Kangaroo Care (Skin Contact) Reduces Crying Response to Pain in Preterm Neonates: Pilot Results

Abstract

Objectives-When preterm infants experience heel stick, crying commonly occurs and has adverse physical effects. A reduction in crying is desired. Kangaroo Care, skin contact between mother and infant, reduces pain as measured by the Premature Infant Pain Profile, and may reduce crying time. The purpose of the pilot was to test Kangaroo Care's effect on the preterm infant's crying response to heel-stick.Methods-A prospective cross-over study with 10 prematures 2-9 days old (30-32 weeks postmenstrual age) was conducted. Infants were randomly assigned to two sequences (Day 1 heel stick in Kangaroo Care [after 30 minutes of prone skin contact upright between maternal breasts] and Day 2 heel stick in incubator [inclined, nested and prone] or the opposite sequence) was conducted. Video tapes of Baseline, Heel Warming, Heel Stick, and Recovery phases were independently scored for audible and inaudible crying times by two research assistants. The audible and inaudible crying times for each subject in each phase were summed and the mean between the scorer's values was analyzed by repeated measures ANOVA.Results-Subject characteristics did not differ between those in the two sequences. Crying time differed between the study phases on both days (p ≤ 0.001). When in Kangaroo Care as compared to the incubator, crying time was less during the Heel stick (p = 0.001) and Recovery (p = 0.01) phases. Conclusion-BecauseKangaroo Care reduced crying in response to heel stick in medically stable preterm infants who were 2-9 days old, a definitive study is recommended.

Os efeitos da posição canguru em resposta aos procedimentos dolorosos em recém-nascidos pré-termo: uma revisão da literatura

“…Pain response is apparently reduced in deeply sleeping PN. (18) Other significant factors to which kangaroo care appears to contribute include the activation of the autonomic system, as evidenced by a reduced heart rate, and the activation of the endogenous opioid system, (16) which mediate the physiological response during painful PN procedures.…”

“…According to Kostandy et al, (18) kangaroo care analgesic effects are related to the blockade of the transmission of nociceptive stimuli via afferent fibers or the inhibition of descending fibers. Continued tactile stimulation offered by kangaroo care appears to be related to activation of the pain inhibition system via endogenous system modulation.…”

“…Maintaining this position for twenty minutes changes the baby's blood cortisol levels and allows for the release of beta-endorphins, which reduce stress. (18) Additionally, the maternal contact promotes cortical pain center activation. However, according to Johnston et al, (13) in extremely PN, endogenous mechanism activation is not as fast and potent as in older babies or adults.…”

“…(5,12-17) Kostandy et al (18) evaluated pain only, observing the behavioral state using the ABSS (Anderson Behavioral State Scoring System) scale. Ferber & Makhoul (19) assessed pain using the NIDCAP (Newborn Individualized Developmental Care and Assessment Program) scale.…”

“…However, Kostandy et al (18) state that for acute procedures, kangaroo care appears to reduce the response to pain. Akcan, Yigit & Atici (15) highlight that starting kangaroo care thirty minutes before an invasive procedure and maintaining it for an additional ten minutes after the end of an invasive procedure can be effective for reducing the response to pain during any invasive procedure in PN.…”