Paternal vs Maternal Kangaroo Care for Procedural Pain in Preterm Neonates A Randomized Crossover Trial

Objective: To test paternal vs maternal kangaroo care (KC) to reduce pain from heel lance. Design: Randomized crossover design. Setting: Three university-affiliated level III neonatal intensive care units. Patients: Sixty-two preterm neonates at 28 to 36 weeks' gestational age who were expected to stay in the neonatal intensive care unit for at least 2 blood sampling procedures, without major congenital anomalies, grade III or IV intraventricular hemorrhage, or periventricular leukomalacia; without surgical interventions; not receiving parenteral analgesics or sedatives within 72 hours; and with parental consent. Intervention: During 2 separate medically ordered heel lance procedures at least 24 hours apart, infants were held in KC for 30 minutes before and during the procedure with the mother or with the father, and with the other parent in the subsequent session. Which parent came first was randomized. Main Outcome Measures: The Premature Infant Pain Profile and time for heart rate to return to baseline were the primary outcomes. Results: At 30 and 60 seconds after the heel lance, infants in maternal KC displayed significantly lower scores on the Premature Infant Pain Profile than when in paternal KC(30 seconds mean difference, 1.435 [95% confidence interval, 0.232-2.632]); 60 seconds mean difference, 1.548[95% confidence interval, 0.069-3.027]). At 90 and 120 seconds, there were no differences. The difference in time to return to KC heart rate before the heel lance was significant, with the time in maternal KC being 204 seconds and in paternal KC, 246 seconds (mean difference, 42 seconds[95% confidence interval, 5.16-81.06 seconds]). Conclusions: Mothers were marginally more effective than fathers in decreasing pain response. Future research should address feasibility issues and nonparent providers of KC during painful procedures.