CoolCuddle and autonomic regulation in infants with hypoxic‐ischaemic encephalopathy: an intervention study

Chakkarapani, Ela, Okano, Satomi, Odd, David ORCID: https://orcid.org/0000-0002-6416-4966 and CoolCuddle Study Investigators 2026. CoolCuddle and autonomic regulation in infants with hypoxic‐ischaemic encephalopathy: an intervention study. Acta Paediatrica: Nurturing the Child 115 (8) , pp. 1688-1699. 10.1111/apa.70547

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Abstract

Aim: We evaluated the impact of ‘CoolCuddle’, parental cuddling during therapeutic hypothermia intervention for hypoxic‐ischaemic encephalopathy, on heart rate variability (HRV). Methods: In this prospective, single‐group, interventional study with repeated measures, we included infants ≥ 36 weeks' gestation undergoing hypothermia and CoolCuddle with HRV data. Time‐domain HRV was assessed before, during, and after each cuddle. Primary outcomes were heart rate, mean RR interval (ANN), standard deviation of normal RR intervals, and root mean square of successive differences (RMSSD). Results: In 65 CoolCuddles from 26 infants, CoolCuddle did not significantly alter HRV. However, infants with a 1‐min Apgar < 7 had increased heart rates during (+2.33 bpm) and after (+3.27 bpm) cuddling, whereas those with higher Apgar scores showed decreases (−1.43 and −8.21 bpm) compared with pre‐cuddle. Infants with Apgar < 7 or abnormal aEEG had reduced ANN during (−11.96 ms, −12.75 ms) and after (−19.89 ms, −19.00 ms), while those with higher Apgar or normal aEEG showed increases (+15.32 ms, +23.33 ms(during‐cuddle); +63.94 ms, +55.06 ms (post‐cuddle)). Maternal cuddling was associated with higher post‐cuddle RMSSD (+1.06 ms) than paternal cuddling (−0.73 ms), (p = 0.04). Conclusion: While CoolCuddle had little overall effect on HRV, autonomic responses varied by asphyxia and encephalopathy severity and parent, suggesting differential modulation in vulnerable infants.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/
Publisher:	Wiley
ISSN:	0803-5253
Date of First Compliant Deposit:	22 April 2026
Date of Acceptance:	7 April 2026
Last Modified:	04 Aug 2026 13:25
URI:	https://orca.cardiff.ac.uk/id/eprint/186576

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