Repetitive versus standard tactile stimulation of preterm infants at birth – A randomized controlled trial

Abstract

Aim: To evaluate the direct effect of repetitive tactile stimulation on breathing effort of preterm infants at birth. Methods: This randomized controlled trial compared the effect of repetitive stimulation on respiratory effort during the first 4 min after birth with standard stimulation based on clinical indication in preterm infants with a gestational age of 27–32 weeks. All details of the stimulation performed were noted. The main study parameter measured was respiratory minute volume, other study parameters assessed measures of respiratory effort; tidal volumes, rate of rise to maximum tidal volumes, percentage of recruitment breaths, and oxygenation of the infant. Results: There was no significant difference in respiratory minute volume in the repetitive stimulation group when compared to the standard group. Oxygen saturation was significantly higher (87.6 ± 3.3% vs 81.7 ± 8.7%, p =.01) while the amount of FiO2 given during transport to the NICU was lower (28.2 (22.8–35.0)% vs 33.6 (29.4–44.1)%, p =.04). There was no significant difference in administration of positive pressure ventilation (52% vs 78%, p =.13), or the duration of ventilation (median (IQR) time 8 (0–118)s vs 35 (13–131)s, p =.23). Caregivers decided less often to administer caffeine in the delivery room to stimulate breathing in the repetitive stimulation group (10% vs 39%, p =.036). Conclusion: Although the increase in respiratory effort during repetitive stimulation did not reach significance, oxygenation significantly improved with a lower level of FiO2 at transport to the NICU. Repetitive tactile stimulation could be of added value to improve breathing effort at birth.