Origins of tactile vulnerability in high-risk infants.
OBJECTIVE
This study examined the degree to which birthweight, gestational age, fetal drug exposure, hazardous postnatal medical events, and a mother's predisposition toward touch predicted the likelihood of an infant's tactile vulnerability during nursing care.


METHODS
The convenience sample included 99 hospitalized infants in their second week of life and their mothers.


METHODS
The design was correlational.


METHODS
A standardized observational assessment was used to code the infant's physiological and behavioral responses to touch during 4 different episodes of nursing care. Chart review was performed to collect information regarding fetal drug exposure, birthweight, gestational age, and postnatal medical events. Mothers completed a questionnaire regarding their own comfort with using touch and being touched.


METHODS
The Tactile Vulnerability Assessment measured infant reactivity to and tolerance for touch during nursing care. The Postnatal Complications Scale identified hazardous medical conditions and treatments experienced by the infant during the first 2 weeks of life, and the Physical Contact Assessment evaluated a mother's predisposition toward touch.


RESULTS
The number of hazardous postnatal medical events experienced by an infant was the primary predictor of tactile vulnerability, accounting for 28% of the variance in the infant's likelihood of developing hyperarousal and distress from touch during care. Illicit fetal drug exposure and maternal predisposition toward touch were also significant predictors.


CONCLUSIONS
The significant relationship of postnatal medical events to tactile vulnerability suggests that it may be associated with the presence of infant pain or injury to the infant's central nervous system. Symptoms of drug withdrawal and the impact of teratogens on arousal regulation may also be implicated in greater distress from touch by infants. In addition, findings suggest the potential for inherited transmission of a vulnerability to touch. Assessment of infant vulnerability, including discussion with parents about their views of the infant's needs regarding touch, may enhance problem identification and early intervention to reduce infant distress and further medical problems.
Weiss
Sandra J
SJ
Department of Community Health Systems, School of Nursing, University of California-San Francisco, San Francisco, CA 94143-0608, USA. sandra.weiss@nursing.ucsf.edu
Wilson
Peggy
P
D000328:Adult; D001143:Arousal / Q000502:physiology; D005260:Female; D006801:Humans; D006941:Hyperesthesia / Q000209:etiology* / Q000451:nursing*; D013287:Illicit Drugs / Q000009:adverse effects; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009035:Mothers / Q000523:psychology*; D017283:Neonatal Nursing; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012189:Retrospective Studies; D012684:Sensory Thresholds / Q000502:physiology; D011795:Surveys and Questionnaires; D014110:Touch
D013287:Illicit Drugs