Effects of a Nurturing and Quiet Intervention (NeuroN-QI) on Preterm Infants' Neurodevelopment and Maternal Stress and Anxiety: A Pilot Randomized Clinical Trial

Background: The current state of knowledge reveals that the development of the brain of preterm babies is influenced by specific neonatal experiences during hospitalization, such as environmental sensory stimulation (light and noise), as well as proximity to mothers. However, there is a lack of evidence regarding the benefits that could be associated with the combination of care interventions to improve the health outcomes of preterm infants and their mothers, and in particular the development of the brain of infants during their hospitalization in the neonatal unit.

The aim of this pilot study is to assess the feasibility and acceptability of a developmental care intervention including periods of nurturing between mothers and their infant (skin-to-skin contact and auditory stimulation) to promote physical and emotional proximity and a quiet period (controlled light and noise levels and olfactory stimulation in incubators) and to estimate the effect of this intervention on infants’ neurodevelopment as well as on maternal stress and anxiety.

Criteria:

Inclusion: Infants will be eligible if they are born between 26 and 316/7 WGA.

Exclusion: Infants will be excluded if they: a) have birth defects or genetic disorders, b) have an intraventricular hemorrhage >grade II, c) receive analgesics or paralyzing agents. Mothers will be excluded if they: a) are <18 years of age, b) gave birth to multiple, c) have a physical condition that does not allow kangaroo care, d) abuse substances or alcohol, e) chose formula or mixed feeding, f) do not speak, read or write French or English.

Intervention: Experimental vs Control.

• Experimental: Skin to skin care will be first done for a period of 2 hours. Followed by one hour of olfactory stimulation and a quiet period. During the first 15 min of the kangaroo care, the mother will read a book of their choice to the baby. During the 2 hours, the light and the noise of the room will be measured with a photometer and a sonometer respectively. Then, the mom will be invited to express breast milk which will be placed on a compress inside the incubator near the infant's nose in order to offer olfactory stimulation during the one-hour of quiet period.

• Control: Skin to skin care will be first done for a period of 2 hours. During the 2 hours, the light and the noise of the room will be measured with a photometer and a sonometer respectively.

Before and after every intervention, mothers will be asked to fill up a short stress and anxiety questionnaire. This intervention will take place 3 times a week. (Of course mother's are free to do skin to skin as much as they want but only 3/week will be recorded). One video at 36 weeks post-menstrual age of the baby will be videotaped for 30 minutes during a care intervention (i.e. changing diaper, bathing…) in order to assess preterm infants with the APIB (The Assessment of Preterm Infants' Behavior).

Duration: From the moment of recruitment until baby is 36 weeks GA.

Goal for recruitment: 15 patients.

Research coordinator in charge at the Montreal Children's Hospital: Daniela Villegas Martinez