Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1105-1113 (doi:10.1542/peds.2004-2440)

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Salivary Cortisol and Mood and Pain Profiles During Skin-to-Skin Care for an Unselected Group of Mothers and Infants in Neonatal Intensive Care

Evalotte Mörelius, RN, MS^*, Elvar Theodorsson, MD, PhD and Nina Nelson, MD, PhD^*

^* Department of Molecular and Clinical Medicine, Division of Pediatrics
Department of Biomedicine and Surgery, Division of Clinical Chemistry, University Hospital, Linköping, Sweden

Objectives. Mother-infant separation after birth is a well-known source of stress. Parents and preterm infants in neonatal intensive care are separated immediately after birth. Skin-to-skin care is 1 possible method to reduce the separation-dependent stress. The aim of the present study was to investigate how skin-to-skin care influences stress for the mother and the infant in neonatal intensive care.

Methods. Seventeen mother-infant pairs were included at their first and fourth skin-to-skin care. The infants were 25 to 33 weeks' gestational age, with birth weights ranging from 495 to 2590 g. In mothers, salivary cortisol, heart rate, mood scale, and stress measured on a visual analog scale (VAS) were analyzed. In infants, salivary cortisol and heart rate were analyzed, and because pain is one facet of stress, 2 different pain scales were used.

Results. In mothers, the skin-to-skin care decreased salivary cortisol (32%), heart rate (7%), and VAS (89%), whereas mood increased (6%). Before the fourth skin-to-skin care, mothers rated less stress on VAS, and salivary cortisol and heart rate improved faster. The infants' cortisol either increased or decreased. Their heart rates and pain scores decreased during skin-to-skin care.

Conclusions. Our results lend additional support to the value of skin-to-skin care in neonatal intensive care. Variable stress responses in preterm infants favor the need for individualized care. The mothers' need for support seem to be more pronounced in the first skin-to-skin session as our results show a higher degree of stress as compared with later skin-to-skin care.

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Key Words: cortisol • newborn infant • maternal behavior • pain measurement • stress

Abbreviations: SSC, skin-to-skin care • SaO₂, oxygen saturation • VAS, visual analogue scale • PIPP, Premature Infant Pain Profile • NIPS, Neonatal Infant Pain Scale • Fr, Friedman statistical test • Wi, Wilcoxon signed ranks tests

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Accepted Jan 25, 2005.

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