The Effect of Kangaroo Care on Pain and Physiological Parameters in Preterm Infants on Heel-stick Procedure: A Randomized Controlled, Cross-over Study

Noushin Beheshtipoor, Ashraf Memarizadeh, Fatemeh Hashemi, Shahnaz Porarian, Masoume Rambod
Background: Due to the higher risk of  pain in preterm infants, pain management is important for such infants. The present study aimed to determine the effectiveness of kangaroo care on the severity of pain and physiological parameters after heel-stick in preterm infants. Materials and Methods: This was a prospective and randomized controlled cross-over study. Twenty preterm infants allocated into an intervention (30 minutes of kangaroo care before and throughout heel-stick) and a control condition (standard incubator care during heel-stick). The severity of pain and the physiological parameters (heart rate and oxygen saturation) were collected after the heel-stick procedure. Results: The pain mean scores in the intervention and control conditions were respectively 4.9 (SD=2.91) and 11.00 (SD=4.21) and a significant difference was found between the two conditions regarding the pain score 30 seconds after the heel-stick [t=5.33, p<0.001]. Moreover, a significant difference between the two conditions concerning the infants' heart rate (F=3.73, p<0.0001) and oxygen saturation (F=1.84, p<0.0001) was demonstrated during the three study periods. Conclusion: In order to relieve the preterm infants' pain and prevent quick acceleration and deceleration of heart rate and oxygen saturation in the intervention condition, the intervention is recommended to be done in a nursery.
Heel stick; Kangaroo Care; Pain; Premature Infant

Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA : the journal of the American Medical Association. 2008;300(1):60-70.

Evans JC, McCartney EM, Lawhon G, Galloway J. Longitudinal comparison of preterm pain responses to repeated heelsticks. Pediatric nursing. 2005;31(3):216-21.

Lago P, Guadagni A, Merazzi D, Ancora G, Bellieni CV, Cavazza A, et al. Pain management in the neonatal intensive care unit: a national survey in Italy. Paediatric anaesthesia. 2005;15(11):925-31.

Fitzgerald M. The development of nociceptive circuits. Nature reviews Neuroscience. 2005;6(7):507-20.

Fitzgerald M, Beggs S. The neurobiology of pain: developmental aspects. The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry. 2001;7(3):246-57.

Cong X, Ludington-Hoe SM, McCain G, Fu P. Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early human development. 2009;85(9):561-7.

Anand KJ. Clinical importance of pain and stress in preterm neonates. Biology of the neonate. 1998;73(1):1-9.

Holsti L, Grunau RE, Oberlander TF, Whitfield MF. Specific Newborn Individualized Developmental Care and Assessment Program movements are associated with acute pain in preterm infants in the neonatal intensive care unit. Pediatrics. 2004;114(1):65-72.

Abdulkader HM, Freer Y, Garry EM, Fleetwood-Walker SM, McIntosh N. Prematurity and neonatal noxious events exert lasting effects on infant pain behaviour. Early human development. 2008;84(6):351-5.

Hermann C, Hohmeister J, Demirakca S, Zohsel K, Flor H. Long-term alteration of pain sensitivity in school-aged children with early pain experiences. Pain. 2006;125(3):278-85.

Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonates. Seminars in fetal & neonatal medicine. 2006;11(4):268-75..

Grunau RE, Holsti L, Haley DW, Oberlander T, Weinberg J, Solimano A, et al. Neonatal procedural pain exposure predicts lower cortisol and behavioral reactivity in preterm infants in the NICU. Pain. 2005;113(3):293-300.

Grunau RE, Weinberg J, Whitfield MF. Neonatal procedural pain and preterm infant cortisol response to novelty at 8 months. Pediatrics. 2004;114(1):77-84.

Cignacco E, Hamers JPH, Stoffel L, van Lingen RA, Gessler P, McDougall J, et al. The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain. 2007;11(2):139-52.

Anand KJ, Hall RW, Desai N, Shephard B, Bergqvist LL, Young TE, et al. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet. 2004;363(9422):1673-82.

Johnston CC, Campbell-Yeo M, Filion F. Paternal vs maternal kangaroo care for procedural pain in preterm neonates: a randomized crossover trial. Archives of pediatrics & adolescent medicine. 2011;165(9):792-6.

Chiu SH, Anderson GC. Effect of early skin-to-skin contact on mother-preterm infant interaction through 18 months: randomized controlled trial. International journal of nursing studies. 2009;46(9):1168-80.

Moore ER, Anderson GC. Randomized controlled trial of very early mother-infant skin-to-skin contact and breastfeeding status. J Midwifery Wom Heal. 2007;52(2):116-25.

Worku B, Kassie A. Kangaroo mother care: a randomized controlled trial on effectiveness of early kangaroo mother care for the low birthweight infants in Addis Ababa, Ethiopia. Journal of tropical pediatrics. 2005;51(2):93-7.

Johnston CC, Filion F, Campbell-Yeo M, Goulet C, Bell L, McNaughton K, et al. Kangaroo mother care diminishes pain from heel lance in very preterm neonates: a crossover trial. Bmc Pediatr. 2008;8:13. 36.

Azevedo VM, Xavier CC, Gontijo Fde O. Safety of Kangaroo Mother Care in intubated neonates under 1500 g. Journal of tropical pediatrics. 2012;58(1):38-42.

Castral TC, Warnock F, Leite AM, Haas VJ, Scochi CG. The effects of skin-to-skin contact during acute pain in preterm newborns. Eur J Pain. 2008;12(4):464-71.

Gazzolo D, Masetti P, Meli M. Kangaroo care improves post-extubation cardiorespiratory parameters in infants after open heart surgery. Acta paediatrica. 2000;89(6):728-9.

Sajedi F, Kashaninia Z, Rahgozar M, Asadi Noghabi F. The Effect of Kangaroo Care on Physiologic Responses to Pain of an Intramuscular Injection in Neonates. Iran J Pediatr. 2007;17(4):339-44.

Johnston CC, Stevens B, Pinelli J, Gibbins S, Filion F, Jack A, et al. Kangaroo care is effective in diminishing pain response in preterm neonates. Archives of pediatrics & adolescent medicine. 2003;157(11):1084-8.

Ruiz RJ, Avant KC. Effects of maternal prenatal stress on infant outcomes: a synthesis of the literature. ANS Advances in nursing science. 2005;28(40:345-55.

Cong X, Cusson RM, Walsh S, Hussain N, Ludington-Hoe SM, Zhang

D. Effects of Skin-to-Skin Contact on Autonomic Pain Responses in Preterm Infants. The journal of pain : official journal of the American Pain Society. 2012;13(7):636-45.

Akcan E, Yigit R, Atici A. The effect of kangaroo care on pain in premature infants during invasive procedures. The Turkish journal of pediatrics. 2009;51(1):14-8.

Saeidi R, Asnaashari Z, Amirnejad M, Esmaeili H, Robatsangi MG. Use of "kangaroo care" to alleviate the intensity of vaccination pain in newborns. Iran J Pediatr. 2011;21(1):99-102.

Polit DF, Beck CT. Nursing research, generating and assessing evidence for nursing practice. 9th Edition ed. New York. Baltimore: Lippincott Williams & Wilkins, Philadelphia; 2012.

verklan MT, Walden M. Core Curriculum for Neonatal Intensive Care Nursing. Fourth ed. Saunders: Elsevier Inc; 2010. 936 p.

Ballantyne M, Stevens B, McAllister M, Dionne K, Jack A. Validation of the premature infant pain profile in the clinical setting. The Clinical journal of pain. 1999;15(4):297-303.

Stevens B, Johnston C, Petryshen P, Taddio A. Premature Infant Pain Profile: development and initial validation. The Clinical journal of pain. 1996;12(1):13-22.

Vederhus BJ, Eide GE, Natvig GK. Psychometric testing of a Norwegian version of the Premature Infant Pain Profile: an acute pain assessment tool. A clinical validation study. International journal of nursing practice. 2006;12(6):334-44.

Liaw JJ, Yang L, Katherine Wang KW, Chen CM, Chang YC, Yin T. Non-nutritive sucking and facilitated tucking relieve preterm infant pain during heel-stick procedures: a prospective, randomised controlled crossover trial. International journal of nursing studies. 2012;49(3):300-9.

Cong X, Ludington-Hoe SM, Walsh S. Randomized crossover trial of kangaroo care to reduce biobehavioral pain responses in preterm infants: a pilot study. Biological research for nursing. 2011;13(2):204-16.

Gray L, Watt L, Blass EM. Skin-to-skin contact is analgesic in healthy newborns. Pediatrics. 2000;105(1):e14.

Warnock FF, Castral TC, Brant R, Sekilian M, Leite AM, Owens Sde L, et al. Brief report: Maternal kangaroo care for neonatal pain relief: a systematic narrative review. Journal of pediatric psychology. 2010;35(9):975-84.

Kostandy RR, Ludington-Hoe SM, Cong X, Abouelfettoh A, Bronson C, Stankus A, et al. Kangaroo Care (skin contact) reduces crying response to pain in preterm neonates: pilot results. Pain management nursing : official journal of the American Society of Pain Management Nurses. 2008;9(2):55-65.

Carbajal R, Gall O, Annequin D. Pain management in neonates. Expert review of neurotherapeutics. 2004;4(3):491-505.

Uvnas-Moberg K. Oxytocin may mediate the benefits of positive social interaction and emotions. Psychoneuroendocrino. 1998;23(8):819-35.

Uvanas-Moberg K, Arn I, Magnusson D. The psychobiology of emotion: the role of the oxytocinergic system. International journal of behavioral medicine. 2005;12(2):59-65.

Ludington-Hoe SM, Johnson MW, Morgan K, Lewis T, Gutman J, Wilson PD, et al. Neurophysiologic assessment of neonatal sleep organization: preliminary results of a randomized, controlled trial of skin contact with preterm infants. Pediatrics. 2006;117(5):909-23.

Goubet N, Rattaz C, Pierrat V, Bullinger A, Lequien P. Olfactory experience mediates response to pain in preterm newborns. Developmental psychobiology. 2003;42(2):171-80.

Mooncey S, Giannakoulopoulos X, Glover V, Acolet D, Modi N. The effect of mother-infant skin-to-skin contact on plasma cortisol and beta-endorphin concentrations in preterm newborns. Infant Behav Dev. 1997;20(4):553-7.

Ritz T, Meuret AE, Ayala ES. The psychophysiology of blood-injection-injury phobia: looking beyond the diphasic response paradigm. International journal of psychophysiology : official journal of the International Organization of Psychophysiology. 2010;78(1):50-67.

Dodd VL. Implications of kangaroo care for growth and development in preterm infants. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG. 2005;34(2):218-32.

Ludington-Hoe SM, Ferreira C, Swinth J, Ceccardi JJ. Safe criteria and procedure for kangaroo care with intubated preterm infants. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG. 2003;32(5):579-88.

Ludington-Hoe SM, Swinth JY. Developmental aspects of kangaroo care. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG. 1996;25(8):691-703.

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