Effects of Kangaroo Mother Care on Repeated Procedural Pain and Cerebral Oxygenation in Preterm Infants

Abstract

Objective The study aimed to investigate the effects of kangaroo mother care (KMC) on repeated procedural pain and cerebral oxygenation in preterm infants.

Study Design Preterm infants of 31 to 33 weeks of gestational age were randomly divided into an intervention group (n = 36) and a control group (n = 37). Premature infant pain profile (PIPP) scores, heart rate, oxygen saturation, regional cerebral tissue oxygenation saturation (rcSO₂), and cerebral fractional tissue oxygen extraction (cFTOE) were evaluated during repeated heel stick procedures. Each heel stick procedure included three phases: baseline, blood collection, and recovery. KMC was given to the intervention group 30 minutes before baseline until the end of the recovery phase.

Results Compared with the control group, the intervention group showed lower PIPP scores and heart rates, higher oxygen saturation, and rcSO₂ from the blood collection to recovery phases during repeated heel sticks. Moreover, there were significant changes in cFTOE for the control group, but not the intervention group associated with repeated heel stick procedures.

Conclusion The analgesic effect of KMC is sustained over repeated painful procedures in preterm infants, and it is conducive to stabilizing cerebral oxygenation, which may protect the development of brain function.

Key Points

• KMC stabilizes cerebral oxygenation during repeated heel sticks in preterm infants.

• The analgesic effect of KMC is sustained over repeated painful procedures in preterm infants.

• KMC may protect the development of brain function.

Keywords

preterm infants - kangaroo mother care - pain - cerebral oxygenation

Publikationsverlauf

Eingereicht: 14. Dezember 2020

Angenommen: 25. Mai 2021

Artikel online veröffentlicht:
30. Juni 2021

• References

• 1 Fernandez Rojas R, Huang X, Ou KL. A machine learning approach for the identification of a biomarker of human pain using fNIRS. Sci Rep 2019; 9 (01) 5645
• 2 Anand KJ. Clinical importance of pain and stress in preterm neonates. Biol Neonate 1998; 73 (01) 1-9
• 3 Hatfield LA. Neonatal pain: what's age got to do with it?. Surg Neurol Int 2014; 5 (Suppl. 13) S479-S489
• 4 Field T. Preterm newborn pain research review. Infant Behav Dev 2017; 49: 141-150
• 5 Mooney-Leber SM, Brummelte S. Neonatal pain and reduced maternal care: early-life stressors interacting to impact brain and behavioral development. Neuroscience 2017; 342: 21-36
• 6 Foster JP, Taylor C, Spence K. Topical anaesthesia for needle-related pain in newborn infants. Cochrane Database Syst Rev 2017; 2: CD010331
• 7 Nimbalkar SM, Chaudhary NS, Gadhavi KV, Phatak A. Kangaroo mother care in reducing pain in preterm neonates on heel prick. Indian J Pediatr 2013; 80 (01) 6-10
• 8 Cong X, Ludington-Hoe SM, Walsh S. Randomized crossover trial of kangaroo care to reduce biobehavioral pain responses in preterm infants: a pilot study. Biol Res Nurs 2011; 13 (02) 204-216
• 9 Dezhdar S, Jahanpour F, Firouz Bakht S, Ostovar A. The effects of kangaroo mother care and swaddling on venipuncture pain in premature neonates: a randomized clinical trial. Iran Red Crescent Med J 2016; 18 (04) e29649
• 10 Johnston C, Campbell-Yeo M, Disher T. et al. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2017; 2: CD008435
• 11 Kussman BD, Aasted CM, Yücel MA. et al. Capturing pain in the cortex during general anesthesia: near infrared spectroscopy measures in patients undergoing catheter ablation of arrhythmias. PLoS One 2016; 11 (07) e0158975
• 12 El-Nagger NSM, Bayoumi OR. Effect of applying nesting technique as a developmental care on physiological functioning and neurobehavioral organization of premature infants. JoLS 2016; 13 (1s): 79-92
• 13 Tane R, Rustina Y, Waluyanti FT. Nesting with fixation and position to facilitate quiet sleep and oxygen saturation on low-birth weight infants. Compr Child Adolesc Nurs 2019; 42 (Suppl. 01) 29-37
• 14 Stevens B, Johnston C, Petryshen P, Taddio A. Premature infant pain profile: development and initial validation. Clin J Pain 1996; 12 (01) 13-22
• 15 Stevens B, Johnston C, Taddio A, Gibbins S, Yamada J. The premature infant pain profile: evaluation 13 years after development. Clin J Pain 2010; 26 (09) 813-830
• 16 Gao H, Xu G, Gao H. et al. Effect of repeated kangaroo mother care on repeated procedural pain in preterm infants: a randomized controlled trial. Int J Nurs Stud 2015; 52 (07) 1157-1165
• 17 Choudhary M, Dogiyal H, Sharma D. et al. To study the effect of Kangaroo Mother Care on pain response in preterm neonates and to determine the behavioral and physiological responses to painful stimuli in preterm neonates: a study from western Rajasthan. J Matern Fetal Neonatal Med 2016; 29 (05) 826-831
• 18 Campbell-Yeo M, Johnston CC, Benoit B. et al. Sustained efficacy of kangaroo care for repeated painful procedures over neonatal intensive care unit hospitalization: a single-blind randomized controlled trial. Pain 2019; 160 (11) 2580-2588
• 19 Begum EA, Bonno M, Ohtani N. et al. Cerebral oxygenation responses during kangaroo care in low birth weight infants. BMC Pediatr 2008; 8: 51
• 20 Hwang MJ, Seol GH. Cerebral oxygenation and pain of heel blood sampling using manual and automatic lancets in premature infants. J Perinat Neonatal Nurs 2015; 29 (04) 356-362
• 21 Garvey AA, Kooi EMW, Smith A, Dempsey EM. Interpretation of cerebral oxygenation changes in the preterm infant. Children (Basel) 2018; 5 (07) E94
• 22 Alderliesten T, van Bel F, van der Aa NE. et al. Low Cerebral oxygenation in preterm infants is associated with adverse neurodevelopmental outcome. J Pediatr 2019; 207: 109-116.e2
• 23 Bergman NJ. The neuroscience of birth--and the case for zero separation. Curationis 2014; 37 (02) e1-e4
• 24 Bonan KC, Pimentel Filho JdaC, Tristão RM, Jesus JA, Campos Junior D. Sleep deprivation, pain and prematurity: a review study. Arq Neuropsiquiatr 2015; 73 (02) 147-154
• 25 Bastani F, Rajai N, Farsi Z, Als H. The effects of kangaroo care on the sleep and wake states of preterm infants. J Nurs Res 2017; 25 (03) 231-239