Joumal of Advanced Nurstng, 1990,15,877-885
Effects of early parent touch on preterm infants' heart rates and arterial oxygen saturation levels Lynda Law Hamson RN PhD Assoaate Professor and Dtrector of Research, The Untverstty of Alabama Capstone College of Nurstng
James D Leeper PhD Professor and Chair, Departrrtent of Behavtoral and Community Medicine, The Unwerstty of Alabama College of Commtmtty Health Sctertces
and Mahnhee Yoon Doctoral Candtdate, Department of Management and Markehng, The Untverstty of Alabama, College of Commerce and Bustrtess Admtntstrahon, Tuscaloosa, Alabama, USA
Accepted for publicahon 17 December 1989
HARRISON L L, LEEPER J D & YOON M (1990) Journal of Advanced Nurstng 15,877-885 Effects of early parent touch on preterm infants' heart rates and arterial oxygen saturation levels A descnptive exploratory design was used m tins study to evaluate the effects of eariy parent touch on the heart rates and arterial oxygen (O^) saturation leveis of 36 preterm mfants The infants were between 27—33 weeks gestationai age at birth, and were free of congenital defects infants were videotaped dunng parent visits on up to tiiree separate occasions dunng the first month of life Parents were encouraged to mteract with their infants as they usually wouid, and data on the infants' heart rates and O^ saturahon ieveis were recorded every 6 seconds on a portabie computer that was mterfaced with the infants' monitors Mean O^ saturation leveis were significantly lower dunng parent touch than dunng baseline periods on 45% of the visits, and significantly iugher dunng parent touch penods on 19% of the visits Oj saturation vanabihty was greater dunng penods of parent touch, and there were more abnormal O^ saturation values dunng parent touch than during baseline penods Mean heart rates dunng parent touch were significantly lower compared to baseline on 17% of the visits, and were higlier dunng parent toudi on 43% of the visits There were no overall differences m mean heart rates i>etween baseime, parent touch and post-visit ciassificahons, aithough heart rate vanabihty was greater dunng penods of parent touch iThe results mdicate that preterm infants' responses to eariy parent touch are variable, and suggest that blanket poiiaes that limit parent touch dunng the eariy weeks of life may not b>e appropnate It may he more appropnate to teach parents to modify the types and amounts of touch they provide based on the infants' physiologic and behavioural cues
Correspomknce Dr L L Hamson Aaocutte Prr mi Dmdor of Raeirdu The Umoersab/ of Aiidxnmt Capshme CoU^ of Nursng PO Box 358 Tuscabosa Akbtam 35476-03S8, IBA
877
LL Hamson eiai
INTRODUCTION Although touch may be an important mediator of the development of attadiment ijetween parents and mfants, nurses often discourage parents from touching their preterm infants iiecause of the infant's compromized heaith status and the hypoxia which can result from excessive handlmg Yet many parents have noted that eariy opportumhes for tachle contact with their preterm mfants help them to cope with their feebngs of loss, and to begm to develop feelmgs of doseness towards their infants (Nance 1982) The queshon of whether early parent touch iias adverse effects on preterm uifants has not yet been zmswered The purpose of this study was to descnbe the effects of early parent touch on the heart rates and artenal oxygen saturahon levels of preterm mfants dunng the hrst 2-4 weeics of the infants' bves
from the iarger study are reported elsewhere (Hamson 1989a)
RELATED LITERATURE
There has been relatively bttie research to descnbe preterm uifants' sensitivihes to difiFerent types of tactiie stimub Haith (1986) noted that all body parts are sensihve to cutaneous shmuii by 32 weeks gestationai age, although Rose et al (1976) found that preterm infants (with a mean gestationai age of 33 2 weeks) showed minimal behavlourai responses and no significant cardiac responses to aijdominai tactiie stimuiahon with a piastic filament Few studies were found that focused on the infants' unmediate physiological or behavioural responses to tactile stunulahon Beaver (1987) evaluated the effects of supplemental stroking dunng a heel shck procedure on eight preterm uifants who were between 32-34 weeks CONCEPTUAL FRAMEWORK gestahonai age at birth Each infant received tiiree treatTouch IS the 'earbest and most elementai medium of human ments in a random order (a) heel touch only, (b) heel stidc, commumcahon' (Bamett 1972) Appropnate tactiie expen- or (c) stroking the leg while a heel shck was perfonned The ence IS essentiai for the optimai growth and deveiopment third treatment (strokmg dunng the heel shck) resulted m of tiie mfant, and for tiie deveiopment of parent-^nfant the greatest change in ali tiiree physioiogic parameters, attachment (Frank 1957, Hariow 1958, Kiaus & Kenneii with mcreases in biood pressure and heart rate, and a de1982) The study was based on a conceptuai framework for crease m transcutaneous oxygen (Tj.POj) ieveis anaiysmg the meanmg of touch that was deveioped by White-Traut & Goidman (1988) found that preterm Weiss (1979) infants' heart and respu-atory rates increased followmg a Roy's (1984) adaptahon modei provided the nursmg muitimodai stimulation treatment that mduded tactile, conceptual framework for tius study This model mcorpor- visual, auditory and veshbular stimulation Although the ates concepts from adaptation and systems theory The physiologic parameters stabilized 20 minutes foUowmg the focus of nursing may he individuals or groups which are treatment, the researchers concluded that preterm infants' viewed as open systems In this study, the preterm infant unmediate responses to shmuiation regimens shouid he was the system of mterest Roy (1984) ldenhfied tiiree momtored doseiy types of stunub that compnse system inputs (a) focal stunuli (those unmediateiy confrontmg the person), (b) contextual stimub (all other mtemal and extemal stimub), Poking and (c) residuai stimuii (vaiues, ijeiiefs, traits or athtudes Oehier (1985) exammed tiie physioiogic responses of 15 which may mfluence the system) The system output is preterm infants (rangmg from 26-30 weeks gestationai age conceptualized by Roy as either adaphve (promoting the at buth) to tactile and auditory stunulahon, and found that mtegnty of the system), or maiadaphve (faiimg to jwomote T J ' O j leveis remamed the same or lnaeased dunng audisystem growth) The goai of nursmg is to enhance shmub tory stunulahoa but tended to decrease dunng touching or tiiat iead to adaphve responses and modify stimub tiiat iead simuitaneous toudung/taikmg Oehier stressed the need to maiadaptive responses This study exammed the effects for further research to determine whether 'ways of providof a specific focai stimuius (parentai touch) on the unmedi- mg tachie stimuiahon other tiian stroiang may prove to ije ate physioiogicai adaptahon of preterm infants enndung for the mfants and not cause avoidance behaviors This research was part of a iarger project tiiat was aiso or hypoxia' Poweil (1974) noted that many of the smaUest babies m designed to descnije the physicai ciiaractenshcs of touch used by parents in toudung their preterm mfants, and to her study 'reacted to (the) stroiang as if it were quite determme wiiether infant's physioiogicai responses to noxious' This comment is parhculaHy significant m the bght parent touch were affected by certam contextuai stimub of lecmlt studies wiuch iiave demonstrated tiiat excessive (such as gestationai age or morbidity status). Other re»iits itandbng associated with medicai/nursmg procedures 878
Early parent touch
resuits m hypoxarania m very smail preterm infants (Long et al 1980, Noms et al 1982, Speidei 1978) Hypoxia and biood pressure eievahons winch may resuit from excessive handbng may iead to mtraventncuiar iiaemorriiage m preterm infants, particuiariy m those who are iess than 32 weeks gestahonal age (Tardy & Volpe 1982) In order to minimize the nsk of hypoxia and mtraventncuiar haemorrhage, a number of researchers and cbruaans have advocated iimihng the iiandimg of very smaii preterm mfants (Long et al 1980, Lucey 1981, Speidei 1978 (personai commurucation from W H TooieytoL Hamson, 19June 1984) Luddmgton (1983), m proposmg guideimes for stunuiation of high-nsk infants, suggested that prematures less than 32 weeks gestation shouid receive no addihonal tactile or vestibuiar shmuiation dunng the first 10 days of iife Gorski et al (1983) stressed the need for research based on direct observation of preterm mfants' responses to shmuli provided m tiie neonatal mtensive care unit (NICU) No studies were found that descnijed, speafically, how parents touch their hospitalized preterm infants or evaluated mfants' physiologic responses to parent touch Similarly, no research was identified that compared the types of touch provided for preterm uifants by parents with that provided by non-parent caregivers Observation of preterm mfants' responses to parental contact are parhculariy important in view of the widespread concem aijout promohng early par«it-mfant contact m order to eniiance mfant developmoit and parent-infant attadiment, whiie at the same hme preventmg compiicahons (such as hypoxia) which couid iead to adverse neuroiogic sequeiae m the infants
Study questions Two queshons guided this study 1 2
What are tiie effects of parental touch on the heart rates of preterm infants? Wiiat are the rfFects of parentai touch on the artenai oxygen saturahon ieveis of preterm infants?
METHODS Subjeds and srttii^; Tiie subjects fcff tius study were 36 preterm infants wiio were between 25 «id 33 weeks gestahonai age at buth, and tlieir paroits H K ahscAs were pahents m an NICU m tiie southem Urated ShAes tiiat serves as a regionai referrai centre Tiw U ^ B ^ itad no amgenitai an(»nahes and iiad not tmckrgotw sa^ay Parents were toid titat the purpose ctf tite ^:tidy was to team about pret«nn infiants' responses
to stimuiahon provided dunng parent visits, mdudmg tactiie stimuiahon, and those who agreed to parhapate signed mformed consent forms A totai of 17 parents deduied to partiapate m the study Of tiie 36 infants m the sample, 14 were male and 22 were female Tweive infants were White and 24 were Biack The mean gestationai age of the infants at birth was 29 6 weeks (SD 2 4), and tiie mean buthweight was 1337 grams (SD 403, range 688-2080) Instruments and measurements The infants' heart rates were measured by contmuous recordings from Corametnc cardiac monitors The infants' artenal oxygen (O^) saturation levels were measured by contmuous recordmgs from a Neilcor pulse oximeter The pulse oximeter consists of a smali proije containmg two iight-emittmg diodes and a photosemiconducter wiuch was attached to the infant's forefoot Deckardt & Steward (1984) reported tiiat O^ saturahon levels were correlated with transcutaneous oxygen (T^PO^) leveis over a wide range of O^ saturahons In addition, puise oximeter readmgs were doseiy correiated with m vivo artenai oxygen saturahon readmgs These authors suggested tiiat the oxygenation status of hypoxaemic infants may ije more sensihveiy measured by puise oximeters than by T ^ O ^ monitors In addihon, puise oximeters do not pose the nsk of skm bums to the uifants wiuch accompanies the use of T^PO^ monitors (Deckardt & Steward 1984) The pnmary source of measurement error with puise oximetry is mohon artifact m extremely achve infants (New 1985) Heat lamps, radiant warmers and phototherapy bghts might also affect puise oximetry readmgs However, this probiem can usuaiiy he avoided by shielcbng the sensor (Jenrus & Peabody 1987) The reliability of the oxuneter readmgs was assessed by companng the hecirt rate readings on the pulse oximeter with those on the Corametnc cardiac monitor m order to ensure an adequate pulsahie biood flow as suggested by Deddiardt & Steward (1984) Aii sensors were covered with probe covers suppbed by the Neiicor Corporation When the O ^ saturation ieveis were distorted ijecause of mohon arhfact, those readmgs were not mduded m the anaiysis For a more compiete discussion of the procedures used to reduce the nsk of measurement error m this study, see Hamson (1989b) The mfant's^estohonoiage was assessed by the neonatoiogists m the study NICU, usmg the system descnijed by (1979) Procedures A descnphve exploratory d e s ^ was used to answer t i ^ study queshons Because no previous studies vtae found 879
LL Htmson et al
that descnijed the specific [^ysicai diaractenshcs of touch used by parents of preterm uifants, tiie researdiers deaded not to impose controis on ttie types of touch to be provided Once data are avaiiabie descnbmg the physicai charactenstics of eariy parent touch, more controiied studies can ije unpiemented to evaiuate the physioiogic effects of the types of parent touch that are most often provided to preterm infants Attempts were made to videotape each study infant dunng three parent visits to the NICU when the mfants were ijetween 5-14 days of age For some infants, the data coiiechon times iiad to ije aitered ijecause parents were unable to visit the NICU dunng the specified data collechon tunes, or the infants' medical condihons were unstable and the physiaans requested that the parents should not touch the infants Twenty-seven infants were videotaped durmg tiiree parent visits, six were taped dunng two visits, and tiiree were videotaped dunng oniy one visit The mean ages of tiie infants durmg the tiiree visits were 5 8, 8 4 and 11 3 days, respechveiy A Compaq portabie computer was mterfaced with the uifants' Corametnc cardiac monitor and Neiicor puise oximeter with an anaiog-to-digital converter (ADC) A computer program was developed usmg the Asyst software package to program the mterface between the computer and tiie ADC Data on the infant's heart rate and artenai oxygen saturation levels were recorded every 6 seconds by the computer, and stored on a hard disic The researdier chedced the readmgs on the monitors and the computer screen penodicaily tiiroughout the data coiiection penods, to oisure that they were consistent The videocamera was mterfaced with the computer usmg a videocombmer, so tiiat data on the tune, observahon nunJjer and the physioiogic parameters were recorded on tiie videotape Physioic^c parameters were recorded for a 5-mmute baseiine pCTiod ijefore the parents approadied the infants' ijedsides Once the parents approadied the ijedside, tiie researdier adjusted the focus of the videocamera, and then ieft the ijedside to decrease tiie possibibty tiiat parents might become anxious as a resuit ctf an observer's presence Parents wo-e encouraged to mteract with theu- uifants as they usuaiiy wouid, aiwl at tiie end of tiie visits were given a copy of tiie videotape to keep At the end of the parent visit, post-visit data were coiiected for 10 mmutes The NICU staff were aware of the study puiposes and geieraiiy tned not to mterrupt the parents dunng tiie visit If, however, the uifants required care dunng tiie data coiiecti 2 O I
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Effects of early parent touch on preterm infants' heart rates and arterial oxygen saturation levels Lynda Law Hamson RN PhD Assoaate Professor and Dtrector of Research, The Untverstty of Alabama Capstone College of Nurstng
James D Leeper PhD Professor and Chair, Departrrtent of Behavtoral and Community Medicine, The Unwerstty of Alabama College of Commtmtty Health Sctertces
and Mahnhee Yoon Doctoral Candtdate, Department of Management and Markehng, The Untverstty of Alabama, College of Commerce and Bustrtess Admtntstrahon, Tuscaloosa, Alabama, USA
Accepted for publicahon 17 December 1989
HARRISON L L, LEEPER J D & YOON M (1990) Journal of Advanced Nurstng 15,877-885 Effects of early parent touch on preterm infants' heart rates and arterial oxygen saturation levels A descnptive exploratory design was used m tins study to evaluate the effects of eariy parent touch on the heart rates and arterial oxygen (O^) saturation leveis of 36 preterm mfants The infants were between 27—33 weeks gestationai age at birth, and were free of congenital defects infants were videotaped dunng parent visits on up to tiiree separate occasions dunng the first month of life Parents were encouraged to mteract with their infants as they usually wouid, and data on the infants' heart rates and O^ saturahon ieveis were recorded every 6 seconds on a portabie computer that was mterfaced with the infants' monitors Mean O^ saturation leveis were significantly lower dunng parent touch than dunng baseline periods on 45% of the visits, and significantly iugher dunng parent touch penods on 19% of the visits Oj saturation vanabihty was greater dunng penods of parent touch, and there were more abnormal O^ saturation values dunng parent touch than during baseline penods Mean heart rates dunng parent touch were significantly lower compared to baseline on 17% of the visits, and were higlier dunng parent toudi on 43% of the visits There were no overall differences m mean heart rates i>etween baseime, parent touch and post-visit ciassificahons, aithough heart rate vanabihty was greater dunng penods of parent touch iThe results mdicate that preterm infants' responses to eariy parent touch are variable, and suggest that blanket poiiaes that limit parent touch dunng the eariy weeks of life may not b>e appropnate It may he more appropnate to teach parents to modify the types and amounts of touch they provide based on the infants' physiologic and behavioural cues
Correspomknce Dr L L Hamson Aaocutte Prr mi Dmdor of Raeirdu The Umoersab/ of Aiidxnmt Capshme CoU^ of Nursng PO Box 358 Tuscabosa Akbtam 35476-03S8, IBA
877
LL Hamson eiai
INTRODUCTION Although touch may be an important mediator of the development of attadiment ijetween parents and mfants, nurses often discourage parents from touching their preterm infants iiecause of the infant's compromized heaith status and the hypoxia which can result from excessive handlmg Yet many parents have noted that eariy opportumhes for tachle contact with their preterm mfants help them to cope with their feebngs of loss, and to begm to develop feelmgs of doseness towards their infants (Nance 1982) The queshon of whether early parent touch iias adverse effects on preterm uifants has not yet been zmswered The purpose of this study was to descnbe the effects of early parent touch on the heart rates and artenal oxygen saturahon levels of preterm mfants dunng the hrst 2-4 weeics of the infants' bves
from the iarger study are reported elsewhere (Hamson 1989a)
RELATED LITERATURE
There has been relatively bttie research to descnbe preterm uifants' sensitivihes to difiFerent types of tactiie stimub Haith (1986) noted that all body parts are sensihve to cutaneous shmuii by 32 weeks gestationai age, although Rose et al (1976) found that preterm infants (with a mean gestationai age of 33 2 weeks) showed minimal behavlourai responses and no significant cardiac responses to aijdominai tactiie stimuiahon with a piastic filament Few studies were found that focused on the infants' unmediate physiological or behavioural responses to tactile stunulahon Beaver (1987) evaluated the effects of supplemental stroking dunng a heel shck procedure on eight preterm uifants who were between 32-34 weeks CONCEPTUAL FRAMEWORK gestahonai age at birth Each infant received tiiree treatTouch IS the 'earbest and most elementai medium of human ments in a random order (a) heel touch only, (b) heel stidc, commumcahon' (Bamett 1972) Appropnate tactiie expen- or (c) stroking the leg while a heel shck was perfonned The ence IS essentiai for the optimai growth and deveiopment third treatment (strokmg dunng the heel shck) resulted m of tiie mfant, and for tiie deveiopment of parent-^nfant the greatest change in ali tiiree physioiogic parameters, attachment (Frank 1957, Hariow 1958, Kiaus & Kenneii with mcreases in biood pressure and heart rate, and a de1982) The study was based on a conceptuai framework for crease m transcutaneous oxygen (Tj.POj) ieveis anaiysmg the meanmg of touch that was deveioped by White-Traut & Goidman (1988) found that preterm Weiss (1979) infants' heart and respu-atory rates increased followmg a Roy's (1984) adaptahon modei provided the nursmg muitimodai stimulation treatment that mduded tactile, conceptual framework for tius study This model mcorpor- visual, auditory and veshbular stimulation Although the ates concepts from adaptation and systems theory The physiologic parameters stabilized 20 minutes foUowmg the focus of nursing may he individuals or groups which are treatment, the researchers concluded that preterm infants' viewed as open systems In this study, the preterm infant unmediate responses to shmuiation regimens shouid he was the system of mterest Roy (1984) ldenhfied tiiree momtored doseiy types of stunub that compnse system inputs (a) focal stunuli (those unmediateiy confrontmg the person), (b) contextual stimub (all other mtemal and extemal stimub), Poking and (c) residuai stimuii (vaiues, ijeiiefs, traits or athtudes Oehier (1985) exammed tiie physioiogic responses of 15 which may mfluence the system) The system output is preterm infants (rangmg from 26-30 weeks gestationai age conceptualized by Roy as either adaphve (promoting the at buth) to tactile and auditory stunulahon, and found that mtegnty of the system), or maiadaphve (faiimg to jwomote T J ' O j leveis remamed the same or lnaeased dunng audisystem growth) The goai of nursmg is to enhance shmub tory stunulahoa but tended to decrease dunng touching or tiiat iead to adaphve responses and modify stimub tiiat iead simuitaneous toudung/taikmg Oehier stressed the need to maiadaptive responses This study exammed the effects for further research to determine whether 'ways of providof a specific focai stimuius (parentai touch) on the unmedi- mg tachie stimuiahon other tiian stroiang may prove to ije ate physioiogicai adaptahon of preterm infants enndung for the mfants and not cause avoidance behaviors This research was part of a iarger project tiiat was aiso or hypoxia' Poweil (1974) noted that many of the smaUest babies m designed to descnije the physicai ciiaractenshcs of touch used by parents in toudung their preterm mfants, and to her study 'reacted to (the) stroiang as if it were quite determme wiiether infant's physioiogicai responses to noxious' This comment is parhculaHy significant m the bght parent touch were affected by certam contextuai stimub of lecmlt studies wiuch iiave demonstrated tiiat excessive (such as gestationai age or morbidity status). Other re»iits itandbng associated with medicai/nursmg procedures 878
Early parent touch
resuits m hypoxarania m very smail preterm infants (Long et al 1980, Noms et al 1982, Speidei 1978) Hypoxia and biood pressure eievahons winch may resuit from excessive handbng may iead to mtraventncuiar iiaemorriiage m preterm infants, particuiariy m those who are iess than 32 weeks gestahonal age (Tardy & Volpe 1982) In order to minimize the nsk of hypoxia and mtraventncuiar haemorrhage, a number of researchers and cbruaans have advocated iimihng the iiandimg of very smaii preterm mfants (Long et al 1980, Lucey 1981, Speidei 1978 (personai commurucation from W H TooieytoL Hamson, 19June 1984) Luddmgton (1983), m proposmg guideimes for stunuiation of high-nsk infants, suggested that prematures less than 32 weeks gestation shouid receive no addihonal tactile or vestibuiar shmuiation dunng the first 10 days of iife Gorski et al (1983) stressed the need for research based on direct observation of preterm mfants' responses to shmuli provided m tiie neonatal mtensive care unit (NICU) No studies were found that descnijed, speafically, how parents touch their hospitalized preterm infants or evaluated mfants' physiologic responses to parent touch Similarly, no research was identified that compared the types of touch provided for preterm uifants by parents with that provided by non-parent caregivers Observation of preterm mfants' responses to parental contact are parhculariy important in view of the widespread concem aijout promohng early par«it-mfant contact m order to eniiance mfant developmoit and parent-infant attadiment, whiie at the same hme preventmg compiicahons (such as hypoxia) which couid iead to adverse neuroiogic sequeiae m the infants
Study questions Two queshons guided this study 1 2
What are tiie effects of parental touch on the heart rates of preterm infants? Wiiat are the rfFects of parentai touch on the artenai oxygen saturahon ieveis of preterm infants?
METHODS Subjeds and srttii^; Tiie subjects fcff tius study were 36 preterm infants wiio were between 25 «id 33 weeks gestahonai age at buth, and tlieir paroits H K ahscAs were pahents m an NICU m tiie southem Urated ShAes tiiat serves as a regionai referrai centre Tiw U ^ B ^ itad no amgenitai an(»nahes and iiad not tmckrgotw sa^ay Parents were toid titat the purpose ctf tite ^:tidy was to team about pret«nn infiants' responses
to stimuiahon provided dunng parent visits, mdudmg tactiie stimuiahon, and those who agreed to parhapate signed mformed consent forms A totai of 17 parents deduied to partiapate m the study Of tiie 36 infants m the sample, 14 were male and 22 were female Tweive infants were White and 24 were Biack The mean gestationai age of the infants at birth was 29 6 weeks (SD 2 4), and tiie mean buthweight was 1337 grams (SD 403, range 688-2080) Instruments and measurements The infants' heart rates were measured by contmuous recordings from Corametnc cardiac monitors The infants' artenal oxygen (O^) saturation levels were measured by contmuous recordmgs from a Neilcor pulse oximeter The pulse oximeter consists of a smali proije containmg two iight-emittmg diodes and a photosemiconducter wiuch was attached to the infant's forefoot Deckardt & Steward (1984) reported tiiat O^ saturahon levels were correlated with transcutaneous oxygen (T^PO^) leveis over a wide range of O^ saturahons In addition, puise oximeter readmgs were doseiy correiated with m vivo artenai oxygen saturahon readmgs These authors suggested tiiat the oxygenation status of hypoxaemic infants may ije more sensihveiy measured by puise oximeters than by T ^ O ^ monitors In addihon, puise oximeters do not pose the nsk of skm bums to the uifants wiuch accompanies the use of T^PO^ monitors (Deckardt & Steward 1984) The pnmary source of measurement error with puise oximetry is mohon artifact m extremely achve infants (New 1985) Heat lamps, radiant warmers and phototherapy bghts might also affect puise oximetry readmgs However, this probiem can usuaiiy he avoided by shielcbng the sensor (Jenrus & Peabody 1987) The reliability of the oxuneter readmgs was assessed by companng the hecirt rate readings on the pulse oximeter with those on the Corametnc cardiac monitor m order to ensure an adequate pulsahie biood flow as suggested by Deddiardt & Steward (1984) Aii sensors were covered with probe covers suppbed by the Neiicor Corporation When the O ^ saturation ieveis were distorted ijecause of mohon arhfact, those readmgs were not mduded m the anaiysis For a more compiete discussion of the procedures used to reduce the nsk of measurement error m this study, see Hamson (1989b) The mfant's^estohonoiage was assessed by the neonatoiogists m the study NICU, usmg the system descnijed by (1979) Procedures A descnphve exploratory d e s ^ was used to answer t i ^ study queshons Because no previous studies vtae found 879
LL Htmson et al
that descnijed the specific [^ysicai diaractenshcs of touch used by parents of preterm uifants, tiie researdiers deaded not to impose controis on ttie types of touch to be provided Once data are avaiiabie descnbmg the physicai charactenstics of eariy parent touch, more controiied studies can ije unpiemented to evaiuate the physioiogic effects of the types of parent touch that are most often provided to preterm infants Attempts were made to videotape each study infant dunng three parent visits to the NICU when the mfants were ijetween 5-14 days of age For some infants, the data coiiechon times iiad to ije aitered ijecause parents were unable to visit the NICU dunng the specified data collechon tunes, or the infants' medical condihons were unstable and the physiaans requested that the parents should not touch the infants Twenty-seven infants were videotaped durmg tiiree parent visits, six were taped dunng two visits, and tiiree were videotaped dunng oniy one visit The mean ages of tiie infants durmg the tiiree visits were 5 8, 8 4 and 11 3 days, respechveiy A Compaq portabie computer was mterfaced with the uifants' Corametnc cardiac monitor and Neiicor puise oximeter with an anaiog-to-digital converter (ADC) A computer program was developed usmg the Asyst software package to program the mterface between the computer and tiie ADC Data on the infant's heart rate and artenai oxygen saturation levels were recorded every 6 seconds by the computer, and stored on a hard disic The researdier chedced the readmgs on the monitors and the computer screen penodicaily tiiroughout the data coiiection penods, to oisure that they were consistent The videocamera was mterfaced with the computer usmg a videocombmer, so tiiat data on the tune, observahon nunJjer and the physioiogic parameters were recorded on tiie videotape Physioic^c parameters were recorded for a 5-mmute baseiine pCTiod ijefore the parents approadied the infants' ijedsides Once the parents approadied the ijedside, tiie researdier adjusted the focus of the videocamera, and then ieft the ijedside to decrease tiie possibibty tiiat parents might become anxious as a resuit ctf an observer's presence Parents wo-e encouraged to mteract with theu- uifants as they usuaiiy wouid, aiwl at tiie end of tiie visits were given a copy of tiie videotape to keep At the end of the parent visit, post-visit data were coiiected for 10 mmutes The NICU staff were aware of the study puiposes and geieraiiy tned not to mterrupt the parents dunng tiie visit If, however, the uifants required care dunng tiie data coiiecti 2 O I
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