The effects of skin-to-skin care on the diaphragmatic electrical activity in preterm infants.

Background: Skin-to-skin care (SSC) is widely used in neonatal intensive care units due to its positive effects on infant physiology and parent-infant interaction.

Aims: We investigated the safety and the effect of SSC on the diaphragm electrical activity (EAdi) in premature infants recovering from respiratory distress syndrome treated on noninvasive neurally adjusted respiratory assist.

Study Design: An observational cross-over study design was used. The infants were evaluated during SSC and in both prone and supine positions before and after SSC during a 9-hour study period. The EAdi was measured via miniaturized sensors incorporated into a feeding tube.

Subjects: Seventeen premature infants with a mean age of 20d (range, 2-43d) were studied. Their mean birth weight was 900g (490-1845g) and mean gestational age at birth 28wk (25-32wk).

Outcome Measures: Under each condition, EAdi peak (representing tidal, neural inspiratory effort) and EAdi minimum (representing neural expiratory activity) were numerically quantified. Oxygen saturation, heart rate, and apnea were recorded.

Results: The mean EAdi minimum values were lower during SSC and prone position. In addition, a tendency towards lower EAdi peak values was found during SSC. There were no differences in the occurrence of apnea between the study phases.

Conclusions: SSC is safe and it is not associated with increased neural activity of the diaphragm. On the contrary, low EAdi minimum values were registered reflecting more complete diaphragmatic de-activation between respiratory cycles.