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Physiological stress responses in infants at 29–32 weeks’ postmenstrual age during clustered nursing cares and standardised neurobehavioural assessments
  1. Leesa G Allinson1,2,
  2. Linda Denehy2,
  3. Lex W Doyle1,3,4,5,
  4. Abbey L Eeles1,
  5. Jennifer A Dawson3,5,
  6. Katherine J Lee4,6,
  7. Alicia J Spittle1,2,3
  1. 1 Victorian Infant Brain Studies, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  2. 2 Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
  3. 3 Neonatal Services, The Royal Women’s Hospital, Melbourne, Victoria, Australia
  4. 4 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  5. 5 Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Melbourne, Victoria, Australia
  6. 6 Clinical Epidemiology and Biostatistics, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Dr Leesa G Allinson; leesa.allinson{at}


Objective To compare the physiological stress responses of infants born <30 weeks’ gestational age when undergoing clustered nursing cares with standardised neurobehavioural assessments in neonatal nurseries.

Design/methods Thirty-four infants born <30 weeks’ gestation were recruited from a tertiary neonatal intensive care unit. Heart rate (HR) and oxygen saturation were recorded during clustered nursing cares and during standardised neurobehavioural assessments (including the General Movements Assessment, Hammersmith Neonatal Neurological Examination and Premie-Neuro Assessment). Two assessors extracted HR and oxygen saturations at 5 s intervals, with HR instability defined either as tachycardia (HR >180 beats per minute (bpm)) or bradycardia (HR <100 bpm). Oxygen desaturations were defined as SpO2<90%. Physiological stability was compared between nursing cares and neurobehavioural assessments using linear (for continuous outcomes) and logistic (HR instability and oxygen desaturation) regression.

Results Compared with clustered nursing cares HR was lower (mean difference −5.9 bpm; 95% CI −6.5 to 5.3; P<0.001) and oxygen saturation higher (mean difference 2.4%; 95% CI 2.1% to 2.6%; P<0.001) during standardised neurobehavioural assessments. Compared with clustered nursing cares neurobehavioural assessments were also associated with reduced odds of tachycardia (OR 0.44, 95% CI 0.22 to 0.86), HR instability (OR 0.43, 95% CI 0.22 to 0.85) and oxygen desaturation (OR 0.43, 95% CI 0.26 to 0.70).

Conclusions Standardised neurobehavioural assessments are associated with less physiological stress than clustered nursing cares in infants aged 29–32 weeks’ postmenstrual age, and are therefore possible without causing undue physiological disturbance in medically stable infants.

  • neonatology
  • nursing care
  • occupational therapy
  • physical therapy
  • neuro development

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  • An abridged version of this paper was presented as a poster at the Perinatal Society of Australia and New Zealand 19th Annual Conference (PSANZ) 2015 and cited as follows: Allinson LG, Denehy L, Doyle LW, Dawson JA, Spittle AJ. Physiological responses in infants at 29–32 weeks' gestational age during clustered nursing cares and standardised neurobehavioural assessments: A401. Journal of Paediatrics & Child Health, 51 Supplement 1:128, April 2015.

  • Contributors LWD and AJS conceptualised and designed the study with study design assistance from LD and JAD. LGA and ALE were responsible for acquisition of data. LGA carried out data analyses with the assistance of KJL, LWD and AJS who provided interpretation of analysed data. LGA drafted the initial manuscript. LGA, LWD, AJS, LD, JAD, ALE and KJL reviewed, revised and approved the final manuscript.

  • Funding This work was supported in part by the Australian National Health and Medical Research Council (Project Grant ID 1024516); Centre of Clinical Research Excellence (Grant ID 546519); Centre of Research Excellence Grant (ID 1060733); Early Career Fellowship (ID 1053767) to AJS; Career Development Fellowships to AJS (ID 1108714) and KJL (ID1053609); Australian Postgraduate Scholarship to LGA; the Victorian Government Operational Infrastructure Support Program; and The Royal Children’s Hospital Foundation.

  • Competing interests AJS is a member of the General Movements Trust, a not-for-profit organisation, involved in training the General Movements Assessment. The other authors have no potential conflicts of interest relevant to this article to disclose.

  • Ethics approval Human Research Ethics Committees at the Royal Women’s Hospital, Melbourne.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data from the study to share.

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