Spontaneous cries can alter the physiological well-being and cerebral oxygenation of very preterm infants

Abstract

IntroductionInfant crying is a major expression of distress and can occur without any exogenous stimulation. Little is known, however, about the effects of crying on physiological homeostasis in very preterm infants (VPIs). MethodsEnvironmental, behavioral (video and audio recording) and physiologic (heart rate [HR], respiratory rate [RR], and systemic [SaO2] and regional cerebral oxygenation [rSO2]) parameters were prospectively evaluated over 10h in 18 VPIs (median gestational age, 28 [27–31] weeks). Only episodes of “spontaneous” and isolated cries were analyzed. Changes in parameters were compared over 5-second periods between baselines and 40s following the onset of crying. Two periods were distinguished: 0–20s (a) and 20–40s (b). Minimal and/or maximal values in these periods were also compared to the baseline. ResultsOf the 18 VPIs initially studied, 13 (72%) presented crying episodes (CE). They experienced 210 “spontaneous” and isolated CE, with a median of 9 [range, 1–63] CEs per child. Physiological values varied significantly from the baseline with mainly a mean decrease in HR of −4.8±5.3beats/min (b) after an initial mean increase of +2.6±2.0beats/min (a); a mean decrease in RR of −3.8±4.8cycles/min (a), followed by a mean increase of +5.6±7.3cycles/min (b) and mean unidirectional decreases in SaO2 and rSO2 (minimal values) of −1.8±2.3% and −2.5±3.0%, respectively. ConclusionSpontaneous cries can alter the homeostasis of VPIs. Their possible adverse consequences and high occurrence emphasize the need for better prevention and response to them.