The Impact of Holding on Stress and Bonding in Mother-Infant Pairs During Therapeutic Hypothermia

NCT ID: NCT03837717

Last Updated: 2021-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

34 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-12-04

Study Completion Date

2021-02-08

Brief Summary

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This research is being done to try to improve the experience of mothers and babies during therapeutic hypothermia. Currently, mothers are not able to hold their baby during hypothermia treatment. Mothers have reported that not being able to hold their baby during this time is stressful. Additionally, it is known that holding has many benefits for mothers' and babies' psychological and physical health.

Therapeutic hypothermia is the standard of care. The experimental interventions of this study are to have mothers hold their babies during this treatment, collect saliva samples from mothers and babies, and test the saliva samples for the hormones cortisol and oxytocin. The investigators will test saliva of infants and their mothers before and after holding. The investigators hope to demonstrate decreased cortisol, a marker for stress, and increased oxytocin, a marker for bonding, in infants and mothers while they are held during therapeutic hypothermia.

Detailed Description

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The inability to hold an infant being treated with therapeutic hypothermia in the neonatal intensive care unit has been subjectively reported by ours and other research groups as a significant source of stress for parents. The investigators aim to assess the impact of holding on endocrinological markers of stress and bonding. Specifically, the investigators plan to collect salivary cortisol and oxytocin levels from infants undergoing therapeutic hypothermia and their mothers prior to and immediately after a 30-minute holding period.

The investigators hypothesize that measurable increases in salivary oxytocin levels, coinciding with the reported qualitative increased levels of bonding, will be observed after the holding period. The investigators anticipate the reported stress reduction after holding to be quantified by measurable decreases in salivary cortisol levels. The investigators hypothesize these hormone changes will be present in both the mother and the infant when compared to samples taken without the holding intervention.

Conditions

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Hypoxic-Ischemic Encephalopathy Neonatal Encephalopathy

Keywords

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Saliva Neonatal Encephalopathy Hypoxic-Ischemic Encephalopathy Bonding Oxytocin Stress Cortisol

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Infants and mothers will be randomly assigned to the holding condition occurring on the second versus the third day of hypothermia.

On the day of holding, four samples of saliva will be obtained; two from the mother (pre and post holding) and two from the infant (pre and post holding). The first sample will be collected prior to holding, and the second sample immediately at the end of holding before the infant is placed back in the bed.

On the day without holding, four additional samples of saliva will be obtained; two from the mother (pre and post "not holding") and two from the infant (pre and post "not holding").
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Holding First

Holding will occur on the second day of hypothermia treatment. Saliva will be collected on Day 2 and Day 3

Group Type EXPERIMENTAL

Holding

Intervention Type BEHAVIORAL

Mothers will be assisted with holding their infants (and the cooling blanket) for a single 30-minute period, with the use of a thin foam barrier for thermal protection. Mothers and infants will not be skin-to-skin.

Saliva collection

Intervention Type OTHER

Saliva will be collected from infants (via syringe suction) and mothers (via passive drool), and tested for levels of cortisol and oxytocin

No Holding

Intervention Type BEHAVIORAL

Saliva will be collected from Mothers and infants, and vital sign information will be collected from infants in the same manner as the Holding intervention, with the exception of having mother's hold their infants.

No Holding First

Holding will occur on the third day of hypothermia treatment. Saliva will be collected on Day 2 and Day 3

Group Type EXPERIMENTAL

Holding

Intervention Type BEHAVIORAL

Mothers will be assisted with holding their infants (and the cooling blanket) for a single 30-minute period, with the use of a thin foam barrier for thermal protection. Mothers and infants will not be skin-to-skin.

Saliva collection

Intervention Type OTHER

Saliva will be collected from infants (via syringe suction) and mothers (via passive drool), and tested for levels of cortisol and oxytocin

No Holding

Intervention Type BEHAVIORAL

Saliva will be collected from Mothers and infants, and vital sign information will be collected from infants in the same manner as the Holding intervention, with the exception of having mother's hold their infants.

Interventions

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Holding

Mothers will be assisted with holding their infants (and the cooling blanket) for a single 30-minute period, with the use of a thin foam barrier for thermal protection. Mothers and infants will not be skin-to-skin.

Intervention Type BEHAVIORAL

Saliva collection

Saliva will be collected from infants (via syringe suction) and mothers (via passive drool), and tested for levels of cortisol and oxytocin

Intervention Type OTHER

No Holding

Saliva will be collected from Mothers and infants, and vital sign information will be collected from infants in the same manner as the Holding intervention, with the exception of having mother's hold their infants.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* gestational age at birth of 35 weeks or greater
* absence of clinical or electrographic seizures during the first 24 hours of therapeutic hypothermia
* designation as "clinically stable" by the attending neonatologist on service
* respiratory status of: room air, nasal cannula, continuous positive airway pressure or intubated on conventional ventilator

Exclusion Criteria

* designation as "clinically unstable" by the a member of the medical team
* use of inhaled nitric oxide for persistent pulmonary hypertension of the newborn
* high frequency oscillator ventilation
* presence of electrographic seizures
* use of vasopressors or paralytic agents, presence of chest tubes, wound vacuums, or drains
* in utero opiate exposure
Minimum Eligible Age

24 Hours

Maximum Eligible Age

2 Days

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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MaineHealth

OTHER

Sponsor Role lead

Responsible Party

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Alexa Craig

Attending Pediatric Neurologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alexa K Craig, MD

Role: PRINCIPAL_INVESTIGATOR

MaineHealth

Locations

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Maine Medical Center

Portland, Maine, United States

Site Status

Countries

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United States

References

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Vittner D, McGrath J, Robinson J, Lawhon G, Cusson R, Eisenfeld L, Walsh S, Young E, Cong X. Increase in Oxytocin From Skin-to-Skin Contact Enhances Development of Parent-Infant Relationship. Biol Res Nurs. 2018 Jan;20(1):54-62. doi: 10.1177/1099800417735633. Epub 2017 Oct 11.

Reference Type BACKGROUND
PMID: 29017336 (View on PubMed)

Craig AK, James C, Bainter J, Evans S, Gerwin R. Parental perceptions of neonatal therapeutic hypothermia; emotional and healing experiences. J Matern Fetal Neonatal Med. 2020 Sep;33(17):2889-2896. doi: 10.1080/14767058.2018.1563592. Epub 2019 Jan 8.

Reference Type BACKGROUND
PMID: 30585100 (View on PubMed)

Craig AK, Gerwin R, Bainter J, Evans S, James C. Exploring parent expectations of neonatal therapeutic hypothermia. J Perinatol. 2018 Jul;38(7):857-864. doi: 10.1038/s41372-018-0117-8. Epub 2018 May 8.

Reference Type BACKGROUND
PMID: 29740186 (View on PubMed)

Craig AK, Gerwin R, Bainter J, Evans S, James C. Exploring Parent Experience of Communication About Therapeutic Hypothermia in the Neonatal Intensive Care Unit. Adv Neonatal Care. 2018 Apr;18(2):136-143. doi: 10.1097/ANC.0000000000000473.

Reference Type BACKGROUND
PMID: 29595551 (View on PubMed)

Craig A, Deerwester K, Fox L, Jacobs J, Evans S. Maternal holding during therapeutic hypothermia for infants with neonatal encephalopathy is feasible. Acta Paediatr. 2019 Sep;108(9):1597-1602. doi: 10.1111/apa.14743. Epub 2019 Mar 5.

Reference Type BACKGROUND
PMID: 30721531 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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1183063

Identifier Type: -

Identifier Source: org_study_id