Effects of Skin-to-Skin Contact on Autonomic Pain Responses in Preterm Infants

School of Nursing, University of Connecticut, Storrs, Connecticut 06269-2026, USA.
The journal of pain: official journal of the American Pain Society (Impact Factor: 4.22). 05/2012; 13(7):636-45. DOI: 10.1016/j.jpain.2012.02.008
Source: PubMed

ABSTRACT The purpose of this randomized crossover trial was to determine the effects on autonomic responses in preterm infants of longer Kangaroo Care (30 minutes, KC30) and shorter KC (15 minutes, KC15) before and throughout heel stick compared with incubator care (IC). Beat-to-beat heart rate (HR) and spectral power analysis of heart rate variability, low frequency power (LF), high frequency power (HF), and LF/HF ratio were measured in 26 infants. HR changes from Baseline to Heel Stick were significantly less in KC30 and KC15 than in IC, and more infants had HR decrease in IC than in 2 KC conditions. In IC, LF and HF significantly increased from Baseline to Heel Stick and dropped from Heel Stick to Recovery; in 2 KC conditions, no changes across study phases were found. During Heel Stick, LF and HF were significantly higher in IC than in KC30. In all 3 conditions, LF/HF ratio decreased from Baseline to Heel Stick and increased to Recovery; no differences were found between IC and two KC conditions. Both longer and shorter KC before and throughout heel stick can stabilize HR response in preterm infants, and longer KC significantly affected infants' sympathetic and parasympathetic responses during heel stick compared with incubator care. PERSPECTIVE: This study showed that KC has a significant effect on reducing autonomic pain responses in preterm infants. The findings support that KC is a safe and effective pain intervention in the neonatal intensive care unit.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Preterm birth is associated with long-term deficits in executive functioning and cognitive performance. As advances in neonatal care enable more preterm infants to survive, development of strategies to address high rates of neurodevelopmental disabilities and poor academic achievement in preterm infants are crucial. Evidence suggests that infants' brains are plastic in nature and, therefore, can be shaped by the environment. Kangaroo care has become popularized as a means of modifying the stress of the NICU environment. However, few studies have examined whether kangaroo care affects neurodevelopmental outcomes in preterm infants. This review examined available literature that investigated the effect of kangaroo care on cognition in preterm infants. Current evidence suggests that short-term benefits of kangaroo care are associated with improved neurodevelopment. However, few studies have examined the long-term impact of kangaroo care on cognitive outcomes in preterm infants. To address neurological disparities in children born preterm, research using kangaroo care as a strategy to improve neurodevelopment in preterm infants is warranted.
    The Journal of perinatal & neonatal nursing 10/2014; 28(4):290-9. DOI:10.1097/JPN.0000000000000062 · 1.01 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Skin-to-skin contact reduces pain response in preterm infants subjected to minor painful procedures, such as heel lance. Diaper change is a procedure performed several times daily in hospitalized preterm infants. Routine care giving tasks such as diaper change may be stressful for the infant. Aims The purpose of this study was to investigate whether diaper change induces stress and if skin-to-skin contact could reduce such stress, measured by changes in skin conductance. Study design This was a randomized crossover pilot study in 19 preterm infants with gestational age between 28 and 34 weeks. The diaper change procedure was done twice in each infant, once during skin-to-skin contact, and once in incubator or bed with the mother present. Outcome measures During diaper change heart rate (HR), peripheral oxygen saturation (SpO2), and changes in skin conductance (SC) peaks per sec, using the Skin Conductance Algesimeter (SCA), were registered. Results The mean SC peaks/sec increased/decreased significantly under/after change of diapers which thereby underpins that this is a stressful procedure for the preterm infant. Skin-to-skin contact (SSC) entails significantly lower stress levels (p < 0.05) compared to diaper changed in an incubator/bed measured by the SCA. Conclusions Diaper change is a stressful procedure for preterm infants and may be ameliorated by skin-to-skin contact.
    Early human development 04/2014; DOI:10.1016/j.earlhumdev.2014.01.011 · 1.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite growing knowledge, neonatal pain remains unrecognized, undertreated, and generally challenging. A cross-sectional survey study was conducted to investigate neonatal nurses' perceptions, knowledge, and practice of infant pain in the United States and China, including 343 neonatal nurses (American nurses [n = 237]; Chinese nurses [n = 106]). Nurses' responses regarding neonatal pain reflected adequate knowledge in general pain concepts, but knowledge deficits related to several topics were found (e.g., preterm infants are more sensitive to pain and long-term consequences of pain). Most reported regular use of pain assessment tools, but fewer agreed that the tool used was appropriate and accurate. More American nurses (83%) than Chinese nurses (58%) felt confident in the use of pain medications, while more Chinese nurses (78%) than American nurses (61%) acknowledged the effectiveness of nonpharmacologic interventions. About half reported that pain in their units was well managed (American: 44.3%; Chinese: 55.7%), and less than half felt that pain guidelines/protocols were research-based (American: 42.6%; Chinese: 34.9%). Nurses' perceptions of well-managed pain in their units were significantly correlated with adequate education/training, use of accurate tools, and use of research-based protocols. Barriers to effective pain management included resistance to change, lack of knowledge, lack of time, fear of side effects of pain medication, and lack of trust in the tools. The survey reflects concerns that pain has not been well managed in many neonatal intensive care units in the United States and China. Further actions are needed to solve the issues of inadequate training, lack of clinically feasible pain tools, and absence of evidence-based guidelines/protocols.
    Pain management nursing: official journal of the American Society of Pain Management Nurses 02/2014; DOI:10.1016/j.pmn.2013.10.002 · 1.79 Impact Factor


Available from
May 22, 2014