The effects of kangaroo care on delirium management in neonates under non-invasive mechanical ventilation: A randomized control trial
-
Kayvan Mirnia
,
Jason W. Osborne
,
Hamid Sharif-Nia
,
David Sánchez-Teruel
,
Fatemeh Khoshnavay Fomani
,
Nasim Mirzaei
Abstract
Background & Aims: Little is known about managing delirium in neonates admitted to Neonatal Intensive Care Units. The current study investigated whether kangaroo mother care can affect neonates' delirium under non-invasive mechanical ventilation.
Materials & Methods: In this randomized control trial, a total of 50 term neonates who were under non-invasive mechanical ventilation were allocated to intervention and control groups (n=25 in each group) using block randomization. Utilizing “Cornell Assessment of Pediatric Delirium”, and “ACoRN respiratory sequence protocol”, the data were gathered at baseline, 24, 48, and 72 hours after. The intervention group received 30 minutes of kangaroo mother care daily.
Results: There was a statistical delirium mean scores difference between the two groups on day 2 (p < 0.045) but not on other days. Repeated measures modeling (linear mixed models and generalized linear mixed models) indicated significant differences in change curves for both Cornell Assessment of Pediatric Delirium scores and the incidence of delirium.
Conclusion: Implementing kangaroo mother care for a 30-minute duration each day for neonates under non-invasive mechanical ventilation may markedly decrease delirium occurrence.
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12. Turkel SB, Tavaré CJ. Delirium in children and adolescents. The Journal of Neuropsychiatry and Clinical Neurosciences. 2003 Nov;15(4):431-5.
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14. Davanzo R, Brovedani P, Travan L, Kennedy J, Crocetta A, Sanesi C, Strajn T, De Cunto A. Intermittent kangaroo mother care: a NICU protocol. Journal of Human Lactation. 2013 Aug;29(3):332-8.
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17. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000 Dec 15;25(24):3186-91.
18. Osborne JW. Regression & linear modeling: Best practices and modern methods. Sage Publications; 2016 Mar 24.
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23. Traube C, Silver G, Gerber LM, Kaur S, Mauer EA, Kerson A, Joyce C, Greenwald BM. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Critical Care Medicine. 2017 May 1;45(5):891-8.
24. Ge XH, Wei WR, Feng TN, Xu LL, Hu YQ, Yuan CR. Analysis of risk factor for pediatric intensive care unit delirium in children: a case-control study. American Journal of Translational Research. 2021;13(8):9143.
25. Meagher DJ. Delirium: optimizing management. BMJ. 2001 Jan 20;322(7279):144-9.
27. Cabral DM, Antonini SR, Custódio RJ, Martinelli Jr CE, Da Silva CA. Measurement of salivary cortisol as a marker of stress in newborns in a neonatal intensive care unit. Hormone Research in Paediatrics. 2013 Jul 1;79(6):373-8.
28. Nimbalkar SM, Chaudhary NS, Gadhavi KV, Phatak A. Kangaroo mother care in reducing pain in preterm neonates on heel prick. The Indian Journal of Pediatrics. 2013 Jan;80:6-10.
29. Cong X, Cusson RM, Walsh S, Hussain N, Ludington-Hoe SM, Zhang D. Effects of skin-to-skin contact on autonomic pain responses in preterm infants. The Journal of Pain. 2012 Jul 1;13(7):636-45.
30. Cong X, Ludington-Hoe SM, McCain G, Fu P. Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early Human Development. 2009 Sep 1;85(9):561-7.
31. Kostandy RR, Ludington-Hoe SM, Cong X, Abouelfettoh A, Bronson C, Stankus A, Jarrell JR. Kangaroo Care (skin contact) reduces crying response to pain in preterm neonates: pilot results. Pain Management Nursing. 2008 Jun 1;9(2):55-65.
32. Mörelius E, Örtenstrand A, Theodorsson E, Frostell A. A randomized trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Human Development. 2015 Jan 1;91(1):63-70.
33. Almgren M. Benefits of skin-to-skin contact during the neonatal period: Governed by epigenetic mechanisms? Genes & diseases. 2018 Mar 1;5(1):24-6.
34. Bergman NJ. New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care. Frontiers in Psychology. 2024 Jul 9;15:1385320.
2. Siegel EJ, Groves AM, Silver G, Hojsak J, Lim CA, Traube C. Delirium in the NICU: a point prevalence study. Hospital Pediatrics. 2021 Nov 1;11(11):e321-6.
3. Tarrell A, Giles L, Smith B, Traube C, Watt K. Delirium in the NICU. Journal of Perinatology. 2024 Feb;44(2):157-63.
4. Hadian Shirazi Z, Soltanian M, Sabet Sarvestani R. Relief and care in the shade: A concept extracted from practices of neonatal nurses during pain management. Nursing Practice Today. 2020; 7(3):208-16.
5. Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. The American Journal of Geriatric Psychiatry. 2013 Dec 1;21(12):1190-222.
6. Groves A, Traube C, Silver G. Detection and management of delirium in the neonatal unit: A case series. Pediatrics. 2016 Mar 1;137(3).
7. Edwards LE, Hutchison LB, Hornik CD, Smith PB, Cotten CM, Bidegain M. A case of infant delirium in the neonatal intensive care unit. Journal of Neonatal-Perinatal Medicine. 2017 Jan 1;10(1):119-23.
8. Brahmbhatt K, Whitgob E. Diagnosis and management of delirium in critically ill infants: case report and review. Pediatrics. 2016 Mar 1;137(3).
9. Silver G, Kearney J, Traube C, Hertzig M. Delirium screening anchored in child development: The Cornell Assessment for Pediatric Delirium. Palliative & supportive care. 2015 Aug;13(4):1005-11.
10. Fernández-Medina IM, Jiménez-Fernández L, Solaz-García ÁJ, Llorca-Porcar A, Martínez-Miguel E, Collados-Gómez L. Consensus document for the kangaroo mother care method. Anales de Pediatría (English Edition). 2024 Sep 1;101(3):208-16.
11. Zengin H, Suzan OK, Hur G, Kolukısa T, Eroglu A, Cinar N. The effects of kangaroo mother care on physiological parameters of premature neonates in neonatal intensive care unit: A systematic review. Journal of Pediatric Nursing. 2023 Jul 1;71:e18-27.
12. Turkel SB, Tavaré CJ. Delirium in children and adolescents. The Journal of Neuropsychiatry and Clinical Neurosciences. 2003 Nov;15(4):431-5.
13. Traube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, Halpert S, Augenstein J, Sickles LE, Li C, Greenwald B. Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU. Critical Care Medicine. 2014 Mar 1;42(3):656-63.
14. Davanzo R, Brovedani P, Travan L, Kennedy J, Crocetta A, Sanesi C, Strajn T, De Cunto A. Intermittent kangaroo mother care: a NICU protocol. Journal of Human Lactation. 2013 Aug;29(3):332-8.
15. Silver G, Traube C, Kearney J, Kelly D, Yoon MJ, Nash Moyal W, Gangopadhyay M, Shao H, Ward MJ. Detecting pediatric delirium: development of a rapid observational assessment tool. Intensive Care Medicine. 2012 Jun;38:1025-31.
16. Hoshino H, Matsuishi Y, Enomoto Y, Shimojo N, Kido T, Matsuzaki A, Matsubara M, Kato H, Hoshino T, Traube C, Silver G. The validity and reliability of the Japanese version of the cornell assessment of pediatric delirium. Pediatric Critical Care Medicine. 2020 May 1;21(5):e267-73.
17. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000 Dec 15;25(24):3186-91.
18. Osborne JW. Regression & linear modeling: Best practices and modern methods. Sage Publications; 2016 Mar 24.
19. Ista E, Traube C, de Neef M, Schieveld J, Knoester H, Molag M, Kudchadkar SR, Strik J. Factors associated with delirium in children: a systematic review and meta-analysis. Pediatric Critical Care Medicine. 2023 May 1;24(5):372-81.
20. Dechnik A, Traube C. Delirium in hospitalised children. The Lancet Child & Adolescent Health. 2020 Apr 1;4(4):312-21.
21. Jamehdar M, Nourizadeh R, Divband A, Valizadeh L, Hosseini M, Hakimi S. KMC by surrogate can have an effect equal to KMC by mother in improving the nutritional behavior and arterial oxygen saturation of the preterm infant: results of a controlled randomized clinical trial. BMC Pediatrics. 2022 May 2;22(1):242.
22. Song JT, Kinshella ML, Kawaza K, Goldfarb DM. Neonatal intensive care unit interventions to improve breastfeeding rates at discharge among preterm and low birth weight infants: a systematic review and meta-analysis. Breastfeeding Medicine. 2023 Feb 1;18(2):97-106.
23. Traube C, Silver G, Gerber LM, Kaur S, Mauer EA, Kerson A, Joyce C, Greenwald BM. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Critical Care Medicine. 2017 May 1;45(5):891-8.
24. Ge XH, Wei WR, Feng TN, Xu LL, Hu YQ, Yuan CR. Analysis of risk factor for pediatric intensive care unit delirium in children: a case-control study. American Journal of Translational Research. 2021;13(8):9143.
25. Meagher DJ. Delirium: optimizing management. BMJ. 2001 Jan 20;322(7279):144-9.
27. Cabral DM, Antonini SR, Custódio RJ, Martinelli Jr CE, Da Silva CA. Measurement of salivary cortisol as a marker of stress in newborns in a neonatal intensive care unit. Hormone Research in Paediatrics. 2013 Jul 1;79(6):373-8.
28. Nimbalkar SM, Chaudhary NS, Gadhavi KV, Phatak A. Kangaroo mother care in reducing pain in preterm neonates on heel prick. The Indian Journal of Pediatrics. 2013 Jan;80:6-10.
29. Cong X, Cusson RM, Walsh S, Hussain N, Ludington-Hoe SM, Zhang D. Effects of skin-to-skin contact on autonomic pain responses in preterm infants. The Journal of Pain. 2012 Jul 1;13(7):636-45.
30. Cong X, Ludington-Hoe SM, McCain G, Fu P. Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early Human Development. 2009 Sep 1;85(9):561-7.
31. Kostandy RR, Ludington-Hoe SM, Cong X, Abouelfettoh A, Bronson C, Stankus A, Jarrell JR. Kangaroo Care (skin contact) reduces crying response to pain in preterm neonates: pilot results. Pain Management Nursing. 2008 Jun 1;9(2):55-65.
32. Mörelius E, Örtenstrand A, Theodorsson E, Frostell A. A randomized trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Human Development. 2015 Jan 1;91(1):63-70.
33. Almgren M. Benefits of skin-to-skin contact during the neonatal period: Governed by epigenetic mechanisms? Genes & diseases. 2018 Mar 1;5(1):24-6.
34. Bergman NJ. New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care. Frontiers in Psychology. 2024 Jul 9;15:1385320.
| Files | ||
| Issue | Vol 12 No 1 (2025): Winter | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/npt.v12i1.17528 | |
| Keywords | ||
| infant; delirium; mechanical ventilation; neonatal intensive care unit; kangaroo mother care method | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mirnia K, W. Osborne J, Sharif-Nia H, Sánchez-Teruel D, Khoshnavay Fomani F, Mirzaei N. The effects of kangaroo care on delirium management in neonates under non-invasive mechanical ventilation: A randomized control trial. NPT. 2024;12(1):85-97.
