CoolCuddle

Do parents cuddling babies undergoing cooling therapy for hypoxic-ischaemic encephalopathy (HIE) affect the cooling process or intensive care? Refinement and evaluation of an intervention protocol. 

Chief Investigator	Institution	Dates	Funding Stream	Grant Ref	Amount
Chakkarapani, Dr Ela	University of Bristol	01/09/2019 - 02/03/2021 (18 months)	NIHR Research for Patient Benefit (RfPB)	PB-PG-1217-20020	£148,412.00

Summary

In the UK, each year around 2100 babies develop brain injury due to lack of oxygen around birth. These babies now undergo cooling therapy and intensive care for almost 4 days to reduce long-term disabilities. Despite this, one-third of cooled babies still die or develop disabilities. Their parents are under extreme stress, which is further worsened by the current practice of not allowing parents to cuddle their babies during cooling therapy, due to concerns of affecting the cooling process and intensive care. This practice may affect the bonding between mothers and cooled babies, which in turn could affect establishing breastfeeding, mental health of parents and brain development of the child.

Aim

We will refine a 'CoolCuddle' care process to enable parents to cuddle their babies during cooling.

Design

The study will have 3 stages and include St Michael's and Southmead Hospital's neonatal units in Bristol. The 'CoolCuddle' process will be led by two nurses.

Stage 1: (3 months) For 4-6 parent-infant pairs, we will follow a standard procedure of safely moving the baby from the open cot to parent's arms after fixing the tubes and lines attached to the baby. We will have up to 4 'CoolCuddle' times for each infant for up to 2 hours at a time. We will adjust and improve the "CoolCuddle" process using information from talking through what happens during the process.

Stage 2: (12 months) We will test the refined "CoolCuddle" on further 20-24 parent-infant pairs. We will measure its effect on the stability of the cooling process, breathing support, heart function and brain activity by comparing these when the infant is being cuddled and when not. We will also record any problems during the cuddling period and compare breastfeeding and parent-infant bonding scores with existing information. We will invite the parents and staff to be interviewed so we can explore their views of 'CoolCuddle' and what they feel about it.

Stage 3: (3 months) We will produce a modified "CoolCuddle" protocol that can be included within existing Cooling care pathway.

Patient Involvement

We have discussed the study question, design and our outcomes with parents of previously cooled babies. They felt that it would greatly benefit future parents in reducing stress and helplessness, make them feel more confident and improve breastfeeding. Parents indicated that the side effects for the baby should be measured and that the impact of 'CoolCuddle' on breastfeeding and parental bonding were appropriate outcome markers.

Dissemination

The refined process and results will be published in peer-reviewed journals, neonatal network websites and through the neonatal charity Bliss. With further funding, a safe "CoolCuddle" protocol could be implemented nationally over 2 years with surveillance of safety and adverse effects.