title: Kangaroo care: cardio-respiratory relationships between the infant and caregiver.
abstract: BACKGROUND
  Kangaroo care, i.e., skin-to-skin cohabitation (SSC) between an infant and caregiver, is often used in neonatal intensive care units to promote bonding, breastfeeding and infant growth. The direct salutary effects of SSC on cardio-respiratory control in preterm infants remain equivocal; some reports suggest improved breathing stability, others indicate worsening of apnea, bradycardia and hypoxemia.
  
  
  OBJECTIVE
  The purpose of this study was to investigate physiological relationships between the infant and caregiver during SSC. We hypothesized that respiratory stability of the premature infant is influenced by the caregiver's heartbeat.
  
  
  METHODS
  A prospective study was performed in eleven preterm infants (6 female; mean PCA 32 wks). SSC was compared to a preceding incubator-control period (CTL) matched for time from feed and condition duration. Abdominal respiratory movement, electrocardiogram, skin temperature and blood-oxygen levels were recorded from the infant and the caregiver.
  
  
  RESULTS
  During CTL, infant interbreath interval variance (IBIv; respiratory instability) was directly related to its own heart rate variance (HRv; rho=0.770, p=0.009). During SSC, infant IBIv and apnea incidence were each related to caregiver HRv (rho 0.764, p=0.006; rho 0.677, p=0.022, respectively). Infant cardio-respiratory coupling was also enhanced during SSC compared to CTL in the eupneic frequency range (0.7-1.5 Hz, p=0.018) and reduced for slower frequencies (0.15-0.45 Hz; p=0.036).
  
  
  CONCLUSIONS
  These findings suggest that during SSC, respiratory control of the premature infant is influenced by the caregiver's cardiac rhythm. We propose that the caregiver's heartbeat causes sensory perturbations of the infant via somatic or other afferents, revealing a novel cohabitation-induced feed-back mechanism of respiratory control in the neonate.
authors.affiliation: Department of Neurology University of Massachusetts Medical School, Worcester, MA 01655, USA; Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA 01655, USA. Electronic address: Elisabeth.Salisbury@umassmed.edu.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bloch-Salisbury
authors.affiliation: Department of Neurology University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Zuzarte
authors.affiliation: Department of Neurology University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: Premananda
authors.initials: P
authors.lastname: Indic
authors.affiliation: Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: Francis
authors.initials: F
authors.lastname: Bednarek
authors.affiliation: Department of Neurology University of Massachusetts Medical School, Worcester, MA 01655, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Paydarfar
mesh_terms: D001049:Apnea / Q000453:epidemiology; D001919:Bradycardia / Q000453:epidemiology; D002320:Cardiovascular Physiological Phenomena; D017028:Caregivers; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D060127:Kangaroo-Mother Care Method; D008297:Male; D009034:Mother-Child Relations; D011446:Prospective Studies; D012119:Respiration; D056152:Respiratory Rate; D012881:Skin Temperature
keywords: Apnea; Cardiorespiratory coupling; Preterm infants; Respiratory stability; Skin-to-skin cohabitation