July 31, 2019 – For preterm infants in the newborn intensive care unit (NICU), skin-to-skin contact with the mother – sometimes called "kangaroo care" – reduces pain from repeated painful procedures, reports a study in PAIN®, the official publication of the International Association for the Study of Pain(IASP). The journal is published in the Lippincott portfolio by Wolters Kluwer.
Kangaroo care is just as effective as sucrose (sugar water) solution – the current standard for reducing pain in the NICU – with no apparent harmful effects on early infant development, according to the new research by Marsha Campbell-Yeo, PhD, NNP-BC, RN, of Dalhousie University, Halifax, Nova Scotia, Canada, and colleagues. "Kangaroo care remained an efficacious intervention over repeated painful procedures," the researchers write.
Reducing Pain in the NICU: Kangaroo Care, Sucrose, or Both?
Preterm infants in the NICU undergo frequent painful procedures: seven to 17 per day. Without treatment, these procedures have known harmful outcomes, ranging from immediate jumps in heart rate and blood pressure to long-lasting changes in pain sensitivity and brain development, as well as adverse effects on learning, behavior and emotional regulation.
In the study, 242 preterm infants (average gestational age 32 weeks) in stable clinical condition were randomly assigned to receive one of three treatments before all routine painful procedures: kangaroo care, 24% sucrose solution, or kangaroo care plus sucrose. In kangaroo care, the mother holds the infant upright on her bare chest.
Pain responses were assessed using a validated tool – the Premature Infant Pain Profile, which measures pain based on observable behaviors and facial expressions as well as changes in heart rate and oxygen levels – during three medically indicated blood-sampling (heel lance) procedures. Previous studies have shown that kangaroo care and sucrose are moderately effective strategies to reduce pain during a single procedure; the new study is the first to compare their useduring repeated procedures.
Average pain scores were similar between groups, suggesting that kangaroo care and sucrose solution were similarly effective in reducing pain. Combining the two techniques had no additional benefit. The percentage of infants rated as having mild, moderate or severe pain was also similar between groups. Few infants had severe pain; those who did were not significantly different across group assignment.
Neurodevelopmental assessment, including subscales of motor development, vigor and alertness, and orientation, were also similar between groups. Previous studies had suggested neurobehavioral effects in very preterm infants receiving very frequent doses of sucrose. The study is the first to show a sustained effect of kangaroo care in reducing pain responses alone or in combination with 24% sucrose, compared to 24% sucrose alone in preterm infants undergoing repeated "tissue-breaking" procedures in the NICU.
Dr. Campbell-Yeo and coauthors note previous studies reporting other benefits of kangaroo care for both the infant and parents. "Our findings challenge the existing recommendation of using sucrose as the primary standard of care for the management of repeated tissue-breaking procedures for preterm neonates undergoing procedural pain," the researchers conclude. "Clinicians should consider kangaroo care as at least an equivalent alternative."
PAINis IASP's official journal. Published monthly, PAINpresents original research on the nature, mechanisms, and treatment of pain. Available to IASP members as a membership benefit, this peer-reviewed journal provides a forum for the dissemination of multidisciplinary research in the basic and clinical sciences. It is cited in Current Contentsand Index Medicus.
About the International Association for the Study of Pain
IASP is the leading professional organization for science, practice, and education in the field of pain. Membership is open to all professionals involved in research, diagnosis, or treatment of pain. IASP has more than 7,000 members in 133 countries, 90 national chapters, and 20 special interest groups (SIGs). IASP brings together scientists, clinicians, health-care providers, and policymakers to stimulate and support the study of pain and translate that knowledge into improved pain relief worldwide.
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