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Sustained efficacy of kangaroo care for repeated painful procedures over neonatal intensive care unit hospitalization

a single-blind randomized controlled trial

Campbell-Yeo, Marshaa,b,*; Johnston, C. Celestec; Benoit, Britneyb,d; Disher, Timothyb,d; Caddell, Kimb; Vincer, Michaelb,e; Walker, Claire-Dominiquef; Latimer, Margotb,d; Streiner, David L.g,h; Inglis, Darlenei

doi: 10.1097/j.pain.0000000000001646
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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: marsha.campbell-yeo@dal.ca (M. Campbell-Yeo).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received February 26, 2019

Received in revised form May 24, 2019

Accepted May 28, 2019

© 2019 International Association for the Study of Pain