460 - Maternal Bonding Scores Correlate with Reduction in Markers of Physiologic Stress as Measured by Heart Rate Variability in Infants with Congenital Heart Disease During Skin-to-Skin Contact

Publication Number: 460.5834

Alexa Asch, Children's National Health System, Washington, DC, United States; Rathinaswamy Govindan, Children's National Hospital, Washington, DC, United States; Ellen Bartolini, Children's National Health System, Washington, DC, United States; Venkata Chaitanya Chirumamilla, Children's National Hospital, College Park, MD, United States; Cara Pleau, Children's National Health System, Washington, DC, United States; Sarah D. Schlatterer, Children's National Health System, Washington, DC, United States

Background: Skin-to-skin contact (SSC) has been shown to be beneficial to both mothers and babies, but it has been understudied in the congenital heart disease (CHD) population and may not be routinely practiced in cardiac intensive care units (CICU). Neonates with CHD have been shown to experience dysregulation of autonomic function, as measured by heart rate variability (HRV), especially after cardiac surgery.

Objective: To evaluate the relationship between maternal stress, anxiety, and feelings of bonding with HRV, a physiologic marker of stress, in both mothers and infants with CHD during a trial of low-dose, post-operative SSC in the Children’s National CICU and cardiac step-down unit.

Design/Methods: In this single-center, prospective pilot study, 21 mother-infant dyads participated in up to three sessions of SSC within a 10-day postoperative period. Mother and infant electrocardiograms (EKG) were simultaneously recorded with the Biopac MP-160® device during a baseline period for 15-minutes and during SSC for an hour minimum. HRV metrics were calculated using 5-minute epochs of data for each mother and infant, including high frequency (HF), low frequency (LF), standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), and the ratio SDNN to RMSSD. The mothers completed the State Trait Anxiety Inventory-6 (STAI-6) and a short form of the Postpartum Bonding Questionnaire (PBQ) at the beginning of the study period and after each day of SSC. The relationship between the maternal responses and HRV metrics was studied using a linear mixed-effects model clustering by subjects with random intercepts.

Results: Infant LF (p=0.049), HF (p < 0.001), and RMSSD (p=0.024) significantly decreased and infant SDNN/RMSSD (p=0.018) significantly increased during SSC as maternal PBQ scores improved. There was no significant relationship between the PBQ scores and HRV metrics of the mothers or between the STAI-6 scores and any of the HRV metrics. Infant and mother HRV metrics decreased from baseline during SSC. Maternal STAI-6 scores and PBQ scores improved significantly after SSC, indicating a reduction in maternal anxiety and increased feelings of bonding in the mothers.

Conclusion(s): Decreased HRV metrics may reflect reduced stress in the infants, which corresponded to improved PBQ scores in the mothers. Our data indicate that even low-dose SSC may improve feelings of maternal bonding and positively impact the physiology of postoperative neonates with CHD. Implementation of SSC should be considered postoperatively in this population.