Effect of Routine Nurse Caregiving on the Stress Responses and Behavior State in Preterm Infants: A Systematic Review.
Nicole Cistone, Rita H Pickler, Christine A Fortney and 1 others
PMID 38968382WHAT IT FOUND
Routine NICU caregiving for preterm infants, such as diaper changes, bathing, and suctioning, was associated with stress signs and disrupted sleep.
Swaddling and clustered care may reduce stress signs, but evidence is limited and care was often bundled.
Key findings
01Routine nurse caregiving was associated with higher heart rate, respiratory rate, blood pressure, crying, and lower oxygen saturation in preterm infants.
02Swaddled bathing was associated with fewer behavioral stress cues than standard bathing.
03In one study, preterm infants were handled an average of 143 times in 24 hours, for 3.9 hours (16% of the day), and slept 14.9 hours (62% of the day).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
All 13 included studies were rated fair, not good, because many lacked randomization, blinding, or clear definitions of caregiving. The review included only 13 studies, and sample sizes ranged from 11 to 60 preterm infants, so findings are limited by small and varied samples. Only about a third of studies were conducted in the US, so care practices may not match US NICUs. Half of the studies did not provide enough information about the caregiving context, and many observed only one caregiving event. Caregiving was often bundled, and standard care was not clearly described, so the effect of any single procedure or strategy cannot be separated.
Declared interests
The authors declared no competing interests.
The easy way to misread this
Do not conclude that clustered care or swaddling is proven to reduce infant stress. The review was based on fair-quality studies with inconsistent caregiving definitions, and several interventions were bundled, so the effect of any single component cannot be separated.