Tactile stimulation in very preterm infants and their needs of non-invasive respiratory support

Abstract

Aim: Despite the lack of evidence, current resuscitation guidelines recommend tactile stimulation in apneic infants within the first minutes of life. The aim was to investigate whether timing, duration or intensity of tactile stimulation influences the extent of non-invasive respiratory support in extremely preterm infants during neonatal resuscitation.

Methods: In an observational study, we analyzed 47 video recordings and physiological parameters during postnatal transition in preterm infants below 32^0/7 weeks of gestational age. Infants were divided into three groups according to the intensity of respiratory support.

Results: All infants were stimulated at least once during neonatal resuscitation regardless of their respiratory support. Only 51% got stimulated within the first minute. Rubbing the feet was the preferred stimulation method and was followed by rubbing or touching the chest. Almost all very preterm infants were exposed to stimulation and manipulation most of the time within their first 15 min of life. Tactile stimulation lasted significantly longer but stimulation at multiple body areas started later in infants receiving prolonged non-invasive respiratory support.

Conclusion: This observational study demonstrated that stimulation of very preterm infants is a commonly used and easy applicable method to stimulate spontaneous breathing during neonatal resuscitation. The concomitant physical stimulation of different body parts and therefore larger surface areas might be beneficial.

Keywords: delivery room management; neonatal resuscitation; respiratory support; tactile stimulation; very preterm infants.

Figure 1

Respiratory support. Overall time used for intermittent positive pressure ventilation (iPPV) or initial inflations (INFL) (A) as well as iPPV-episodes and INFL-attempts (B) are shown for the LRS, late respiratory stability group and ERS, early respiratory stability group during the first 15 min of postnatal support. p-values - **p = 0.004, *p = 0.027.

Figure 2

Overall duration of active tactile stimulation (TS) during the first 15 min of postnatal support. Three subgroups are depicted: LRS, late respiratory stability group; ERS, early respiratory stability group; IRS, immediately respiratory stability group, no need of iPPV or INFL within the first 15 min of postnatal support. (%) – proportion of infants within the particular group; p-values - **p = 0.003, *p = 0.010.

Figure 3

Stimulation procedure divided by different stimulation methods. Overall duration (A) and first time (B) of different tactile stimulation (TS) methods during the first 15 min of postnatal support. Three subgroups are depicted: LRS, late respiratory stability group; ERS, early respiratory stability group; IRS, immediately respiratory stability group. (%) – proportion of stimulated infants within the particular group; p-values – (A) **p = 0.005, *p = 0.024; (B) **p = 0.009, *p = 0.015. Various stimulation method – defined as stimulation not assignable to one of the other methods.

Figure 4

Concomitant stimulations. Overall duration (A) and first time (B). Scatter dot plot for only one stimulation method up to more than two applicated concomitant stimulation methods. Two subgroups are depicted: LRS, late respiratory stability group; ERS, early respiratory stability group. (%) – proportion of stimulated infants within the particular group; p-values - *p = 0.015; *p = 0.015.