April 24, 2008 -- Kangaroo mother care -- cuddling a premature baby close to the mother's skin -- lessens pain in even very preterm babies.
It works in premature infants of 32 to 36 weeks' gestation, according to an earlier study by Celeste Johnston, DEd, RN, and colleagues at McGill University School of Nursing.
But can it work in babies born as early as 28 weeks' gestation? The answer is a qualified yes, Johnston and colleagues now find.
These "very preterm" babies do seem to feel a bit less pain when cuddled by their mothers while nurses obtain blood samples from a heelstick. Even more importantly, the babies recover from the painful experience much faster when cuddled.
"The pain response in very preterm neonates appears to be reduced by skin-to-skin maternal contact," Johnston says in a news release. "This response [to cuddling] is not as powerful as it is in older preterm babies, but the shorter recovery time using kangaroo mother care is important in helping maintain the baby's health."
Kangaroo mother care was invented in 1978 by Colombian pediatrician Edgar Rey. Faced with a shortage of incubators, Rey found that mothers could use their own bodies to warm premature infants. Years of study show the technique to be at least as safe and effective as incubators, and it lessens mothers' anxiety while promoting mother/infant bonding and breastfeeding.
The technique calls for the tiny child to be held upright between the mothers' breasts and covered with a blanket. Because the child must be held upright against warm skin 24 hours a day, mothers can share kangaroo care with fathers and others.
The Johnston study enrolled babies who needed at least two blood draws via heelstick. They performed one heelstick while the baby lay in an incubator, and another while the baby was being held in kangaroo care. The babies' facial expressions were videotaped, and researchers monitored their vital signs.
It's hard to judge exactly how much pain a premature infant is feeling. The researchers used a scale called the premature infant pain profile, a composite measure of physiological and behavioral signs.
Unlike the older preemies, who felt less pain throughout the procedure when given kangaroo care, the very preterm infants in the current study felt less pain only 90 seconds after the heelstick when cuddled by their mothers. Even then, they had only 2 fewer points of pain on the 21-point scale.
More importantly, the very preterm babies recovered from the painful heelstick about a minute faster when held kangaroo-style than when left in the incubator. That's a sign the babies' bodies are beginning to self-regulate, a process known as homeostasis.
"The ability to recover quickly is a sign of ability to maintain homeostasis, a major task that the very preterm neonate must accomplish in order to grow and develop," Johnston and colleagues write.
"Mothers should be offered kangaroo mother care as neonatal intensive-care unit policy, not only to be close to their infant, but also to provide comfort," they add.
The findings appear in the April 23 issue of the online journal BMC Pediatrics.