intervention
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5107
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleNOVEL METHODS EXAMINING STRESS, REST AND GROWTH IN NICU VULNERABLE INFANT POPULATIONSen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211741-
dc.description.abstractPurpose: To describe novel methods used to investigate stress reactivity, growth and rest in preterm infants randomized to a music intervention while quantifying noise levels in the neonatal intensive care unit (NICU). Background: Innovative techniques are available to study the sensitive balance of the hypothalamic-pituitary-adrenal axis and neuroendocrine system function among infants in NICU who are at risk for increased stress, poor rest and decreased growth. Music has the unique ability to reduce stress, enhance rest and promote growth. Due to characteristic challenges of these babies, minimal research has been conducted in these areas as it is impractical to obtain large quantities of blood commonly needed to test biomarkers for stress and growth. Further, equipment for evaluating rest and noise is often cumbersome around the tubes, wires and monitors attached to tiny babies. Methods: We conducted a randomized controlled blinded multi-center pilot study to examine a structured music intervention over a seven day period. Using Urn Randomization, eligible preterm infants (N=19) were randomized to: 1) a music or 2) sham intervention based on high versus low degree of perinatal stress identified on standardized instruments, namely, the Perceived Stress Scale (PSS) reported by mothers and the Clinical Risk Index for Babies (CRIB). The Neurobiologic Risk Score (NBRS) was used to score infant biophysiologic stress over the NICU stay. Growth variables of weight gain in grams and serum insulin and IGF-1 were obtained before and after the one week study period. Hours of rest were quantified by actigraphy and validated with the Newborn Behavioral Observation (NBO) tool.  NICU environmental noise decibels and frequencies were analyzed with portable noise dosimeters. Stress reactivity was examined at timed intervals before and after a stressor blood stick with salivary cortisol strips collected pre and post the one week intervention. Analyses: Descriptive statistics and two-sample independent t-tests were used to examine the data and determine group differences in stress, weight gain, rest, Insulin, and IGF-1. Results: The data suggests that stress scores (PSS, CRIB, and NBRS) were similar between the two groups. Compared to the controls, the music group was found to have lower salivary cortisol levels during the stress reactivity tests, a higher number of sleep bouts, lower activity counts, increased Insulin and IGF-1, and lower lengths of stay. Implications: Lingual cortisol strips offered a non-invasive method of obtaining cortisol levels to examine stress reactivity. Actigraphy provided a means of quantifying rest that was validated by the NBO tool and nurses notes. Noise dosimeters were shown to be useful for assessing NICU noise. In sum, clinical scientists need innovative ways to examine variables that impact health outcomes of at-risk infants cared for in the NICU. Funding: 1) NIH/NINR-T32 NR007077 Health Disparities and Vulnerable Populations Research Training Program. 2) Oppenheimer Complimentary Alternative, Integrative Medicine Grant. 3) American Association of Critical Care Nurses Clinical Care Grant. en_GB
dc.subjectNeonatal intensive care uniten_GB
dc.subjectStress reactivityen_GB
dc.subjectMusic interventionen_GB
dc.date.available2012-02-20T12:11:34Z-
dc.date.issued2012-02-20T12:11:34Z-
dc.date.accessioned2012-02-20T12:11:34Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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