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C. Celeste Johnston, DEd, RN; Bonnie Stevens, PhD, RN; Janet Pinelli, DNS, RN; Sharyn Gibbins, PhD, RN; Francoise Filion, MS, RN; Anne Jack, MS, RN; Susan Steele, RN; Kristina Boyer, MSc(A), RN; Annie Veilleux, MD

Arch Pediatr Adolesc Med. 2003;157:1084-1088.

Objective  To test the efficacy of maternal skin-to-skin contact, or kangaroo care (KC), on diminishing the pain response of preterm neonates to heel lancing.

Design  A crossover design was used, in which the neonates served as their own controls.

Subjects  Preterm neonates (n = 74), between 32 and 36 weeks' postmenstrual age and within 10 days of birth, who were breathing without assistance and who were not receiving sedatives or analgesics in 3 level II to III neonatal intensive care units in Canada.

Interventions  In the experimental condition, the neonate was held in KC for 30 minutes before the heel-lancing procedure and remained in KC for the duration of the procedure. In the control condition, the neonate was in the prone position in the isolette. The ordering of conditions was random.

Main Outcome Measures  The primary outcome was the Premature Infant Pain Profile, which is composed of 3 facial actions, maximum heart rate, and minimum oxygen saturation changes from baseline in 30-second blocks. Videotapes, taken with the camera positioned on the neonate's face so that an observer could not tell whether the neonate was being held or was in the isolette, were coded by research assistants who were naïve to the purpose of the study. Heart rate and oxygen levels were continuously monitored into a computer for later analysis. A repeated-measures analysis of covariance was used, with order of condition and site as factors and severity of illness as a covariate.

Results  Premature Infant Pain Profile scores across the first 90 seconds from the heel-lancing procedure were significantly (.002<P<.04) lower by 2 points in the KC condition.

Conclusions  For preterm neonates who are 32 weeks' postmenstrual age or older, KC seems to effectively decrease pain from heel lancing. Further study is needed to determine if younger neonates or those requiring assistance in breathing, or older infants or toddlers, would benefit from KC, or if it would remain effective over several procedures. Given its effectiveness, and that parents of neonates in critical care units want to participate more in comforting their children, KC is a potentially beneficial strategy for promoting family health.

From the School of Nursing, McGill University (Dr Johnston, Mr Filion, and Ms Boyer), and the Department of Neonatology, Hopital Sainte Justine (Dr Veilleux), Montreal, Quebec; Faculty Nursing, University of Toronto (Dr Stevens and Ms Jack), the Department of Nursing, Hospital for Sick Children (Dr Stevens and Ms Boyer), and Sunnybrook and Women's College Health Sciences Centre (Dr Gibbins), Toronto, Ontario; and Department of Neonatology, McMaster University, Hamilton, Ontario (Dr Pinelli and Ms Steele).

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