scholarly journals Co-bedding of Preterm Newborn Pigs Reduces Necrotizing Enterocolitis Incidence Independent of Vital Functions and Cortisol Levels

2021 ◽  
Vol 9 ◽  
Author(s):  
Anders Brunse ◽  
Yueming Peng ◽  
Yanqi Li ◽  
Jens Lykkesfeldt ◽  
Per Torp Sangild

Background: Preterm infants are born with immature organs, leading to morbidities such as necrotizing enterocolitis (NEC), a gut inflammatory disease associated with adverse feeding responses but also hemodynamic and respiratory instability. Skin-to-skin contact including “kangaroo care” may improve infant survival and health via improved vital functions (e.g., pulmonary, cardiovascular) and endocrine influences by adrenal glucocorticoids. Clinical effects of skin-to-skin contact for newborn siblings (“co-bedding”) are not known. Using NEC-susceptible Preterm pigs as models, we hypothesized that co-bedding and exogenous glucocorticoids improve vital functions and NEC resistance.Methods: In experiment 1, cesarean-delivered, formula-fed Preterm pigs were reared in incubators with (co-bedding, COB, n = 30) or without (single-bedding, SIN, n = 29) a sibling until euthanasia and tissue collection on day four. In experiment 2, single-bedded Preterm pigs were treated postnatally with a tapering dose of hydrocortisone (HC, n = 19, 1–3 mg/kg/d) or saline (CON, n = 19).Results: Co-bedding reduced NEC incidence (38 vs. 65%, p < 0.05) and increased the density of colonic goblet cells (+20%, p < 0.05) but had no effect on pulmonary and cardiovascular functions (respiration, blood pressure, heart rate, blood gases) or cortisol levels. There were limited differences in intestinal villous architecture and digestive enzyme activities. In experiment 2, HC treatment increased NEC lesions in the small intestine without any effects on pulmonary or cardiovascular functions.Conclusion: Co-bedding may improve gut function and NEC resistance independently of cardiorespiratory function and cortisol levels, but pharmacological cortisol treatment predispose to NEC. Preterm pigs may be a useful tool to better understand the physiological effects of co-bedding, neonatal stressors and their possible interactions with morbidities in Preterm neonates.

2021 ◽  
Author(s):  
Iryna Sarapuk ◽  
Halyna Pavlyshyn

Abstract The objective was to study the peculiarities of hormonal stress in preterm infants in the NICU and their mothers, and to investigate how skin-to-skin contact influences it. The study included 60 preterm infants with GA˂32 weeks who were treated in NICU and their mothers. The overall design was a baseline-response design. Saliva was collected before (baseline) and after skin-to-skin contact to measure cortisol by enzyme immunoassay method. Infant baseline salivary cortisol level was 0.587 [0.239; 1,714] µg/dL. It was significantly higher in neonates who had invasive ventilation (1.00 [0.38; 2.44]) µg/dL compared to non-ventilated infants (0.335 [0.156; 1.236]) µg/dL, p = 0.022; and positively correlated with the Apgar score at 1st and 5th minutes (r=-0.36; p = 0.011 and r=-0.34; p = 0.017) and duration of ventilation (r = 0.70; p = 0.0000). Maternal baseline salivary cortisol level was 0.212 [0.123; 0.378]µg/dL. There was significant decreasing of salivary cortisol after Kangaroo mother care with skin-to-skin contact in infants (0.162 [0.111; 0.231]) µg/dL, p˂0.001 and mothers (0.096 [0.077; 0.156]) µg/dL, p˂0.001. Conclusion: Preterm infants in the NICU and their mothers experience stress confirmed by the increased baseline cortisol levels. Kangaroo mother care with skin-to-skin contact reduces the stress and normalizes salivary cortisol levels in both infant and mother in the NICU.


2009 ◽  
Vol 4 (4) ◽  
pp. 207-220 ◽  
Author(s):  
Linda Handlin ◽  
Wibke Jonas ◽  
Maria Petersson ◽  
Mikael Ejdebäck ◽  
Anna-Berit Ransjö-Arvidson ◽  
...  

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038938 ◽  
Author(s):  
Agnes Linnér ◽  
Björn Westrup ◽  
Karoline Lode-Kolz ◽  
Stina Klemming ◽  
Siri Lillieskold ◽  
...  

IntroductionIn Scandinavia, 6% of infants are born preterm, before 37 gestational weeks. Instead of continuing in the in-utero environment, maturation needs to occur in a neonatal unit with support of vital functions, separated from the mother’s warmth, nutrition and other benefits. Preterm infants face health and neurodevelopment challenges that may also affect the family and society at large. There is evidence of benefit from immediate and continued skin-to-skin contact (SSC) for term and moderately preterm infants and their parents but there is a knowledge gap on its effect on unstable very preterm infants when initiated immediately after birth.Methods and analysisIn this ongoing randomised controlled trial from Stavanger, Norway and Stockholm, Sweden, we are studying 150 infants born at 28+0 to 32+6 gestational weeks, randomised to receive care immediately after birth in SSC with a parent or conventionally in an incubator. The primary outcome is cardiorespiratory stability according to the stability of the cardiorespiratory system in the preterm score. Secondary outcomes are autonomic stability, thermal control, infection control, SSC time, breastfeeding and growth, epigenetic profile, microbiome profile, infant behaviour, stress resilience, sleep integrity, cortical maturation, neurodevelopment, mother-infant attachment and attunement, and parent experience and mental health.Ethics and disseminationThe study has ethical approval from the Swedish Ethical Review Authority (2017/1135-31/3, 2019–03361) and the Norwegian Regional Ethical Committee (2015/889). The study is conducted according to good clinical practice and the Helsinki declaration. The results of the study will increase the knowledge about the mechanisms behind the effects of SSC for very preterm infants by dissemination to the scientific community through articles and at conferences, and to the society through parenting classes and magazines.Study statusRecruiting since April 2018. Expected trial termination June 2021.Trial registration numberNCT03521310 (ClinicalTrials.gov).


Pain ◽  
2008 ◽  
Vol 139 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Nájala Borges de Sousa Freire ◽  
João Batista Santos Garcia ◽  
Zeni Carvalho Lamy

2019 ◽  
Vol 245 (2) ◽  
pp. 85-95
Author(s):  
Alissa L Meister ◽  
Kim K Doheny ◽  
R Alberto Travagli

Necrotizing enterocolitis is the leading cause of death due to gastrointestinal disease in preterm neonates, affecting 5–12% of neonates born at a very-low birth weight. Necrotizing enterocolitis can present with a slow and insidious onset, with some neonates displaying early symptoms such as feeding intolerance. Treatment during the early stages includes bowel rest and careful use of antibiotics, but surgery is required if pneumoperitoneum and intestinal perforation occur. Mortality rates among neonates requiring surgery are estimated to be 20–30%, mandating the development of non-invasive and reliable biomarkers to predict necrotizing enterocolitis before the onset of clinical signs. Such biomarkers would allow at-risk neonates to receive maximal preventative therapies such as careful nutritional consideration, probiotics, and increased skin-to-skin care. Impact statement Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease; its high mortality rate mandates the development of non-invasive biomarkers to predict NEC before its onset. This review summarizes the pathogenesis, prevention, unresolved issues, and long-term outcomes of NEC.


2018 ◽  
Vol 36 (05) ◽  
pp. 505-510 ◽  
Author(s):  
Megan Marvin ◽  
Fumiyuki Gardner ◽  
Kristin Sarsfield ◽  
R. Travagli ◽  
Kim Doheny

Objective An estimation of the individual's ability to cope with environmental adversity, that is, stress resiliency, can be extrapolated by measuring cardiac vagal tone, that is, high-frequency heart rate variability (HF-HRV); indeed, higher HF-HRV is associated with health and developmental advantages for preterm neonates. Previous studies show skin-to-skin contact (SSC) improves stress resiliency; however, linkages between SSC and HF-HRV on outcomes have not been assessed. We aimed to test the hypothesis that increased SSC frequency would enhance HF-HRV, reduce neonatal morbidity, and improve developmental outcomes. Study Design Weekly electrocardiograms and clinical data were obtained from 101 preterm neonates. SSC frequency was determined from the electronic medical record. Results At postnatal week 1, frequency of SSC and HF-HRV were positively correlated (p =.02); further, multiple stepwise regressions showed higher HF-HRV and SSC predicted reduced days on ventilation and oxygen, and shorter hospital stay (p < 0.001). Higher HF-HRV predicted lower postmenstrual age (PMA) at discharge (p < 0.01). Conclusion Higher SSC frequency was associated with increased HF-HRV during the first postnatal week. SSC and HF-HRV uniquely predicted diminished neonatal morbidity throughout hospitalization. Additionally, HF-HRV uniquely predicted earlier PMA at discharge. Augmenting SSC early in life enhances stress resiliency and improves health outcomes.


2019 ◽  
Vol 9 (2) ◽  
pp. 1
Author(s):  
POURABOLI BATOOL ◽  
ESTABRAGHI MAHDIEH ◽  
JAHANI YOUNES ◽  
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