2024 • Developmental Observer • 9 A B S T R A C T — N I D C A P T R A I N E R S M E E T I N G 2 0 2 3 Aim To evaluate the immediate physiological and behavioural re- sponses of infants during routine nurse-delivered caregiving in the surgical neonatal intensive care unit (NICU) Methods A prospective observational study was conducted in a sur- gical NICU. Paired physiological and behavioural data were collected to evaluate surgical infant responses during rou- tine nurse-delivered caregiving (diaper change). Continuous heart rate (HR) data were reviewed to explore variation in the mean HR pre-, during-, and post-nurse-delivered caregiving. Physiological stress was defined by the study team as a change in the HR of 10bpm or more.1 Videos of infant caregiving were captured by a web camera. Dedicated software combined audio-visual and physiological data. Two NIDCAP Certified Professionals independently scored the video recordings, using a study-specific behavioural observation tool consisting of 43 items: 6 measure infant state; 19 measure stress responses; 7 measure self-regulation; 11 measure caregiver-support. Videos comprised three epochs: epoch one and epoch three pre- and post-caregiving of 10 minutes each; epoch two nurse-deliv- ered caregiving of variable timing. A tick was recorded when a behaviour, state or support was observed, and item scores were summed. Inter-rater reliability was calculated using the Intraclass Correlation Coefficient (ICC). Results Forty infants participated in the study, physiological data was analysed for 40 infants and behavioural data was scored for a sub-group of 10 infants. The sample had a mean gestational age of 36.9 weeks (SD 2.2) and participated in the study at a mean of five (SD 2.9) days postoperative. Twenty-two infants (55%) had gastrointestinal (GIT), ten (25%) cardiac, and eight (20%) respiratory/oesophageal surgery. Physiological results A total of 74,880 data points were reviewed. All groups showed significant changes in heart rate (HR) between pre-caregiving and during caregiving; Mean change (bpm) of 15.4 (SD 13.3) in GIT, 6.3 (SD 4.0) in cardiac, and 16.1 (SD 9.2) in respiratory/ oesophageal groups. Effects of caregiving were seen beyond the caregiving period across all groups with HRs not returning to the pre-caregiving baseline within 10 minutes of caregiving completion. Behavioural results Four-hundred and thirteen minutes of video data were an- alysed; epoch one - 106 minutes, epoch two – 207 minutes, epoch three – 100 minutes. The ICC’s were good to excellent across all components of the behavioural assessment tool (Table 1). The most frequently observed states, stress, and self-reg- ulation behaviours during caregiving for the sub-groups are Behavioural and Physiological Responses of Infants Post-Surgery During Nurse-Delivered Caregiving Griffiths, N 1,2, Laing, S1, Spence, K1,3, Foureur, M4, Popat, H1,5, James-Nunez, K1, Sinclair, L2 1 Grace Centre for Newborn Intensive Care, The Sydney Children’s Hospital Network (Westmead) NSW, Australia, 2 University of Technology Sydney, NSW, Australia, 3 Western Sydney University, NSW, Australia, 4 University of Newcastle, NSW, Australia, 5 University of Sydney NSW, Australia Table 1: Intra-class correlations for scale components of the observational tool, by epoch Scale component Epoch 1 Pre-caregiving Epoch 2 Caregiving Epoch 3 Post-caregiving Infant state 0.72 0.71 0.53 Stress responses 0.91 0.84 0.78 Self-regulation behaviours 0.90 0.90 0.74 ICC agreement grading: Poor <.40, Good to moderate .41 to 0.75, Excellent >.762 DOI 10.14434/do.v17i1.37079 10 • 2024 • Developmental Observer A B S T R A C T — N I D C A P T R A I N E R S M E E T I N G 2 0 2 3 reported as median scores. For infant states: GIT infants - drowsy/alert/crying (4.2); cardiac infants - drowsy (5.5). Stress responses: GIT infants - extend legs (8), splay fingers/toes (6), squirm (6); cardiac infants - splay fingers/toes (8) and squirm (7.5). Self-regulation behaviours were similar for both groups; GIT infants - hand to face (5), suck/foot clasp/leg brace (3); cardiac infants - hand to face (4), suck/hold on/leg brace (3.5). The most offered support during caregiving was, in descending order - supportive holding, voice, patting/stroking. Relevance to NIDCAP This research provides NIDCAP Trainers, NIDCAP-certified Professionals, bedside clinicians, and families with information to support infants requiring surgery in the neonatal period and specifically the application of developmentally responsive caregiving. Conclusion To our knowledge, there is no published research on surgical infants’ physiological and behavioural responses during nurse caregiving. We found that infants post-surgery demonstrate physiological stress during nurse-delivered caregiving. Dif- ferences were observed between groups and may represent the differing physiological effects of congenital anomalies. It appears that infants post-surgery express similar repertoires of behavioural stress cues and self-regulation behaviours. Ongoing analysis of the study sample will add to these pre- liminary results and the findings may assist bedside clinicians. References 1. Allinson LG, Denehy L, Doyle LW, Eeles AL, Dawson JA, Lee KJ, Spittle AJ. Physiological stress responses in infants at 29-32 weeks' postmenstrual age during clustered nursing cares and standardised neurobehavioural assessments. BMJ Paediatr Open. 2017;1(1):e000025. doi: 10.1136/bmjpo-2017-000025. https://doi.org/10.1136/ bmjpo-2017-000025. 2. Fleiss JL. (1971). Measuring nominal scale agreement among many raters. Psychological Bulletin, 76, 378-382. NIDCAP Federation International Board of Directors and Staff 2024 PRESIDENT Deborah Buehler, PhD NIDCAP Master Trainer APIB Trainer Director, West Coast NIDCAP and APIB Training Center email: nfipresident@nidcap.org VICE PRESIDENT Dorothy Vittner, PhD, RN, FAAN Senior NIDCAP Trainer West Coast NIDCAP & APIB Training Center email: dvitt8@gmail.com CO-TREASURER Gloria McAnulty, PhD National NIDCAP Training Center email: gloria.mcanulty@childrens.harvard. edu CO-TREASURER Jennifer Hofherr, MS, OTR/L, CNT National NIDCAP Training Center NIDCAP Trainer Children's Hospital of University of Illinois NIDCAP Training Center email: jennifer.hofherr@nationwidechildrens.org SECRETARY Jean Powlesland, RN, MS NIDCAP Trainer Director, Children’s Hospital of University of Illinois NIDCAP Training Center email: nidcapchicago@gmail.com Fatima Clemente, MD NIDCAP Trainer Co-Director, São João NIDCAP Training Center email: clemente.fatima@gmail.com Mandy Daly, Dip. H Diet and Nutrition, ACII, DLDU Family Representative, Dublin, Ireland email: mandy.daly@yahoo.co.uk Jennifer Degl, MS Family Representative, New York, USA email: jenniferdegl@gmail.com Dalia Silberstein, RN, PhD NIDCAP Trainer Co-Director, Israel NIDCAP Training Center email: daliasil1960@gmail.com Apoorva Sudini, BS Healthcare Associate PricewaterhouseCoopers, New York, NY email: asudini@outlook.com Charlotte Tscherning, MD, PhD Division Chief of Neonatology Oslo University Hospital, Norway email: charlottecasper66@gmail.com Juzer Tyebkhan, MBBS NIDCAP Trainer Director, Edmonton NIDCAP Training Centre email: juzer.tyebkhan@ albertahealthservices.ca STAFF Rodd E. Hedlund, MEd Director, NIDCAP Nursery Program NIDCAP Trainer email: nidcapnurserydirector@ nidcap.org Sandra Kosta, BA Executive Director of Administration and Finance email: sandra.kosta@childrens. harvard.edu FOUNDER OF THE NIDCAP FEDERATION INTERNATIONAL, INC. Heidelise Als, PhD 1940-2022 NIDCAP Founder, Past President 2001-2012 Senior NIDCAP Master Trainer Senior APIB Master Trainer Director, National NIDCAP Training Center, 1982-2022 https://doi.org/10.1136/bmjpo-2017-000025 https://doi.org/10.1136/bmjpo-2017-000025