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Parent Engagement Correlates With Parent and Preterm Infant Oxytocin Release During Skin-to-Skin Contact

Vittner, Dorothy, PhD, RN, CHPE; Butler, Samantha, PhD; Smith, Kelsey, MA; Makris, Nefeli, BS, RN; Brownell, Elizabeth, PhD; Samra, Haifa, PhD, RN-NIC, FAAN; McGrath, Jacqueline, PhD, RN, FNAP, FAAN

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000558
Original Research

Background: Preterm infants remain increasingly neurodevelopmentally disadvantaged. Parental touch, especially during skin-to-skin contact (SSC), has potential to reduce adverse consequences.

Purpose: To examine relationships between parental engagement and salivary oxytocin and cortisol levels for parents participating in SSC intervention.

Methods: A randomized crossover design study was conducted in a neonatal intensive care unit; 28 stable preterm infants, mothers, and fathers participated. Parental engagement was measured using the Parental Risk Evaluation Engagement Model Instrument (PREEMI) prior to hospital discharge. Saliva samples for oxytocin and cortisol levels were collected 15-minute pre-SSC, 60-minute during-SSC, and 45-minute post-SSC.

Results: Data were analyzed using Pearson's correlation to measure relationships between parental engagement composite scores and salivary oxytocin and cortisol levels. A significant negative correlation between paternal engagement and paternal oxytocin levels (r = −0.43; P = .03) and a significant negative correlation between infant oxytocin levels and maternal engagement (r = −0.54; P = .004) were present. Adjusted linear regression models demonstrated that as infant oxytocin levels increased during SSC, maternal engagement scores significantly decreased at discharge (β = −.04; P = .01). Linear regression, adjusting for infant oxytocin and cortisol levels, showed that as paternal oxytocin levels increased, there was a significant decrease in paternal engagement (β = −.16; P = .03) and as paternal cortisol levels increased, there was a significant decrease in paternal engagement (β = −68.97; P =.05).

Implications for Practice: Significant relationships exist between parental engagement and salivary oxytocin and cortisol levels. Defining parent engagement facilitates identification of parent risks and needs for intervention to optimize preterm outcomes.

Implications for Research: The PREEMI can serve as a standardized instrument to examine parent engagement.

School of Nursing, University of Connecticut, Storrs (Drs Vittner and Ms Makris); School of Nursing, University of Texas Health Science Center San Antonio, San Antonio, Texas (Dr. McGrath) Connecticut Children's Medical Center, Hartford (Drs Vittner and Brownell and Ms Smith); Boston Children's Hospital, Boston, Massachusetts (Dr Butler); Harvard Medical School, Harvard University, Boston, Massachusetts (Dr Butler); and School of Nursing, South Dakota State University, Brookings (Dr Samra).

Correspondence: Dorothy Vittner, PhD, RN, CHPE, 71 Coleman Rd, Wethersfield, CT 06109 (

This study was supported with funding from the American Nurses Foundation (Eastern Nursing Research Society), National Association of Neonatal Nurses, Sigma Theta Tau International (Mu Chapter), and the University of Connecticut, School of Nursing (Toner funds).

There are no financial relationships with commercial entities or conflicts of interest to disclose.

© 2019 by The National Association of Neonatal Nurses