Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: Pilot study

University of Connecticut School of Nursing, Storrs, CT 06269-2026, USA.
Early human development (Impact Factor: 1.79). 06/2009; 85(9):561-7. DOI: 10.1016/j.earlhumdev.2009.05.012
Source: PubMed


Heel stick is the most common painful procedure for preterm infants in neonatal intensive care units. Resultant pain causes adverse physiological effects in major organ systems. Kangaroo Care (KC), involving mother-infant skin-to-skin contact is a promising analgesic for infant pain; however, the effect of KC on the autonomic nervous system's response to pain is unknown.
To determine if KC results in improved balance in autonomic responses to heel stick pain than the standard method where infants remain in an incubator care (IC) for the heel stick.
A randomized cross-over trial.
Fourteen preterm infants, 30-32 weeks gestational age and less than 9 days postnatal age.
Infant behavioral state, heart rate, heart rate variability (HRV) indices including low frequency (LF) and high frequency (HF) power, and the LF/HF ratio measured over Baseline, Heel Warming, Heel Stick, and Recovery periods in KC and IC conditions.
HRV differences between KC and IC were that LF was higher in KC at Baseline (p<.01) and at Heel Stick (p<.001), and HF was higher in KC at Baseline than in the IC condition (p<.05). The LF/HF ratio had less fluctuation across the periods in KC than in IC condition and was significantly lower during Recovery in KC than in IC (p<.001).
Infants experienced better balance in response in KC than IC condition as shown by more autonomic stability during heel stick. KC may be helpful in mediating physiologic response to painful procedures in preterm infants.

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    • "KAMBARAMI et al. confirmed that kangaroo care could be a safe and effective way for shortening duration of premature neonate's admission in the hospital (20).Furthermore, the premature neonates admitted in NICU are subject to painful invasive procedures which might disturb their tranquility and undermine the immunity system. In this respect, Cong et al (2009), concluded through conducting a study that kangaroo care balances physiological response to painful procedures (21). During the interviews, the interviewers reminded the mothers of nurses' worries about not hastening when taking the premature neonate out of incubator and starting the kangaroo care. "
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    ABSTRACT: Introduction: Premature neonates admitted in NICU besides being separated from their mothers are prone to inevitably painful and stressful situations. Kangaroo care is the most effective method to get rid of this separation and its negative consequences. This study was performed to determine the experiences of mothers having premature neonates concerning Kangaroo care. Material and Methods: The present study is a qualitative research in which focus group discussion method is used for data collection. Research society consisted of mothers having premature neonates Research group reread and categorized the qualitative findings. Contents of interviews were analyzed using the conventional interpretation approach introduced by Dicklman Method. Results: Through content analysis of information emerged two major categories including mothers’ experiences about advantages of kangaroo care in interaction with neonate, and, feeling of physical-mental healthiness of neonate. Executive obstacles of kangaroo care from mothers’ standpoint were also discussed, which will be subsequently presented. Discussion: According to the obtained results, it seems vital to highlight kangaroo care as a safe and effective clinical care-taking treatment in nursery of premature neonates in all hospitals. Nurses shall provide all mothers with the needed instructions for holding the premature and lower-weight neonate properly on their chests and shall promote their knowledge level concerning positive effects of kangaroo care including induction of tranquil sleep, optimization of physiological conditions of neonate, and removal of suckling obstacles.
    Full-text · Article · Oct 2014 · International Journal of Pediatrics
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    • "Preterm neonates show cortical (1,2), biochemical (3), physiological (4,5), and behavioral (6,7) responses to painful procedures. Nonpharmacological management has been recommended for pain relief, such as nonnutritive sucking (8), breastfeeding (9,10), skin-to-skin contact (11,12), and sweetened solutions, including glucose (13), fructose (14), and sucrose (15-19). "
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    ABSTRACT: Sucrose solution is recommended as relevant pain relief management in neonates during acute painful procedures; however, only a few studies have analyzed the potentially adverse effects of sucrose administration to preterm neonates. The goal of this study was to examine the potential side effects of sucrose for pain relief in preterm infants, assessing feeding and weight gain during hospitalization and their feeding patterns postdischarge. The study sample consisted of 43 preterm neonates divided into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which no sucrose was administered. The SG received 0.5 mL/kg 25% oral sucrose for 2 min prior to all acute painful procedures during three consecutive days. A prospective review of medical charts was performed for all samples. The study was done prior to implementation of the institutional sucrose guidelines as a routine service, and followed all ethical requirements. There were no statistically significant differences between groups in terms of weight gain, length of stay with orogastric tubes, and parenteral feeding. Postdischarge, infant nutritional intake included feeding human milk to 67% of the SG and 74% of the CG. There were no statistically significant differences between groups regarding human milk feeding patterns postdischarge. Neonate feeding patterns and weight gain were unaffected following the short-term use of sucrose for pain relief.
    Full-text · Article · May 2014 · Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.]
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    • "Certaines techniques de soins non médicamenteuses comme le portage « kangourou », le « peau a ` peau » ou les périodes d'interaction avec la mère sont connues pour augmenter le confort de l'enfant [16] [17]. Notamment, le cocooning semble constituer un geste simple permettant de rassurer et d'améliorer le confort de l'enfant prématuré. "
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    ABSTRACT: Discomfort, pain, and stress have an adverse impact on the psychomotor development in the premature newborn infant. Recent studies indicate that pain and stress are associated with a reduction of parasympathetic outflow. We hypothesized that cocooning associated with the human voice has a favorable impact on parasympathetic activity in the premature newborn infant. We compared heart rate variability (HRV) before and after standardized cocooning phases associated with the human voice and carried out: 1) by the mother and 2) by a third person. HRV was assessed and expressed as an index reflecting the parasympathetic tone. Ten children were included (median gestational age, 33 weeks (30(+4)-33(+2))). We observed a higher HRV index after the period of cocooning associated with the human voice compared with the baseline measurement (P<0.05), whether the procedure was carried out by the mother or a third person. This study shows that cocooning associated with the human voice enhances HRV in the preterm newborn infant, indicating an increase in parasympathetic activity after cocooning associated with the human voice. However, the impact is similar whether the cocooning associated with the human voice is performed by the mother or a third person. This result suggests that cocooning associated with the human voice carried out either by the mother or a third person contributes to decreasing stress and discomfort in the premature newborn infant.
    Full-text · Article · Jul 2013 · Archives de Pédiatrie
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