探討新生兒狀態與產後壓力及疲倦的關係

Abstract

研究背景：2021年由台灣北部某醫學中心產後病房進行的一項調查顯示，拒絕親子同室的主要原因是新手父母對新生兒突發性猝死的壓力，這種壓力可能在產後住院期間睡眠不足而導致疲倦，甚至提高產後憂鬱的風險。然而，此簡易調查並無嚴謹的研究設計，無法得知其壓力程度，且國內外較無針對此種壓力源，與親子同室、產後疲倦之間進行研究比較。 研究目的：觀察親子同室時，新生兒不同狀態與產婦壓力、疲倦之間的關係。 研究方法：採用縱貫性研究，於2023年1月至6月期間，在台北某醫學中心連續採樣選取43組家庭，使用攜帶式心電圖監測心率變異性數據，以紀錄心率正規化低頻百分比數值，所使用的工具包括：新生兒猝死之感知壓力量表，以及疲憊連續型態量表。兩次數據收集分別在產後4-24小時內和產後第三天進行。最後，使用獨立樣本t檢定、成對樣本t檢定、卡方檢定、皮爾森相關、變異數分析，對資料進行分析，了解產婦壓力、疲倦與親子同室程度間的關聯。 研究結果：產後第三天比第一天，產婦對新生兒猝死的壓力明顯降低 (t = 49.43, p < 0.001)，且第一天測得的猝死壓力與親子同室程度無差異 (χ2 = 5.76, p = 0.763)，然而產婦住院期間整體壓力卻明顯上升 (t = 2.04, p = 0.049)；新生兒安睡於小床時產婦的nLF壓力值最大，為65.4%。半夜當新生兒哭鬧時，持續哺乳或抱著安撫2小時以上者，為高度疲倦，90分鐘以內者則為中度或低度疲倦；哺乳後寶寶馬上哭鬧至少3分鐘，若原先哺乳時間為20分鐘以上者為高度疲倦，10-15分鐘者僅為中度或低度疲倦。 結論：新生兒安睡時產婦的壓力最大，因產婦急著自理日常生活所需，建議於臨床中透過伴侶共同參與照護，可使產婦有足夠時間小睡補眠以減少壓力；此外半夜持續超過2小時的安撫或哺餵會導致產婦較高的疲倦，由於半夜長時間中斷睡眠，建議可教導產婦與其伴侶理解正常新生兒睡眠週期，鼓勵當新生兒進入深層睡眠後即輕輕將寶寶放回小床，以增加半夜睡眠持續時間；然而，新生兒猝死壓力隨住院天數降低，且與疲倦、親子同室程度無顯著關係。

Background: A survey conducted in a postpartum ward at a medical center in northern Taiwan in 2021 revealed that the primary reason for refusing rooming-in care among new parents was the stress of sudden unexpected infant death (SUID). This concern may exacerbate sleep deprivation, leading to fatigue and an increased risk of postpartum depression. However, the research design of this survey was unclear, and only a few data on previous research concentrated on comparative analysis between this stress, rooming-in, and postpartum fatigue. Objective: This study aims to explore the relationship between infant states, postpartum stress, and fatigue during rooming-in. Methods: An observational study design was performed from January to June 2023, involving a consecutive sample of 43 families in a medical center in northern Taiwan. Instruments included a perceived stress scale regarding SUID and a fatigue continuum form. In addition, all participants were required to wear portable electrocardiogram (ECG) devices to monitor heart rate variability (i.e., normalized frequency, which reflects the activation of the sympathetic nervous system, the more the nLF, the higher the stress). The heart rate variability (HRV) data within 24 hours postpartum (T1) and on the third day postpartum (T2) reflect participants’ stress levels. Data analysis was adopted by independent samples t-tests, paired samples t-tests, chi-square tests, Pearson correlations, and ANOVA tests. Results: Stress with SUID significantly decreased on the third day postpartum compared to the first day (t = 49.43, p < 0.001). Surprisingly, the stress to SUID at T1 showed no significant differences among participants with different rooming-in levels (χ2 = 5.76, p = 0.763), indicating that the stress to SUID may not be the main reason for refusing rooming-in. Overall stress levels significantly increased (t = 2.04, p = 0.049). Moreover, nLF stress data was highest when the newborn slept in a crib (65.4%). Those women who engaged in continuous hugging or breastfeeding for more than 2 hours during midnight experienced high fatigue, while those who did less than 90 minutes reported moderate or low fatigue. If the baby cried for at least 3 minutes after breastfeeding, mothers breastfeeding for more than 20 minutes experienced high fatigue, whereas those breastfeeding for 10-15 minutes reported moderate or low fatigue. Conclusions: The greatest stress for postpartum women occurs when their newborns are asleep, as the mothers are eager to attend to their daily self-care needs. We recommended clinical interventions to involve partners' active participation in caregiving, allowing postpartum women sufficient time for brief naps to reduce stress. Additionally, prolonged holding or breastfeeding episodes exceeding two hours during the night contribute to higher fatigue levels. Due to the disruptive nature of prolonged nighttime awakenings, it is suggested to educate the couples about the normal sleep patterns of newborns and encourage them to gently return the baby to the crib once the infant enters deep sleep. It increases the duration of uninterrupted nighttime sleep. However, the stress with SUID decreases with the length of hospital stay and is not significantly related to fatigue or the degree of rooming-in.