Preterm neonates hospitalized in the neonatal intensive care unit undergo frequent painful procedures daily, often without pain treatment, with associated long-term adverse effects. Maternal-infant skin-to-skin contact, or kangaroo care (KC), and sweet-tasting solutions such as sucrose are effective strategies to reduce pain during a single procedure; however, evidence of sustained efficacy over repeated procedures is limited. We aimed to determine the relative sustained efficacy of maternal KC, administered alone or in combination with 24% sucrose, to reduce behavioral pain intensity associated with routine neonatal procedures, compared with 24% sucrose alone. Stable preterm infants (n = 242) were randomized to receive KC and water, KC and 24% sucrose, or 24% sucrose before all routine painful procedures throughout their neonatal intensive care unit stay. Pain intensity, determined using the Premature Infant Pain Profile, was measured during 3 medically indicated heel lances distributed across hospitalization. Maternal and neonatal baseline characteristics, Premature Infant Pain Profile scores at 30, 60, or 90 seconds after heel lance, the distribution of infants with pain scores suggesting mild, moderate, or severe pain, Neurobehavioral Assessment of the Preterm Infant scores, and incidence of adverse outcomes were not statistically significantly different between groups. Maternal KC, as a pain-relieving intervention, remained efficacious over time and repeated painful procedures without evidence of any harm or neurological impact. It seemed to be equally effective as 24% oral sucrose, and the combination of maternal KC and sucrose did not seem to provide additional benefit, challenging the existing recommendation of using sucrose as the primary standard of care.
Kangaroo care remained an efficacious intervention over repeated painful procedures. It was equally effective as sucrose and, when combined, did not provide additional benefit.
aDepartment of Pediatrics, Psychology and Neuroscience, School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
bCentre for Pediatric Pain Research, Isaac Walton Killam Health Centre, Halifax, NS, Canada
cIngram School of Nursing, McGill University, Montreal, QC, Canada
dSchool of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
eDepartment of Pediatrics, Dalhousie University, Halifax, NS, Canada
fNeuroscience Research Division, Douglas Institute, McGill University, Montreal, QC, Canada
gDepartment of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
hDepartment of Psychiatry, University of Toronto, Toronto, ON, Canada
iNeonatal Intensive Care Unit, IWK Health Centre Halifax, NS, Canada
Corresponding author. Address: School of Nursing, Faculty of Health, Dalhousie University, 5869 University Ave, PO Box 15000, Halifax, NS B3H 4R2, Canada. Tel.: 1 (902) 494-4283. E-mail address: email@example.com (M. Campbell-Yeo).
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Received February 26, 2019
Received in revised form May 24, 2019
Accepted May 28, 2019