The handling received by very low birthweight newborns undergoing intensive care in the first few days of life and the effects of this were studied. Infants were handled an average of 4.3 hours (18%) of the total 24 hour observation time and received a mean 234 handling procedures. Parental handling contributed 35% of the total time but was usually benign except in that it could interfere with the infant's rest. Many procedures were associated with undesirable consequences. Endotracheal suctioning was invariably associated with hypoxaemia and was often carried out more frequently, or took longer, than was optimal. Transcutaneous oxygen monitoring, although considered routine for all intensive care infants, was only carried out for 50% of the observation time and often did not accompany periods of likely intensive handling. Increasing technology in neonatal intensive care often results in increased handling of sick infants. Each new innovation, as well as routine procedures, should be viewed in the light of the continuum of neonatal intensive care events, and handling kept to a minimum.
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