{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:08:28Z","timestamp":1784308108812,"version":"3.55.0"},"reference-count":34,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["PB\u2010PG\u20101217\u201020020"],"award-info":[{"award-number":["PB\u2010PG\u20101217\u201020020"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We evaluated the impact of \u2018CoolCuddle\u2019, parental cuddling during therapeutic hypothermia intervention for hypoxic\u2010ischaemic encephalopathy, on heart rate variability (HRV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective, single\u2010group, interventional study with repeated measures, we included infants \u2265\u200936\u2009weeks' gestation undergoing hypothermia and CoolCuddle with HRV data. Time\u2010domain 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 65 CoolCuddles from 26 infants, CoolCuddle did not significantly alter HRV. However, infants with a 1\u2010min Apgar &lt;\u20097 had increased heart rates during (+2.33\u2009bpm) and after (+3.27\u2009bpm) cuddling, whereas those with higher Apgar scores showed decreases (\u22121.43 and \u22128.21\u2009bpm) compared with pre\u2010cuddle. Infants with Apgar &lt;\u20097 or abnormal aEEG had reduced ANN during (\u221211.96\u2009ms, \u221212.75\u2009ms) and after (\u221219.89\u2009ms, \u221219.00\u2009ms), while those with higher Apgar or normal aEEG showed increases (+15.32\u2009ms, +23.33\u2009ms(during\u2010cuddle); +63.94\u2009ms, +55.06\u2009ms (post\u2010cuddle)). Maternal cuddling was associated with higher post\u2010cuddle RMSSD (+1.06\u2009ms) than paternal cuddling (\u22120.73\u2009ms), (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While CoolCuddle had little overall effect on HRV, autonomic responses varied by asphyxia and encephalopathy severity and parent, suggesting differential modulation in vulnerable infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apa.70547","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T06:52:09Z","timestamp":1776408729000},"page":"1688-1699","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>CoolCuddle<\/scp>\n                    and Autonomic Regulation in Infants With Hypoxic\u2010Ischaemic Encephalopathy: An Intervention Study"],"prefix":"10.1111","volume":"115","author":[{"given":"Ela","family":"Chakkarapani","sequence":"first","affiliation":[{"name":"Centre for Academic Child Health, Bristol Medical School University of Bristol  Bristol UK"},{"name":"Neonatal Intensive Care Unit, St Michael's Hospital University Hospitals Bristol &amp; Weston NHS Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satomi","family":"Okano","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, St Michael's Hospital University Hospitals Bristol &amp; Weston NHS Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Odd","sequence":"additional","affiliation":[{"name":"Division of Population Medicine Cardiff University School of Medicine  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"CoolCuddle Study Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2020-320902"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00038-3"},{"key":"e_1_2_14_4_1","unstructured":"NICE \u201cTherapeutic Hypothermia With Intracorporeal Temperature Monitoring for Hypoxic Perinatal Brain Injury \u201dNICEIPG347 (2010)."},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-316509"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.51696"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-21723-1"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699052.2019.1597163"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedn.2024.02.009"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2013.08.012"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo-2021-001280"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.17466"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/02646838.2024.2423178"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-020-03882-3"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1976.00500100030012"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-019-1603-7"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2012.09.009"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2016.11.059"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-016-9957-y"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2016.03.007"},{"key":"e_1_2_14_21_1","unstructured":"E.Chakkarapani L.Beasant S.Okano D. 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