Prospective observational study of infants’ physiological and behavioral responses to nurse-delivered care after surgery

Objective: To investigate infants’ physiological and behavioral responses during routine nurse-delivered care following surgery. Design: Cross-sectional observational study. Setting: Surgical NICU. Participants: Infants (N = 45) who underwent major neonatal surgery after 34 weeks gestation for congenital anomalies. Methods: We used bedside monitoring sources to capture continuous heart rate (HR) data and video-recorded nurse-delivered care episodes. We defined physiological stress as a change in mean HR of 10 bpm or more across pre-, during, and post-nurse-delivered care. Two independent reviewers evaluated infant state, stress, and self-regulation behaviors. We analyzed 99,840 HR data points and 1608 min of infant behavior video data. We used correlation to explore relationships among variables and used analysis of variance (ANOVA) methods and t tests to explore effects of care on infant responses within and between groups. Results: In total, 24 participants (53.3%) had gastrointestinal surgery, 11 (24.4%) had cardiac surgery, and 10 (22.2%) had respiratory/esophageal surgery. Nurse-delivered care significantly affected HR. Changes in mean HR (bpm) varied across groups, with a mean change of 15.3 (SD = 12.88) for gastrointestinal surgery, a mean change of 11.8 (SD = 10.94) for cardiac surgery, and a mean change of 11.3 (SD = 8.19) for respiratory/esophageal surgery (ps’ < .018). All groups exhibited behavioral stress indicators, including squirm, splay, and limb extension. Infants who had cardiac surgery exhibited vocal sounds more frequently than twitching of extremities (p = .019). Conclusion: Infants demonstrated physiological and behavioral stress during post-surgical nurse-delivered care. We observed variation between surgical groups that may represent the differing effects of congenital anomalies. Education about expected responses of infants with specific surgical conditions would equip nurses to better mitigate infant stress post-surgical responses.