Randomized Crossover Trial of Kangaroo Care to Reduce Biobehavioral Pain Responses in Preterm Infants: A Pilot Study

Abstract

Kangaroo care (KC), skin-to-skin contact between mother and infant, is a promising method for blunting pain responses. This crossover pilot tested KC effects on biobehavioral responses to heel stick in preterm infants (30-32 weeks' gestational age, 2-9 days old) measured by Premature Infant Pain Profile (PIPP) and salivary and serum cortisol. Mother-infant dyads were randomly assigned to KC heel stick (KCH) first or incubator heel stick (IH) first. Study 1 (80-min study, N = 18) tested the effect of 80 min of KC before and throughout the heel stick procedure versus incubator care. Study 2 (30-min study, N = 10) tested 30 min of KC before and throughout the heel stick versus incubator care. KCH and IH began during a premeasurement phase and continued through four data collection phases: baseline, heel warming, heel stick, and recovery. PIPP responses were measured every 30 s during data collection; salivary cortisol was measured at the end of baseline and recovery; and serum cortisol was measured during heel stick. Study 1 showed no differences between KCH and IH. Study 2 showed lower PIPP scores at four time points during recovery (p < .05 to p < .001), lower salivary cortisol at the end of recovery (p < .05), and lower serum cortisol during heel stick for the KCH condition (p < .05) as well as clinically lower PIPP scores in the KCH condition during heel stick. Thirty minutes of KC before and throughout the heel stick reduced biobehavioral responses to pain in preterm infants.

Paternal Skin-to-Skin Care and its Effect on Cortisol Levels of the Infants

“…To evaluate the effects of massage on premature infants, Acolet et al (1993) found a decrease in plasma cortisol concentration, but this was not significant (41). Cong et al (2011) selected two groups of preterm neonates and investigated the effects of kangaroo care and heel needling. The first group received 80 minute and the second group received 30 minute of KMC.…”

Human milk for neonatal pain relief during ophthalmoscopy

“…Cortisol affects the metabolism, cardiovascular system, and central nervous system (19) . Salivary cortisol has been used in studies to assess the effects of non-pharmacological interventions against pain in newborn infants, including sucrose, the kangaroo position, and developmental care (20)(21)(22) .…”

Prevention and Management of Procedural Pain in the Neonate: An Update

“…65 However, some investigators have reported decreased cortisol concentrations and decreased autonomic indicators of pain in preterm infants during SSC, suggestive of a physiologic benefit. 66,67 The effects of breastfeeding on pain response have also been investigated. A Cochrane systematic review published in 2012 found that breastfeeding during a heel lance or venipuncture was associated with significantly lower pain responses in term neonates (eg, smaller increases in heart rate and shorter crying time), compared with other nonpharmacologic interventions such as positioning, rocking, or maternal holding.…”