Skin-to-Skin Care for Procedural Pain in Neonates

Summary

A Cochrane review [Abstract] 1 included 25 studies with a total of 2 001 infants. Nineteen studies used heel lance as the painful procedure, one study combined venepuncture and heel stick, 3 used intramuscular injection, one used vaccination, and one used tape removal.

Seventeen studies (n = 810) compared skin-to-skin care (SSC) to a no-treatment control. Although 15 studies measured heart rate during painful procedures, data from only 5 studies (n = 161) could be combined to give a mean difference (MD) of -10.78 beats per minute (95% CI -13.63 to -7.93) favouring SSC. Meta-analysis of 4 studies showed no difference in heart rate following the painful procedure (MD 0.08, 95% CI −4.39 to 4.55; n=120). Two studies (n=38) reported heart rate variability outcomes and found no significant differences. Two studies (n = 101) in a meta-analysis on oxygen saturation at 30 and 60 seconds following the painful procedure did not show a difference. SSC reduced duration of crying due to heel lance (MD −34.16, 95% CI −42.86 to −25.45; 2 studies, n=33), and following intramuscular injection (MD −8.83, 95% CI −14.63 to −3.02; 2 studies, n=100). Five studies used the Premature Infant Pain Profile (PIPP) as a primary outcome, which favoured SCC at 30 seconds (MD -3.21, 95% CI -3.94 to -2.47; n=267), 60 seconds (MD -1.64, 95% CI -2.86 to -0.43; n=156), and 90 seconds (MD -1.28, 95% CI -2.53 to -0.04; n=156), but at 120 seconds there was no difference (MD 0.07, 95% CI −1.11 to 1.25; n=156). No studies on return of heart rate to baseline level, cortisol levels, and facial actions could be combined for meta-analysis.

Eight studies compared SSC to another intervention with or without a no-treatment control. Two cross-over studies (n = 80) compared mother versus other provider on PIPP scores with no significant difference. One study (n=640) compared SSC with and without dextrose and found that the combination was most effective and that SSC alone was more effective than dextrose alone. Similarly, in another study (n=95) SSC was more effective than oral glucose for heart rate. SSC either in combination with breastfeeding or alone was favoured over a no-treatment control, but was not different to breastfeeding. One study (n=127) compared SSC alone and in combination with both sucrose and breastfeeding on heart rate (HR), Neonatal Infant Pain Scale (NIPS) scores, and crying time. The combinations were more effective than SSC alone for NIPS and crying. Expressed breast milk was compared to SSC in one study (n = 50) and found both equally effective on PIPP scores. There were not enough participants with similar outcomes and painful procedures to compare age groups or duration of SSC. No adverse events were reported in any of the studies.