Abstract :
Keywords Clustered care; Bundled care; Stressor; Diaper change; Skin health; NICU Highlights * Significant increases in heart rate occurred over 74% of the time during bundled care with a diaper change. * Less frequent diaper changes do not affect buttock transepidermal water loss or skin pH in stable premature infants. * Significant changes in heart rate are less likely to occur if an infant is awake at the beginning of bundled caregiving. Abstract Background Bundling nurse caregiving interventions are promoted to minimize infant stress. Purpose To evaluate impact of bundled nursing care and diaper change frequency on vital sign stability and skin health of preterm infants born [less than or equal to]32 weeks gestation. Method Stable preterm infants on a 3-hour feeding schedule were randomly assigned to 3- vs. 6-hour diaper changes. Diapers were changed prior to 6 h if stool was present. Direct observation of bundled care events (BCE) identify caregiving activities during each BCE. Skin pH, transepidermal water loss (TEWL), and neonatal skin condition scores (NSCS) were obtained. Vital sign data (HR, RR, O.sub.2 saturation) was downloaded from bedside monitors. Results Forty-six infants contributed to 605 BCEs. BCEs lasted on average 28 min and included nine different activities (e.g., vital signs, feeding). Significant increases in heart rate during BCEs occurred in approximately half of the observations. Among observations with a diaper change increases in heart rate during diapering occurred in over 74% of observations Infants who were awake at the beginning of BCEs had 48% lower odds of having a change in heart rate than infants who were sleeping (p = .02). There were no group differences (3- vs. 6-hour diaper change) in skin health outcomes (TEWL, pH, NSCS). Conclusion Reducing diaper change frequency without stool present should be considered to minimize caregiving stress in preterm infants. Additional research should evaluate the intrusiveness and clusters of activities that significantly impact physiologic stability to better individualize the timing of routine yet intrusive activities. Clinicaltrials.gov registry # NCT03370757 Author Affiliation: (a) Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America (b) Duke University School of Medicine, Department of Pediatrics, Duke University Hospital, DUMC 2739, Durham, NC 27710, United States of America (c) Kimberly Clark Corporation South Office, 2001 Marathon Avenue, Neenah, WI 54956, United States of America * Corresponding author at: Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America. Article History: Received 17 June 2021; Revised 5 November 2021; Accepted 17 November 2021 (footnote)[white star] Neonatal Intensive Care Unit (NICU), bundled care event (BCE), transepidermal water loss (TEWL), neonatal skin condition score (NSCS), electronic health record (EHR), oxygen saturation (O.sub.2 sats), postmenstrual age (PMA), generalized estimating equations (GEE), linear mixed models (LMM). (footnote)1 University of Michigan, 400 N. Ingalls, Ann Arbor, Michigan 48109 (footnote)2 UW-Madison School of Nursing, 701 Highland Ave, Madison, WI 53705 Byline: Debra H. Brandon [debra.brandon@duke.edu] (a,b,*), Daniel Hatch [daniel.hatch@duke.edu] (a), Angel Barnes [angel.barnes@duke.edu] (a), Ashlee J. Vance [ashleev@med.umich.edu] (a,1), Jane Harney [jane.harney@wisc.edu] (a,2), Barbara Voigtman [Barbara.Voigtman@kcc.com] (c), Noelle Younge [noelle.younge@duke.edu] (b)