The Effect of Kangaroo Mother Care on Pain From Heel Lance in Preterm Newborns Admitted to Neonatal Intensive Care Unit: a Crossover Randomized Clinical Trial

Abstract

Background:The heel-lancing procedure is a common tissue damaging procedure routinely performed in premature neonates and causes pain. Therefore, efforts should be made to relieve this pain. Objectives: This study aimed to assess the effect of kangaroo mother care (KMC) for a brief duration of 15 minutes on pain intensity of heel lance in preterm newborns admitted to neonatal intensive care units. Patients and Methods:In this clinical trial with crossover design, 64 vitally stable preterm neonates between 30-36 weeks of gestational age, who needed at least two heel lances, were randomly allocated to two groups. In group A, neonates received KMC 15 minutes before, during, and two minutes after the first heel lancing procedure. In group B, neonates were kept in prone position in incubator 15 minutes before lancing. For second heel lancing, the neonates in group A were put in incubator and group B received KMC. Premature Infant Pain Profile (PIPP) was scored during and within two minutes after finishing the procedure in both conditions. Results: The mean score of pain intensity during the intervention was significantly lower in the KMC position (P < 0/000). Mean score of pain intensity at two minutes after intervention was also significantly lower in the KMC position (P < 0/000). Conclusions: KMC before and during heel lancing is a natural, easy to use, and cost-effective method to decrease pain in premature neonates. It is consistent with modern strategy of family-centered care in neonatal units.

Physiological and psychological outcomes of kangaroo mother care of preterm infants–an overview

“…Cong et al, 30 concluded KMC before and during heel stick procedures, stabilised the infant's heart rate, whilst longer skin-to-skin contact of 30 minutes significantly improved their autonomic pain responses compared to a shorter period of 15 minutes or being in an isolate. These findings were supported by further randomised controlled trials conducted by Chidambaram et al, 31 Mosayebi et al, 32 & Sen et al 33 In two studies by Nimbalkar et al, 34,35 skin-to-skin contact and oral sucrose were noted to have comparable clinical efficacy. Benefit was also noted even with short periods of KMC (15 minutes).…”

“…Increased Parasympathetic Activity [16][17][18] Decreased Heart Rate Decreased Respiratory Rate Increased Oxygen Saturations 14 Increased Temperature 14 Increased Cerebral Blood Flow 18,19 Decreased Secondary Infections 20 Decreased Salivary Oxytocin Concentrations 22,23 Pain Relief for Painful Procedures [27][28][29][30][31][32][33][34][35][36][37] Improved Weight Gains 14,20,38,45 Greater Success in Establishing Early Breastfeeding [39][40][41][42][43][44][45] Improved Early Cognitive Performance 47 Improved Communication Performance 47 Improved Neurobehavioural Performance 14,48 Increased Alertness and Decreased Gaze Aversion 48 Increased Mother-Infant Interaction 48,49 Improved Maternal Affect 48 Improved Maternal Response to Infant Cues 48 It is estimated that there are over 15 million preterm births worldwide each year, with the great majority in developing countries. 10 Neonatal care of premature infants is complex.…”

Does mother scented simulated hand promote comfort, reduce pain, and distress among mechanically ventilated preterm neonates during invasive procedures?

“…Unfortunately, the standard NICU care did not support the multisensory stimulation and containment, in addition to limiting the mothers' opportunities to participate in their neonates' care (19). Although the standard NICU care for the preterm neonates, such as mother skin-to-skin contact (kangaroo care), is strongly recommended in the literature, the excessive handling of the mechanically ventilated preterm neonates during the invasive procedures may increase the risk of accidental extubation of the non-coughed endotracheal tube (20,21). In this context, nurses could use a multi-modal approach such as a weighted maternally scented simulation device.…”

A influência do Método Canguru no tempo de internação do recém-nascido prematuro em unidades hospitalares: uma revisão integrativa

“…Os dois estudos citados trazem que o método canguru não difere de forma significativa dos cuidados na incubade internação18 . Nos estudos de Johnston et al19 , Mosayebi et al20 , Gao et al21 foram comparados a eficácia do método canguru com os cuidados na incubadora. Johnston et al19 randomizaram 61 pacientes e os recém nascidos alocados no grupo intervenção, realizaram a punção do calcanhar 15 minutos depois de iniciado o método.…”

“…Johnston et al19 randomizaram 61 pacientes e os recém nascidos alocados no grupo intervenção, realizaram a punção do calcanhar 15 minutos depois de iniciado o método. Enquanto no estudo de Mosayebi et al20 foram randomizados 64 pacientes, e inicialmente o grupo intervenção realizou a posição do método que se iniciou 15 minutos antes da punção do calcanhar e posteriormente esse mesmo grupo foi alocado no grupo controle onde os recém nascidos permaneceram na incubadora durante a punção.Já no estudo Gao et al21 , foram randomizados 80 recém nascidos, e as mães alocadas no grupo intervenção iniciaram a posição do método canguru 30 minutos antes do procedimento de punção e foram orientadas pelas enfermeiras da unidade. Shukla et al37 compararam o efeito do método com a utilização da glicose oral.…”