TORONTO: Swaddling a tiny premature baby against the skin of a parent - a technique known as "kangaroo care" - can help the infant cope with the pain inflicted by necessary medical procedures, a new study suggests.
The research shows that the technique - which has already been shown to be effective in full-term babies and moderately premature infants - is also helpful with those born very pre-term, between 28 and 32 weeks of gestation.
"We found that babies in skin-to-skin contact with their mothers showed less pain response than when they were in the incubator" when they were undergoing a procedure, said lead author Celeste Johnston, a nursing professor at Montreal's McGill University.
"The effect was significant and we were surprised to find that in babies this young."
The study was published Thursday in the journal BMC Pediatrics.
The options for pain control are limited for infants born so prematurely. Anesthetic creams applied to numb the skin don't appear to work in these babies and morphine would not be given for routine but painful procedures like the lancing of a heel to take blood or the insertion of an intravenous line.
Breastfeeding has been found to help infants cope with pain, but very pre-term babies may not be able to breastfeed. So Johnston and colleagues set out to study whether a technique known as KMC - kangaroo mother care - could help them through painful procedures. (While the study was done using mothers, kangaroo care can be provided by fathers too.)
Kangaroo care started in South America as a way to deal with a shortage of incubators, Johnston explained in an interview. It was thought that skin-to-skin contact between a baby and a parent might be a substitute for the heat that incubators provide to babies too tiny to regulate their own body temperature.
"The baby only has on a diaper. The mother's bare chested. And then they would wrap a blanket or a cloth, a swaddling cloth, around the mother and the baby," Johnston explained. "And the baby then is kept warm on the mother's chest."
The technique is now sometimes used in neonatal units to help infants bond with their parents.
But it was noticed that babies in kangaroo care were in a calmer state, with better blood oxygen levels and lower heart rates. So Johnston and her co-authors wanted to see if the technique could help preemies cope with pain, which sends heart rates racing and blood oxygen levels plummeting.
No one enjoys pain. But in these fragile infants, pain inflicts a cost.
"When painful thing happen to them, that destabilizes them," Johnston said. "Their heart rates go way up, their sats (oxygen saturation levels) go way down."
"When their heart rate goes up like that when something painful happens to them, then that's taking away energy that they could be using to be growing, if you will."
It wasn't clear, though, that infants this young had yet developed the mechanisms that would allow them to benefit from the technique - responses like the ability to produce pain-killing endorphins. For that reason Johnston and her colleagues weren't sure kangaroo care would work with these babies.
However, in a trial where some infants underwent procedures while in kangaroo care and others while simply in an incubator, the swaddled infants recovered more quickly and seemed to be in less pain.
The effect was not as pronounced as with babies born closer to term. But Johnston said it still makes sense to consider the technique in the younger preemies.
"Well, I think so. I mean, what's the alternative? It's better than not being in kangaroo care," she said.
"It's kind of a natural way to go. It doesn't cost anything. (And) the mothers feel much better about doing it."
The research shows that the technique - which has already been shown to be effective in full-term babies and moderately premature infants - is also helpful with those born very pre-term, between 28 and 32 weeks of gestation.
"We found that babies in skin-to-skin contact with their mothers showed less pain response than when they were in the incubator" when they were undergoing a procedure, said lead author Celeste Johnston, a nursing professor at Montreal's McGill University.
"The effect was significant and we were surprised to find that in babies this young."
The study was published Thursday in the journal BMC Pediatrics.
The options for pain control are limited for infants born so prematurely. Anesthetic creams applied to numb the skin don't appear to work in these babies and morphine would not be given for routine but painful procedures like the lancing of a heel to take blood or the insertion of an intravenous line.
Breastfeeding has been found to help infants cope with pain, but very pre-term babies may not be able to breastfeed. So Johnston and colleagues set out to study whether a technique known as KMC - kangaroo mother care - could help them through painful procedures. (While the study was done using mothers, kangaroo care can be provided by fathers too.)
Kangaroo care started in South America as a way to deal with a shortage of incubators, Johnston explained in an interview. It was thought that skin-to-skin contact between a baby and a parent might be a substitute for the heat that incubators provide to babies too tiny to regulate their own body temperature.
"The baby only has on a diaper. The mother's bare chested. And then they would wrap a blanket or a cloth, a swaddling cloth, around the mother and the baby," Johnston explained. "And the baby then is kept warm on the mother's chest."
The technique is now sometimes used in neonatal units to help infants bond with their parents.
But it was noticed that babies in kangaroo care were in a calmer state, with better blood oxygen levels and lower heart rates. So Johnston and her co-authors wanted to see if the technique could help preemies cope with pain, which sends heart rates racing and blood oxygen levels plummeting.
No one enjoys pain. But in these fragile infants, pain inflicts a cost.
"When painful thing happen to them, that destabilizes them," Johnston said. "Their heart rates go way up, their sats (oxygen saturation levels) go way down."
"When their heart rate goes up like that when something painful happens to them, then that's taking away energy that they could be using to be growing, if you will."
It wasn't clear, though, that infants this young had yet developed the mechanisms that would allow them to benefit from the technique - responses like the ability to produce pain-killing endorphins. For that reason Johnston and her colleagues weren't sure kangaroo care would work with these babies.
However, in a trial where some infants underwent procedures while in kangaroo care and others while simply in an incubator, the swaddled infants recovered more quickly and seemed to be in less pain.
The effect was not as pronounced as with babies born closer to term. But Johnston said it still makes sense to consider the technique in the younger preemies.
"Well, I think so. I mean, what's the alternative? It's better than not being in kangaroo care," she said.
"It's kind of a natural way to go. It doesn't cost anything. (And) the mothers feel much better about doing it."
Provided by: The Canadian PressWritten by: Helen Branswell, Medical Reporter, THE CANADIAN PRESSApr. 23, 2008
