Touch has been identified as crucial for the development of parent-infant attachment and for the general well-being of the infant. Because of concerns about preterm infants' inabilities to cope with excessive stimulation, many neonatal intensive care units (NICU's) have instituted minimal handling policies, limiting the amount of handling provided to physiologically fragile preterm infants by both parents and NICU staff members. Previous studies have demonstrated that small preterm infants often become hypoxic following tactile stimulation associated with medical or nursing procedures, parent visits to the NICU, or tactile stimulation that involves stroking. There has been little research, however, to determine whether various forms of touch (other than stroking) provided during the first few weeks of life (when many preterm infants remain physiologically fragile) might actually be soothing and ameliorate the stresses frequently encountered in the NICU. The project's long term objective is to identify a type of soothing touch that parent and nurses might provide to physiologically fragile preterm infants during the early weeks of hospitalization in an NICU. The purpose of the study is to: a) describe the immediate physiological and behavioral responses of preterm infants (27-32 weeks gestation) to gentle human touch and b) evaluate the long-term effects of gentle human touch on morbidity status, motor activity levels, levels of behavioral distress, and developmental outcomes. The sample will include 80 preterm infants between 27-32 weeks gestational age at birth. Infants will be randomly assigned to either a control group or a gentle human touch (GHT) group. Infants in the GHT group will receive three 10-minute periods of gentle human touch daily from 7-16 days post-birth. The touch will consist of the investigator placing one hand on the infant's head and the other across the infant's right arm for 10 minutes, or until the infant exhibits signs of physiologic stress (abnormal rate or oxygen (O2) saturation levels.) Continuous computerized recordings will be made of infant heart rate, O2 saturation, and oxygen concentration levels beginning 10 minutes before and ending 10 minutes after each touch episode. Infant motor activity and behavioral state will be scored from videotape recordings made during these same time periods. Infants in the GHT and control groups will be compared on a number of outcome measures such as length of hospital stay, average daily weight gain, and morbidity status. Time Series, Repeated Measures, Multivariate Analysis of Variance (MANOVA), and Friedman's Analysis procedures will be used to assess infants' immediate behavioral and physiologic responses to gentle human touch, and to compare infants in the GHT and control groups. Multiple regression procedures will be used to assess effects of specific contextual stimuli (eg. morbidity status, gestational age, and birth weight) on the infants' responses to touch.
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