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Soothability and Promotion of Growth in Preterm Infants
2012 State of the Science Congress on Nursing Research
Holly J. Diesel, PhD, RN
Patrick M. Ercole, PhD, MPH
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Purpose & Hypotheses
To examine the effects of a flax seed pillow on premature infant soothability, weight gain and hospital length of stay Infants receiving the intervention will be more
soothed Infants who are soothed will gain more weight Infants who gain more weight will have
shorter hospital length of stays
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Background & Significance
Prematurity is a local and global problem
Premature infants have poorer outcomes
Prematurity is costly
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Review of the Literature
Touch
Developmental Care Model
Massage
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Model
NurseNurse
ParentParent
Preterm Infant
Input
Input
Input Input
GrowthGrowth
No No GrowthGrowth
Interaction
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Power Analyses Power analysis
á = .05Effect size of 10Standard deviation of 10Group size of 1483% power80% retention total sample size of 36Final n = 46
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Methods
Design
Setting
Inclusion/exclusion
Variables
XOX
R
X X
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Recruitment & Enrollment
IRB approval
Staff in-services
Pilot study
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Protocol Enrollment Stabilization Actiwatch Pre-intervention Intervention Post-intervention
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Statistical Procedures
SPSS 17.0
Examination for outliers
Detection of demographic differences
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DemographicsIntervention n=23 Control n=24 t(p)
Infant Ethnicity
Caucasian/white n= 5 (22%) n= 12 (52%) 0.075
African American n=17 (74%) n= 11 (48%)
Hispanic/Latino n= 0 n= 0
Asian/Pacific Islander n=1 (4%) n= 0
Other n= 0 n= 0
Gestational Age
Mean 33.8 (1.77) 33.2 (1.74) 1.13 (.265)
Range 30-36 31-36
Gender
Female 8 (35%) 14 (61%) 1.79 (.080)
Male 15 (65%) 9 (39%)
Birth weight 2120 (473) 2100 (439) .143 (.887)
Birth length 45.1 (2.6) 45.1 (2.6) .028 (.978)
Apgar scores
1 minute 8 (1.77) 8 (1.07) -1.41 (.17)
5 minute 9 (.66) 9 (.66) .000 (1.0)
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Research Question #1
Do infants who receive the flax seed pillow intervention demonstrate greater soothability than the infants in the control group?
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Pre/Post Intervention HRIntervention Control
HR Pre
Mean(sd)
HR Post
Mean(sd)
t(p) HR Pre
Mean(sd)
HR Post Mean(sd)
t(p)
Day 2 T1 148(8.8) 137(11.7) -2.46(.018)* 149(12.0) 151(13.5) -2.94(.770)
Day 2 T2 154(10.0) 139(11.9) -3.18(.003)* 150(15.7) 152(15.1) .916(.366)
Day 3 T1 152(12.2) 139(9.5) -5.02(.000)* 152(9.6) 154(11.9) -.040(.968)
Day 3 T2 153(12.2) 141(9.4) -4.73(.000)* 148(9.7) 157(13.2) 1.61(.114)
Day 4 T1 153(12.8) 138(12.1) -4.02(.000)* 146(12.0) 151(10.6) 1.77(.084)
Day 4 T2 159(10.3) 143(11.3) -2.91(.005)* 152(12.1) 155(15.7) 2.21(.033)
* Statistically significant
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Pre/Post Intervention RRIntervention Control
RR Pre Mean(sd)
RR PostMean(sd)
t (p) RR Pre Mean(sd)
RR PostMean(sd)
t (p)
Day 2 T1 57 (14.9) 43 (12.5) -3.419 (.001)* 58 (11.2) 56 (13.6) -.167(.868)
Day 2 T2 58 (13.6) 53(9.33) -3.014 (.004)* 53 (12.4) 53 (13.0) 1.399(.169)
Day 3 T1 57 (13.1) 40 (10.3) -3.995 (.000)* 53 (8.9) 52 (9.7) .579(.566)
Day 3 T2 56 (13.7) 40 (8.3) -5.135 (.000)* 52 (8.6) 56 (12.9) 1.160(.252)
Day 4 T1 58 (13.5) 42 (10.1) -3.111 (.003)* 54 (12.1) 53 (13.5) .932(.356)
Day 4 T2 62 (10.2) 44 (10.6) -2.863 (.006)* 54 (11.7) 55 (14.9) 2.379(.022)
* Statistically significant
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Pre/Post Intervention NIPSIntervention Control
NIPS Pre Mean(sd)
NIPS PostMean(sd)
t (p) NIPS Pre Mean(sd)
NIPS PostMean(sd)
t (p)
Day 2 T1 1.5 (1.31) .65 (1.02) -2.46 (.018)* 1.2 (1.16) 1.4 (1.12) .713(.479)
Day 2 T2 1.8 (1.67) .30 (.559) -3.285 (.003)* 1.0 (.953) 1.48 (1.60) 1.945(.060)
Day 3 T1 1.1 (1.13) .22 (.518) -3.726 (.001)* .91 (.900) 1.0 (.928) 1.260(.214)
Day 3 T2 1.4 (1.37) .17 (.385) -5.581 (.000)* 1.0 (1.19) 1.9 (1.44) .919(.363)
Day 4 T1 1.3 (1.42) .22 (.846) -2.782 (.008)* .96 (1.43) 1.1 (1.32) .724(.473)
Day 4 T2 2.3 (1.33) .48 (.788) -2.390 (.023)* .78 (.902) 1.4 (1.55) 4.543(.000)*
* Statistically significant
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Pre/Post Intervention Activity
Wake Time Mean (sd) Sleep Time Mean (sd)
Day Intervention Control t (p) Intervention Control t (p)
2 440 (152) 361 (152) 1.77 (.084) 918 (290) 1079 (152) -2.37 (.022)*
3 475 (258) 365 (181) 1.68 (.100) 919 (309) 1077 (182) -2.11 (.042)*
4 380 (181) 320 (124) 1.32 (.195) 1069 (180) 1119 (125) -1.09 (.283)
* Statistically significant
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Research Question #2
Do infants who are soothed gain more weight?
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Comparison of Weight Gain
Intervention
Mean(sd)
Control
Mean(sd)
t(p)
Weight at discharge
(grams)
2379.8 (323.6) 2373.0 (333.4) .070 (.945)
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Extended Daily Mean Weight by Study Group
1900
1950
2000
2050
2100
2150
2200
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Study Day
Mea
n D
aily
Wei
ght (
gram
s)
Intervention-Weight Control-Weight
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Research Question #3
Do infants who gain more weight have shorter hospital length of stay?
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Comparison of Weight Gain & Hospital Length of Stay
Intervention
Mean(sd)
Control
Mean(sd)
t(p)
Weight gain 2379.8 (323.6) 2373.0 (333.4) .070 (.945)
Length of stay 16.5 (9.50) 16.4 (12.4) .013 (.989)
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Discussion Exploratory research
Confirms previous research
Multiple measures with reliability/validity
No adverse effects
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Limitations
Generalizability
Nursery relocation
Parental involvement
Care delivery variation
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Implications
For ResearchLarger sample sizeAdditional populationsAdditional variables
For NursingAdditional intervention optionOpportunity for increased parental involvement
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Conclusion
Flax seed pillow and soothabilitySafe, simple intervention to assist premature
infants with transition to extra-uterine environment
Well received by nursing and parents Increased opportunity for parental involvement
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References
Als, H. (1982). Toward a synactive theory of development: promise for assessment and support of individuality. Infant Mental Health Journal, 3, 229-243.
Anderson, G.C., Chiu, S., Dombrowski, M.A., Swinth, J.Y., Albert, J.M., & Wada, N. (2003). Mother-newborn contact in a randomized trail of kangaroo (skin-to-skin) care. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32 (5), 604-611.
Axelin, A., Salantera, S, & Lehtonen, L. (2006). Facilitated tucking by parents’ in pain management of preterm infants – a randomized crossover trial. Early Human Development, 82, 241-247.
Beachy, J. (2003). Premature infant massage in the NICU. Neonatal Network, 22(3), 39- 45.
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References Byers, J.F. (2003). Components of developmental care and the evidence
for their use in the NICU. The American Journal of Maternal/Child Nursing, 28(3), 174-180.
Dieter, J.N.I, Field, T., Hernandez-Reif, M., Emory, E.K., & Redzepi, M. (2003) . Stable preterm infants gain more weight and sleep less after five days of massage therapy. Journal of Pediatric Psychology, 28(6), 403-411.
Field, T., Hernandez-Reif, M., Feijo, L., & Freedman, J. (2006). Prenatal, perinatal and neonatal stimulation: A survey of neonatal nurseries. Infant Behavior and Development, 29, 24-31.
Grenier, I.R., Bigsby, R., Vergara, E.R., & Lester, B.M. (2003). Comparison of motor self-regulatory and stress behaviors of preterm infants across body positions. American Journal of Occupational Therapy, 57(3), 289-287.
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References Grunau, R., Linhares, M., Holsti, L., Oberlander, T., & Whitfield, M.F.
(2004). Does prone or supine position influence pain response in preterm infants at 32 weeks gestational age? Clinical Journal of Pain, 20(2), 76-82.
Harrison, L.L. (2001). The use of comforting touch and massage to reduce stress for preterm infants in the neonatal intensive care unit. Newborn and Infant Nursing Reviews, 1(4), 235-241.
Liaw, J.J. (2000). Tactile stimulation and preterm infants. Journal of Perinatal & Neonatal Nursing, 14(1), 84-103.
Ream, E., & Richardson, A. (1996). Fatigue: Aconcept analysis. International Journal of Nursing Studies, 33(5), 519-529.
White-Traut, R.C., Nelson, M.N., Silverstri, J.M., Patel, M., Berbaum, M., & Gu, G.G. (2004).