633 Improved respiratory parameters with skin-to-skin contact in extremely premature infants

Abstract

<h3>Aims</h3> During neurally adjusted ventilatory assist (NAVA)/non-invasive (NIV)-NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Skin-to-skin contact (SSC) is widely recommended and is part of standard neonatal care worldwide. Our aim was to determine if SSC improved respiratory parameters in premature infants with evolving or established Bronchopulmonary Dysplasia (BPD). <h3>Methods</h3> Prospective observational study was undertaken in the Neonatal Unit at St George’s Hospital, London. All infants born premature (less than 32 weeks of gestation) who had an indwelling Edi catheter to deliver NAVA mode of ventilation were included in the study. SSC was offered to parents as per standard practice on the neonatal unit. Data were downloaded from the ventilator and respiratory parameters pre-SSC (when baby in the incubator) were compared to best SSC (baby noted to be completely/most settled/asleep by the parent or by the bedside nurse) and end SSC (just before end of SSC). Data compared were an average of five minutes continuous readings obtained from Edi catheter for pre, best and end SSC. All infants received respiratory support using SERVO-n neonatal ventilator, Getinge. Respiratory parameters compared were peak electrical activity of the diaphragm (peak Edi), mean airway pressure (P mean), respiratory rate (RR), expiratory tidal volume (VTe), fraction of inspired oxygen (FiO₂) and percentage of time spent in back-up mode. <h3>Results</h3> Sixty-six episodes of SSC were analysed from 12 premature infants with median gestational age of 24.4 range (23.1-27.0) weeks. Total median duration of SSC was 88.5 (range: 30 -250) minutes. Peak Edi in best SSC median (range) 13.42 (3.66-37.27) and end SSC 13.47 (2.65-38.69) was significantly lower compared to pre- SSC 17.11 (4.04-36.64) microvolts (uV) <i>p</i> &lt;0.001. P mean was significantly lower in best SSC 10.30 (6.79-14.98) and end SSC 10.14 (7.25-15.6) compared to pre-SSC 10.67 (7.49-15.52) cmH2O, <i>p</i> = 0.033 and <i>p</i> = 0.005. RR was lower in best SSC 52.63 (35.59-74.00) and significantly lower in end SSC 52.41 (31.14-78.1) compared to pre-SSC 54.74 (35.11-74.08) breaths/min, <i>p</i> = 0.069 and <i>p</i> = 0.037. VTe was lower in best SSC 40.91 (3.73-100.26) and significantly lower in end SSC 41.50 (3.43-96.87) compared to pre-SSC 42.75 (4.68-92.99) ml <i>p</i> = 0.147 and <i>p</i> = 0.465. There was no statistically significant difference in inspired oxygen requirement in best SSC 39.63 (22.06-54.99) and end SSC 40.31 (22.06-56.05) compared to pre-SSC 39.55 (25.99-56.07), <i>p</i> = 0.878 and <i>p</i> = 0.352. There was no statistically significant difference in the time spent in back-up mode in best SSC 8.52 (0.00-40.33) and end SSC 7.60 (0.00-56.02) compared to pre-SSC 7.04 (0.00-29.30), <i>p</i> = 0.257 and <i>p</i> = 0.800. <h3>Conclusion</h3> The respiratory parameters of peak electrical activity of the diaphragm (peak Edi), mean airway pressure and respiratory rate were significantly improved in extremely preterm babies receiving SSC.