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Preterm Infants' Sympathetic Arousal and Associated Behavioral Responses to Sound Stimuli in the Neonatal Intensive Care Unit

Salavitabar, Arash BS; Haidet, Kim Kopenhaver PhD, NNP-BC; Adkins, Cherie S. PhD, RN; Susman, Elizabeth J. PhD; Palmer, Charles MB, ChB; Storm, Hanne MD, PhD

Section Editor(s): DOWLING, DONNA PHD, RN

doi: 10.1097/ANC.0b013e3181dd6dea
Original Research

PURPOSE To evaluate the utility of skin conductance (SC) as a measure of autonomic arousal to sound stimuli in preterm infants.

DESIGN A pilot cross-sectional, correlations study.

SUBJECTS Eleven preterm infants with a mean gestational age of 31.6 weeks without anomalies or conditions associated with neurodevelopmental delay composed the sample.

METHODS On days 5–7 of life, the following infant responses were simultaneously recorded in response to naturally occurring sound stimuli in the NICU: real-time measurements of heart rate, respiratory rate, and oxygen saturations; sympathetic-mediated sweating via SC; and behavioral responses using the Newborn Individualized Developmental Care and Assessment Program naturalistic observation. Baseline sound levels (BSL, <55 dBA) and high sound levels (HSL, >65 dBA) were measured to index patterns of response during a nonhandling period preceding care.

RESULTS Mean heart rate during precare was directly associated with higher SC increases to sound stimuli (r[10] = 0.697, P = .017). The SC during HSL was significantly higher than that during BSL (P < .0001). Males demonstrated higher SC increases to sound stimuli than females (P = .030). Changes in SC induced by increases in sound intensity were associated with lower attention responses (r[10] = −0.92, P < .0001) and lower summated behavioral responses (r[10] = −0.59, P = .054).

CONCLUSION SC provides a noninvasive, sensitive measure of sympathetic arousal that may not be apparent in behavioral cues or states, or determined by standard physiological responses alone.

College of Medicine (Mr Salavitabar Dr Haidet and Palmer), School of Nursing (Drs Haidet and Adkins), Departments of Pediatrics (Drs Haidet and Palmer) College of Health and Human Development (Dr Susman), The Pennsylvania State University, Hershey; and University of Oslo, Oslo, Norway (Dr Storm).

Address correspondence to Kim Kopenhaver Haidet, PhD, NNP-BC, The Pennsylvania State University, 1300 Academic Support Bldg, Hershey, PA 17033;

© 2010 National Association of Neonatal Nurses