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Influence of Holding Practice on Preterm Infant Development

Neu, Madalynn PhD, RN; Robinson, JoAnn PhD; Schmiege, Sarah J. PhD

MCN: The American Journal of Maternal/Child Nursing: May/June 2013 - Volume 38 - Issue 3 - p 136–143
doi: 10.1097/NMC.0b013e31827ca68c

Purpose: The purpose of this randomized, controlled trial was to determine if nurse-supported kangaroo holding of healthy preterm infants in the first 8 weeks of the infant's life facilitates early behavioral organization and development.

Methods: We randomized 87 infants born between 32 and 35 weeks gestation and their mothers to one of three holding groups: kangaroo (skin-to-skin between mother's breasts), blanket (held in mother's arms), or control (no holding restrictions). Nurse-supported groups (kangaroo and blanket) received 8 weekly visits from a registered nurse who encouraged holding and provided education about infant development. The control group received brief social visits. Mothers recorded time held in a daily diary. The Assessment of Preterm Infant Behavior was administered when infants were 40 to 44 weeks postconceptional age.

Results: Total holding time averaged 4 to 5 hr/day and did not differ among groups. Mothers held kangaroo style an average of 59 min/day in the kangaroo group, and 5 and 9 min/day in the blanket and control groups, respectively (p < .001). Infants in the kangaroo and blanket groups had more optimal scores than the control group in Robust Crying (p = .015) indicating that they could arouse to vigorous crying and calm. Scores, except for Attention and State Regulation, were at least as high as those of full-term infants.

Clinical Implications: When kangaroo holding is compared to blanket holding, both methods may provide equal early behavioral organization and developmental benefit to the infant.

Holding is an intervention performed naturally by mothers and found to enhance regulation in infants.

Madalynn Neu, PhD, RN, is an Assistant Professor at University of Colorado College of Nursing, Aurora, CO. She can be reached via e-mail at

JoAnn Robinson, PhD, is a Professor at Department of Human Development and Family Studies, University of Connecticut, Storrs, CT.

Sarah J. Schmiege, PhD, is an Assistant Professor at Department of Biostatistics and Informatics, University of Colorado, Aurora, CO.

The authors declare no conflict of interest.

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