A new study suggests that very premature babies, born between 28 and 31 weeks, benefit from skin-to-skin contact with their mothers before and during painful procedures.
Skin-on-skin contact between a mother and her baby, commonly known as kangaroo mother care, has been proven to be effective at relieving pain among preemies born between 32 and 36 weeks.
However, the common assumption has been that it could not work on very premature babies because they are too underdeveloped to benefit from it.
The team from McGill University in Montreal that proved the effectiveness of KMC for the older preemies decided to test its effectiveness on the younger ones. They analyzed whether KMC could help the littlest preemies recover from the pain of a heel lance, where blood is drawn from a baby's heel.
The same babies were analyzed twice. First, researchers instructed mothers to hold their babies for 15 minutes prior to a heel lance, as well as throughout the duration of the test. During a second heel lance on another occasion, the babies were simply swaddled in their incubator before and after the test.
The researchers assessed the babies' pain levels using the Premature Infant Pain Profile (PIPP), which factors in facial expressions, heart rate and blood oxygen levels. These were measured just before the test, and then at 30-second intervals during and after.
The results showed that 90 seconds after the test, PIPP scores were considerably lower when babies had KMC.
Specifically, it took KMC babies only a couple of minutes to recover from the pain of the test, while babies who didn't receive KMC were still suffering three minutes after the test. Also, the facial expression of pain was evident less than half the time in babies who received KMC.
"The pain response in very preterm neonates appears to be reduced by skin-to-skin maternal contact," said researcher Celeste Johnston of McGill University.
"This response is not as powerful as it is in older preterm babies, but the shorter recovery time using KMC is important in helping maintain the baby's health."
Johnston also pointed out that providing KMC to her preemie could have benefits for a mother, who has a diminished role in her baby's life while the infant is in intensive care.
The findings were published Wednesday in the journal BMC Pediatrics.
Abstract:
Kangaroo mother care diminishes pain from heel lance in very preterm neonates: A crossover trial
C. Celeste Johnston, Francoise Filion, Marsha Campbell-Yeo, Celine Goulet, Linda Bell, Kathryn McNaughton, Jasmine Byron, Marilyn Aita, G. Allen Finley and Claire-Dominique Walker
Background: Skin-to-skin contact, or kangaroo mother care (KMC) has been shown to be efficacious in diminishing pain response to heel lance in full term and moderately preterm neonates. The purpose of this study was to determine if KMC would also be efficacious in very preterm neonates.
Methods: Preterm neonates (n=61) between 28 0/7 and 31 6/7 weeks gestational age in three Level III NICU's in Canada comprised the sample. A single-blind randomized crossover design was employed. In the experimental condition, the infant was held in KMC for 15 minutes prior to and throughout heel lance procedure. In the control condition, the infant was in prone position swaddled in a blanket in the incubator. The primary outcome was the Premature Infant Pain Profile (PIPP), which is comprised of three facial actions, maximum heart rate, minimum oxygen saturation levels from baseline in 30-second blocks from heel lance. The secondary outcome was time to recover, defined as heart rate return to baseline. Continuous video, heart rate and oxygen saturation monitoring were recorded with event markers during the procedure and were subsequently analyzed. Repeated measures analysis-of-variance was used to generate results.
Results: PIPP scores at 90 seconds post lance were significantly lower in the KMC condition (8.871 (95%CI 7.852-9.889) versus 10.677 (95%CI 9.563-11.792) p <.001) and non-significant mean differences ranging from 1.2 to1.8. favoring KMC condition at 30, 60 and 120 seconds. Time to recovery was significantly shorter, by a minute (123 seconds (95%CI 103-142) versus 193 seconds (95%CI 158-227). Facial actions were highly significantly lower across all points in time reaching a two-fold difference by 120 seconds post-lance and heart rate was significantly lower across the first 90 seconds in the KMC condition.
Conclusions: Very preterm neonates appear to have endogenous mechanisms elicited through skin-to-skin maternal contact that decrease pain response, but not as powerfully as in older preterm neonates. The shorter recovery time in KMC is clinically important in helping maintain homeostasis.
