TAC-TIC : a non-pharmacological approach to the alleviation of neonatal pain.
Intensive care IS a stressful environment and this thesis
addresses the controversy as to whether tactile stimulation
can mitigate the negative influences in ventilated preterms.
There is an underlying assumption throughout the thesis that
the pre term infant in intensive care experiences and is able to
manifest physical and/or psychological pain. Preterms (n=75)
were recruited with parental consent against strict entry
criteria. A pre-test, post-test time series, counterbalanced
design was used to evaluate the impact of an intervention to
The intervention [Touching and Caressing, Tender in Caring
(T AC-TIC)] was compared with a control condition
(spontaneous activity). Indicators of pain represented in the
experiments were immunologic, physiological, and
neurobehavioural. Data were analysed using parametric and
The ontogeny of the secretory Immune system was
investigated (n=70) using an enzyme-linked immunosorbant
assay for Secretory Immunoglobulin A (SIgA). Ventilated
preterms had significantly lower SIgA than infants requiring
no mechanical ventilation. Breast milk fed preterms showed
increased SIgA compared to other modes of nutrition. TACTIC
increased SIgA in a subsample of ventilated preterms
(n=35) with no changes following the control condition.
Cardiovascular responses remained stable throughout T AC-TIC
and spontaneous activity. No changes in gastric pH were
observed in a sub-sample of 18 preterms.
A neurobehavioural checklist was used to analyse videos for
pain and comfort behaviours (n=29). Significantly more
comfort behaviours were reported during T AC-TIC. Analysis
of behavioural state indicated that more time was spent inactive sleep during than after TAC-TIC. No differences In state
occurred between TAC-TIC and control condition.
A ventilated subsample (n=25) of the original cohort was
subjected to analysis at individual level for determination of
congruence between simultaneously measured outcome
variables. T AC-TIC produced increases more often in two or
three variables. Pilot work has also been conducted
addressing further controversies in tactile stimulation.
The results are discussed within the theoretical frameworks of
Gottlieb's hierarchical systems model, and Adamson-Macedo's