Kangaroo Mother Care Effect on Crying Time during Clustered Painful Procedures in Full Term Neonates

Background: Full term neonates face many painful procedures shortly after birth. Repeated unrelieved procedural pain is related to detrimental physiologic and behavioral outcomes including long-term heightened pain or hyperalgesia, increased stress sensitivity, altered neurobehavioral development, and life threatening physiological reactivity. Pain management for full term neonates undergoing clustered painful procedures has not been tested. The Joint Commission mandates that interventions to reduce procedural pain in neonates be administered. One such intervention is Kangaroo Mother Care (KMC). The purpose of this study was to test the effect of KMC on crying time during clustered painful procedures (Hepatitis B vaccine injection and metabolic screening heel stick) in healthy full term neonates. Design and setting: A pilot randomized controlled trial was conducted in the postnatal department of a tertiary urban hospital. Sample: Sixteen healthy full term neonates were randomly assigned to either the intervention group (being with the mother in KMC before, during, and after the clustered painful procedures) or the control group (the neonate were in the crib in the nursery before, during, and after the clustered painful procedures). Methods: After obtaining the IRB approval, the department case manager daily screened the unit for the neonates who met the study inclusion criteria. The case manager recruited and provided the mothers with a brief explanation of the study. When a mother agreed on learning more about the study, the case manager contacted the researcher who visited the mother and provided a full explanation of the study. After the mothers signed the consent forms they were provided with a pre-sealed envelope that contained the study group in which the neonate will be assigned to. Intervention group neonates were held in KMC position before (10-15 minutes), during (injection and heel stick), and after (30 minutes) the clustered painful procedures. Control neonates were taken in their cribs to the nursery before (10-15 minutes), during (injection and heel stick), after (30 minutes) the clustered painful procedures. One staff nurse administered all painful procedures for neonates in both groups. A video camera was set up to record the whole procedure. For the intervention group, the camera was set up in the mother’s room. For the control group, the camera was set up in the nursery. After data collection was done, a research assistant viewed all the video tapes and recorded the crying time in seconds for each phase of the study using a stop watch. Data were entered to the SPSS for data analysis. Descriptive tests will be completed to provide a description of the sample. An independent t-test will be conducted to investigate the differences in the mean crying time between the two groups. Conclusion: KMC has been used as an effective non-pharmacological pain management intervention in full term neonates for one painful procedure. The results of this study could provide some evidence on the effectiveness of KMC during clustered painful procedures.