Paternal vs Maternal Kangaroo Care for Procedural Pain in Preterm Neonates

Abstract

Setting: Three university-affiliated level III neonatal intensive care units. Patients: Sixty-two preterm neonates at 28 to 36 weeks' gestational age who were expected to stay in the neonatal intensive care unit for at least 2 blood sampling procedures, without major congenital anomalies, grade III or IV intraventricular hemorrhage, or periventricular leukomalacia; without surgical interventions; not receiving parenteral analgesics or sedatives within 72 hours; and with parental consent. Intervention: During 2 separate medically ordered heel lance procedures at least 24 hours apart, infants were held in KC for 30 minutes before and during the procedure with the mother or with the father, and with the other parent in the subsequent session. Which parent came first was randomized. Main Outcome Measures: The Premature Infant Pain Profile and time for heart rate to return to baseline were the primary outcomes. Results: At 30 and 60 seconds after the heel lance, infants in maternal KC displayed significantly lower scores on the Premature Infant Pain Profile than when in paternal KC (30 seconds mean difference, 1.435 [95% confidence interval, 0.232-2.632]); 60 seconds mean difference, 1.548 [95% confidence interval, 0.069-3.027]). At 90 and 120 seconds, there were no differences. The difference in time to return to KC heart rate before the heel lance was significant, with the time in maternal KC being 204 seconds and in paternal KC, 246 seconds (mean difference, 42 seconds [95% confidence interval, 5.16-81.06 seconds]). Conclusions: Mothers were marginally more effective than fathers in decreasing pain response. Future research should address feasibility issues and nonparent providers of KC during painful procedures.

Alternative female kangaroo care for procedural pain in preterm neonates: a pilot study

“…The mean difference in PIPP scores between mothers and fathers was similar to this study; however, the effect size was not reported (3). While this study is too small to support other females to provide kangaroo care for painful procedures, there is nothing in it to suggest that there is a problem if the mother is comfortable with it.…”

“…The refusal rate for this study was 52%, substantially higher than in our other studies of kangaroo care for pain, in which the refusal rate has been approximately 20% (3–5,11). Skin‐to‐skin contact is intimate, and many new mothers were not prepared to allow that intimacy to be shared between their baby and an unrelated woman.…”

Skin-to-Skin Contact

“…When maternal SSC was compared to nurse SSC, no differences in pain scores at 30, 60, 90, and 120 seconds postlance were found, suggesting that a nurse, too, can give SSC to reduce pain (Johnston et al, 2012). Fathers are not as effective as mothers for the first 60 seconds following heel stick; but at 90 and 120 seconds postheel stick, fathers reduced infant pain as well as mothers (Johnston, Campbell-Yeo, & Filion, 2011). No matter what physiologic measure of pain, nor what pain assessment tool is used, SSC reduces pain.…”

Non-pharmacological management of neonatal pain: Research and clinical practice in the Neonatal Intensive Care Unit

“…The skin-to-skin position with the mother for 30 minutes is more effective for the pain relief of infants than 15 or 80 minutes (Cong, Ludington-Hoe, & Walsh, 2011;Cong et al, 2012). In addition, the findings are inconclusive regarding whether the skin-to-skin position with fathers and others caregivers is as efficient as with mothers in relation to protecting infants against pain experiences (Johnston, Campbell-Yeo, & Filion, 2011;Johnston et al, 2012).…”