Influence of Holding Practice on Preterm Infant Development

Purpose: The purpose of this randomized, controlled trial was to determine if nurse-supported kangaroo holding of healthy preterm infants in the first 8 weeks of the infant's life facilitates early behavioral organization and development. Methods: We randomized 87 infants born between 32 and 35 weeks gestation and their mothers to one of three holding groups: kangaroo (skin-to-skin between mother's breasts), blanket (held in mother's arms), or control (no holding restrictions). Nurse-supported groups (kangaroo and blanket) received 8 weekly visits from a registered nurse who encouraged holding and provided education about infant development. The control group received brief social visits. Mothers recorded time held in a daily diary. The Assessment of Preterm Infant Behavior was administered when infants were 40 to 44 weeks postconceptional age. Results: Total holding time averaged 4 to 5 hr/day and did not differ among groups. Mothers held kangaroo style an average of 59 min/day in the kangaroo group, and 5 and 9 min/day in the blanket and control groups, respectively (p < .001). Infants in the kangaroo and blanket groups had more optimal scores than the control group in Robust Crying (p = .015) indicating that they could arouse to vigorous crying and calm. Scores, except for Attention and State Regulation, were at least as high as those of full-term infants. Clinical Implications: When kangaroo holding is compared to blanket holding, both methods may provide equal early behavioral organization and developmental benefit to the infant.