Parental Kangaroo Care Reduces Pain in Preterm Neonates

Laurie Barclay, MD

September 12, 2011

September 12, 2011 — Paternal kangaroo care (KC) is only slightly less effective than maternal KC for reducing procedural pain in preterm neonates, according to the results of a randomized crossover trial reported in the September issue of the Archives of Pediatrics & Adolescent Medicine.

"Skin-to-skin contact is a caregiving situation in which the mother holds her infant, clad in only a diaper, against her bare chest with a cover wrapped around the pair," write C. Celeste Johnston, RN, DEd, from McGill University School of Nursing in Montreal, Canada, and colleagues. "This contact is commonly known as ...KC because of its resemblance to marsupial care. ...KC has been promoted around the world for enhancing newborn physiologic stability, breastfeeding, maternal-infant bonding, and growth and development."

The goal of the study was to compare the efficacy of paternal vs maternal KC to decrease pain associated with heel lance. At 3 university-affiliated, level III, neonatal intensive care units (NICUs), 62 preterm neonates were enrolled. Inclusion criteria were 28 to 36 weeks' gestational age, anticipated NICU stay to include at least 2 blood sampling procedures, and parental consent. Exclusion criteria were major congenital anomalies, grade 3 or 4 intraventricular hemorrhage, periventricular leukomalacia, surgical interventions, and administration of parenteral analgesics or sedatives within 72 hours.

Infants were held in KC by the mother or father, as determined by randomization, for 30 minutes before and during the first of 2 separate medically ordered heel lance procedures at least 24 hours apart. The infant was held by the other parent in the subsequent session. The main study endpoints were the Premature Infant Pain Profile (PIPP) and time for heart rate to return to baseline.

Compared with paternal KC, maternal KC was associated with significantly lower scores on the PIPP at 30 and 60 seconds after the heel lance (30 seconds mean difference, 1.435; 95% confidence interval [CI], 0.232 - 2.632; 60 seconds mean difference, 1.548; 95% CI, 0.069 - 3.027). There were no differences between paternal and maternal KC at 90 or at 120 seconds after the heel lance. However, there was a significant difference in time to return to KC heart rate before the heel lance (204 seconds for maternal KC and 246 seconds for paternal KC (mean difference, 42 seconds; 95% CI, 5.16 - 81.06 seconds).

"Mothers were marginally more effective than fathers in decreasing pain response," the study authors write. "Future research should address feasibility issues and nonparent providers of KC during painful procedures."

Limitations of this study include difficulties in scheduling blood work at a time that the selected parent could provide KC, lack of blinding of the parent or the staff caring for the infant, sporadic loss of data across the session, and controversies regarding pain assessment in nonverbal subjects.

"This study offers some support for the uniqueness of the mother providing the close contact of KC," the study authors conclude. "The difference in the male physique, especially the chest, may be perceived by the infant to be not that of a natural caregiver."

The Canadian Institutes of Health Research, the Quebec Health Research Fund, the Quebec Nursing Intervention Research Group, and the Alan Edwards Centre for the Study of Pain supported this study. The study authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2011;165:792-796.

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