Salivary cortisol and behavioral state responses of healthy newborn infants to tactile-only and multisensory interventions

J Obstet Gynecol Neonatal Nurs. 2009 Jan-Feb;38(1):22-34. doi: 10.1111/j.1552-6909.2008.00307.x.


Objective: To compare changes in stress reactivity (measured via the biomarker salivary cortisol) and behavioral state in healthy newborn infants immediately following 1 of 2 interventions: (1) tactile-only stimulation or (2) a multisensory, auditory, tactile, visual, and vestibular stimulation with a control group.

Design: A randomized prospective design pilot study.

Setting: Normal newborn nurseries of 2 midwestern perinatal centers.

Participants: Forty healthy newborn infants receiving standard nursing care.

Methods: Infants were randomly assigned to receive 15 minutes of tactile-only, auditory, tactile, visual, and vestibular, or no stimulation 30 minutes before feeding. Saliva samples were collected before, immediately following, and 10 minutes postintervention. Behavioral state was judged every minute.

Results: Tactile-only group infants had the largest increase in cortisol levels, followed by control group infants. In contrast, infants who received the multisensory intervention showed a significant steady decline in cortisol. Asleep was the predominant state for all 3 groups and cry was minimal.

Conclusions: Tactile-only stimulation may increase infant stress reactivity while the benefit of the multisensory auditory, tactile, visual, and vestibular intervention may be in the reduction of infant stress reactivity. Interventions appeared to have minimal effect on stress reactivity based on behavioral state.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acoustic Stimulation / methods
  • Analysis of Variance
  • Biomarkers / analysis
  • Chi-Square Distribution
  • Clinical Nursing Research
  • Female
  • Humans
  • Hydrocortisone / analysis*
  • Hydrocortisone / physiology
  • Infant Behavior / physiology*
  • Infant Behavior / psychology
  • Infant Care / methods
  • Infant, Newborn
  • Male
  • Midwestern United States
  • Neonatal Nursing / methods
  • Nursing Assessment / methods
  • Photic Stimulation / methods
  • Physical Stimulation / methods*
  • Pilot Projects
  • Prospective Studies
  • Saliva / chemistry*
  • Stress, Physiological / physiology*
  • Touch / physiology*
  • Vestibular Nerve / physiology


  • Biomarkers
  • Hydrocortisone