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The relation between maternal factors and pre-term acute pain response during PKU test in the condition of skin-to-skin contact

Grant number: 07/05051-1
Support Opportunities:Scholarships in Brazil - Doctorate
Effective date (Start): May 01, 2008
Effective date (End): February 28, 2011
Field of knowledge:Health Sciences - Nursing - Pediatric Nursing
Principal Investigator:Carmen Gracinda Silvan Scochi
Grantee:Thaíla Corrêa Castral
Host Institution: Escola de Enfermagem de Ribeirão Preto (EERP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil


Considering maternal behavior as in important factor in neonatal pain response to a nociceptive stimulus, the aim of this study is to exam the relation between maternal and neonatal reactivity during PKU Test, with maternal anxiety as a possible factor that could modify the analgesic effect of maternal skin-to-skin. Others specific aims are: to analyze and compare the neonatal biological and behavioral responses and neurophysiological modulation during PKU Test while infants are in maternal skin-to-skin contact with mothers who are/ are not anxious; to describe and compare maternal soothing strategies among mothers who are/ are not anxious while their infants are in maternal skin-to-skin contact during PKU Test; and to analyze if the maternal anxiety can influence maternal and neonatal reactivity during PKU Test, modifying the analgesic effect of skin-to-skin contact. This is a non-controlled experimental study that will be held in the intermediary neonatal care unit at a university hospital in Ribeirão Preto-SP, Brazil. The sample will consist in 150 mother-preterm dyads that will be submitted to the skin-to-skin condition 15 minutes before, during and after the PKU Test, comparing maternal and neonatal reactivity considering maternal anxiety. We will measure neonatal (facial expression, sleep wake state, cry, heart rate, salivary cortisol, coping strategies) and maternal (salivary cortisol, soothing behavior, anxiety) variables. The data procedure will be divide in six periods as follow: basal (10 minutes), heel cleaning (20 seconds), heel puncture (20 seconds), heel squeezing (time enough to collect blood), wound compression (20 seconds) and recovery (20 minutes). Heart rate will be recorded trough a cardiac monitor every minute during the six periods of the procedure. Neonatal and maternal salivary cortisol will be collected before and 20 minutes after the procedure. Maternal and neonatal behavior variables will be video recorded with one camera focused on the baby’s face and another in the mother-infant dyad. Facial expression will be measured continuously by the Neonatal Facial Coding System every 20 seconds during data collection, as such sleep wake state and cry, considered as stress indicators. The sub-item regulation of the Assessment of Preterm Infant Behavior will be used to code neonatal coping behavior during the procedure. Maternal soothing will be code in 07 behaviors (affection, touch, rocking, vocalization, distraction, face-to-face, non-nutritive sucking stimulus) each 5 seconds during the procedure. Maternal and neonatal salivary cortisol will be colleted before and 20 minutes after the procedure (in the end of the recovery). The mothers will answer two questionnaires (State and Trait Anxiety Inventory and Visual Analogue Mood Scale) to measure maternal anxiety before the procedure, and for the second instrument also immediately after wound compression and recovery. Two people who are blind to the aims of the study will be trained to code maternal and neonatal behavior. After insert the data in the database, maternal and behavior variables will be explored using a canonic correlation with a significance level of α=0.20. Then a multivariate regression model will be used to analyze with more detail the association obtained in the canonic analyses (α=0.05). This project will be submitted to the Research Ethical Committee of the institution which is going to be held. All the mothers and/or responsible for the preterms will be asked to sign the informed consent before data collection. (AU)

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Academic Publications
(References retrieved automatically from State of São Paulo Research Institutions)
CASTRAL, Thaíla Corrêa. The relation between maternal factors with preterm newborn pain and stress response while in maternal kangaroo care. 2011. Doctoral Thesis - Universidade de São Paulo (USP). Escola de Enfermagem de Ribeirão Preto (PCARP/BC) Ribeirão Preto.

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