Effect of Maternal Odor and Kangaroo Care on Serum Cortisol and Comfort Levels in Preterm Infants: a Randomised Trial
Condition: Preterm Birth Complication; Stress Related Disorder; Cortisol Overproduction
MeSH terms: Premature Birth; Adrenocortical Hyperfunction
Study type: Interventional

Summary: 
      Aims and objectives: Studies on stress are generally aimed at young children and infants.
      However, in the neonatal period, "especially in preterm babies", this issue was not given
      enough attention and was almost completely ignored.

      Background: They are exposed to different stressors. Too much stress will increase their
      problems in their future lives.

      Design: This study was planned as a randomized study to determine the effects of Kangaroo
      Care and mother scent application on toxic stress in preterm infants in the Neonatal
      Intensive Care Unit environment and to create evidence-based recommendations regarding these
      applications.

      Methods: Research data were collected from a total of 92 preterm babies born. Babies were
      divided into 3 groups, those who never met their mothers, only mother scent group and KC
      group. The mother's undershirt was used as the maternal odor. Vital signs, blood cortisol
      levels and Preterm Infant Comfort Scale scores were determined and recorded each group.The
      data were evaluated by statistical analysis. The CONSORT checklist for reporting qualitative
      research was used.

      Results: In the group that never encountered mother and mother odor, Preterm Infant Comfort
      Scale, blood cortisol level and vital signs showed severe stress. It was found that maternal
      odor is effective in reducing this stress, but kangaroo care is much more effective in
      preventing stress.

      Conclusion: if premature babies are deprived of their mother, the stress may be exposed to
      reaches toxic levels. It was determined that kangaroo care application during the treatment
      of these babies is a more effective method in reducing stress than the maternal odor
      application method.

      Relevance to clinical practice: The results of this study will contribute to nurses' use of
      kangaroo care and maternal odor in the care of preterm babies to prevent stress and related
      complications.Therefore, it will improve the quality of care of preterm babies in the NICU.
    

Detailed description: 
      About 15 million babies are born preterm every year around the world(Blencowe et al., 2013).
      This corresponds to more than one in every 10 babies born alive(Lincetto & Banerjee, 2020).
      This situation, which is a serious problem all over the world, causes approximately 1 million
      children to die from complications related to preterm birth before the age of 5 years(Walani,
      2020). Many of the living preterm babies also develop psychological and physical problems
      that require follow-up in adolescence, adulthood or lifelong (Kajantie et al., 2021; Manninen
      et al., 2022). Compared to term babies, preterm babies continue their lives with lower motor
      and neurological abilities in the later periods of their lives(Wolke et al., 2019). In
      addition, unlike full-term babies, hospitalization in the neonatal intensive care unit (NICU)
      after birth causes them to be exposed to many stress-inducing factors such as noise, nursing
      intervention and light (Larkin et al., 2019).

      Stress is a term used to describe th eresponse of a person to both positive and negative
      events that he encounters daily throughout his life. Stressors can be physical, emotional,
      environmental or theoretical. Stressors can all affect the body's stress response equally.
      Stress response, also known as "fight or flight" response or general adaptation syndrome,
      includes physiological changes that ocur with an individual's encounter with or perceived
      stress. This stres response is a result of stimulation of the sympathetic nervous system
      resulting in a cascade of neuro-endocrine-immune responses, with reproducible physiologic
      effects that include an increase in respirations, heart rate, blood pressure, and overall
      oxygen consumption (Franke, 2014). Physiological consequences of stress,
      hypothalamus-pituitary-adrenal cortisol are regulated. In response to a stressor, there is an
      increase in the secretion of glucocorticoids, especially cortisol(Gunnar et al., 1991).There
      are three different types of stress. Positive stress; this type of stress is a normal part of
      life, a positive and normal stress response, and is essential for a child's growth and
      development. Positive stress responses are infrequent, short-lived, and mild. Tolerable
      stress; the stress that can be tolerated is more severe, frequent, or persistent. The body
      responds to a greater degree, and these biochemical responses have the potential to
      negatively affect brain architecture. Toxic stress; toxic stress leads to prolonged
      stimulation of the stress response with the body's inability to fully recover(Bergman, 2019a;
      Weber & Harrison, 2019). It differs from a normal stress response because there is a lack of
      caregiver support, reassurance, or emotional attachment. Inadequate caregiver support
      prevents the stress response from being supported or the body returning to its initial
      functions.This stress causes the development of many other problems in addition to the
      increase in the problems that will develop due to preterm birth in their future lives.
      Therefore, minimizing this stress is of vital importance for preterm infants and their
      families (WHO, 2017; Ylijoki et al., 2020).

      Studies on stress are generally aimed at young children and infants. However, in the neonatal
      period, "especially in preterm babies", this issue was not given enough attention and was
      almost completely ignored. Researching this issue will help to make serious changes and
      corrections in the working principles of the neonatal intensive care unit. For this reason,
      this study was planned to determine the effects of Kangaroo Care (KC) and Maternal Odor on
      preterm infants on Toxic Stress and to create evidence-based recommendations about these
      practices in the NICU setting.
    

Intervention name(s): Exposure to maternal odor
Intervention type(s): Behavioral
Intervention description(s): Exposure to maternal odor; the shirt worn by the mother is put in the baby's incubator, kangaroo care; mother lays her baby naked between her breasts
Other intervention name(s): Kangaroo care
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: This research; It was planned as a Randomized Controlled Experimental Study. In the study, the effect of kangaroo care and maternal odor, which are independent variables, on the toxic stress level of preterms, which is the dependent variable, was tried to be determined. The study was carried out NICU at Anka Hospital, in Gaziantep, Turkey. The sample calculation of the research was made using the "Jamovi 1.8" program. The significance level was taken as 0.05 according to the power analysis performed to determine the sufficient sample size, and it was calculated that at least 30 patients should be included in each patient group in order to have a minimum theoretical power of 0.7. The study was planned to be conducted with a total of 135 patients, with 45 patients in each group.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: preterm infant; maternal odor; kangaroo care; cortisol