The Effect of Clustered Care on Physiological and Behavioral Responses in Preterm Infants: Randomized Cross –Over Clinical Trial.

Abstract

Abstract: Introduction: Preterm infants receive different type of procedures in the Neonatal Intensive care unit (NICU) every day and they are suffering from repeated stress and sleep deprivation. Reducing of their stress and providing opportunity for rest is very important for them. In this regard, clustering of routine care procedures is recommended. The aim of this study was to compare the physiological parameters and behavioral responses in preterm infants with clustered care with three, four and five different noninvasive procedures (stress score of 7, 10 and 13 respectively). Methods: This study was a randomized crossover clinical trial performed in NICU of Al Zahra Hospital, Tabriz, Iran in 2013. Thirty one preterm infants with gestational age 30-32 weeks were studied at 32 weeks age by clustered care with three, four and five procedures and physiological parameters consist of heart rate, respiratory rate and blood oxygen saturation and behavioral symptoms were assessed. The analysis of data was done with use of STATA 10 software at 0.05 significant level. Results: The findings showed mean of physiological parameters in clustered care with three, four and five procedures groups during of clustered care were oxygen saturation as: 97.3, 97.2, 97.9 respectively heart rate as: 149.9, 150.4, 154.8, respiratory rate as: 48.9, 50.3 and 48.6 that all of them were in normal range. According to APIB (Assessment of Preterm Infants Behavior) mean score of stability were 2.0, 4.2, 4.0 respectively and score of stress 2.5, 4.0, 3.3 respectively. There weren’t significant differences between mean of physiological parameters before, during and after three type of cluster interventions (p>0.05). We couldn’t find any significant differences in score of stability or stress according to APIB before and after phases but during three type of cluster interventions was found (p<0.05). Conclusion: Clustered care with three procedures could be more acceptable, clustered care with four and five procedures could be recommended by providing cue –based supportive for preterm infants in 32 weeks.