Table 7.
Evidence for parent-delivered interventions: skin-to-skin contact.
| Author (year), country | Study design | Population, setting | Type of pain, intervention | Key findings |
|---|---|---|---|---|
| Gray et al. (89), USA | RCT | 30 full-term infants, maternity ward | Heel lance, SSC mother vs. control (swaddled in crib) | Crying and grimacing were reduced by 82 and 65%, respectively |
| Ludington-Hoe et al. (90), USA | RCT | 24 premature infants, NICU | Heel stick, SSC mother vs. incubator care | Heart rate and crying responses to pain were significantly reduced |
| Castral et al. (91), Brazil | RCT | 59 premature infants, GA 30–36 weeks, NICU | Heel prick, SSC mother vs. incubator care | Infants who received skin-to-skin contact were more likely to have lower NFCS scores. Changes in crying time and heart rate were less for the treated infants |
| Freire et al. (92), Brazil | RCT | 95 preterm infants, GA 28–36 weeks, NICU | Heel lance, SSC mother vs. control (no intervention) | Lower PIPP score |
| Johnston et al. (93), Canada | Randomized crossover | 61 preterm neonates, GA 28–31 weeks, NICU | Heel lance, SSC mother vs. control (swaddled in incubator) | Lower PIPP score, shorter recovery time |
| Kostandy et al. (94), USA | Pilot study, randomized crossover | 10 premature infants, GA 30–32 weeks, NICU | Heel stick, SSC mother vs. incubator care | Reduced crying time |
| Cong et al. (95), USA | Pilot study, randomized crossover | 14 preterm infants, GA 30–32 weeks, NICU | Heel stick, SSC mother vs. incubator care | More autonomic stability |
| Johnston et al. (67), Canada | Randomized crossover | 90 preterm infants, GA 32–36 weeks, NICU | Heel lance, SSC mother vs. enhanced SSC with rocking, infant-directed speech/infant-directed singing and sucking | PIPP score in both groups in the minor pain strata but no difference between groups |
| Cong et al. (96), USA | Randomized crossover | 18 + 10 preterm infants, GA 30–32 weeks, NICU | Heel stick, SSC mother 80 or 30 min vs. incubator care | 30 min SSC reduced PIPP score and cortisol levels |
| Fernandes et al. (97), Portugal | RCT | 110 preterm infants, GA 28–36 weeks, NICU | Venipuncture, SSC mother + sucrose and pacifier vs. sucrose and pacifier | Reduced grimacing |
| Saeidi et al. (98), Iran | RCT | 60 full-term newborns, maternity ward | Vaccination, SSC mother vs. control (infant wrapped in a blanket and put near the bed of the mother) | Lower NIPS score and crying duration |
| Cong et al. (99), USA | Case study | 2 preterm twins, GA 28 weeks, NICU | Heel stick, SSC mother for 15 or 30 min vs. incubator care | Lower PIPP score and shorter crying time, better autonomic stability |
| Cong et al. (100), USA | Randomized crossover | 26 preterm infants, GA 28–32 weeks, NICU | Heel stick, SSC mother for 15 or 30 min vs. incubator care | Better autonomic stability |
| Del Rey Hurtado de Mendoza et al. (36), Spain | RCT | 136 term newborns, tertiary public hospital | Heel lance, SSC mother vs. sucrose vs. SSC + breastfeeding vs. SSC + sucrose | Lower NIPS score in the group with SSC and breastfeeding than in the other groups |
| Johnston et al. (101), Canada | Randomized crossover | 18 preterm neonates, GA 28–37 + 2, NICU | Heel lance, SSC mother vs. SSC unrelated alternative female | Non-related women are marginally less effective than mothers at decreasing pain response |
| Memarizadeh et al. (102), Iran | RCT | 20 premature infants, GA 27–36 weeks, NICU | Heel stick, SSC mother vs. incubator care | Lower PIPP score |
| Kostandy et al. (103), USA | RCT | 36 full-term infants, postpartum unit | Vaccine, SSC mother vs. control (lying in cot) | Shorter crying time during recovery |
| Mitchell et al. (69), USA | RCT | 38 preterm infants, GA 27–30 weeks, NICU | Tracheal or nasal suctioning, SSC over 5 days vs. standard care in incubator | No significant difference in cortisol |
| Nanavati et al. (57), India | RCT | 50 WLBV infants, NICU | Adhesive tape removal, SSC mother vs. expressed breast milk | PIPP score indicated minor or no pain. No difference compared to expressed breast milk group |
| Nimbalkar et al. (104), India | Randomized crossover | 50 preterm neonates, GA 32–36 weeks, NICU | Heel prick, SSC mother vs. control (swaddled in cot) | Lower heart rate and PIPP score |
| Pasquier et al. (105), Canada | RCT | 60 full-term infants after cesarian section, delivery unit | Vitamin K injection, SSC mother vs. support and monitoring (control) | Lower NIPS score, smaller variations in salivary cortisol |
| Campo et al. (70), Phillipines | RCT | 31 full-term infants, maternity unit | Heel prick, SSC mother vs. mothers holding the dressed infant in their arms | No significant difference in HR, SaO2, or NIPS score |
| Chidambaram et al. (106), India | Crossover | 100 preterm infants, GA 32–26 weeks, NICU | Heel prick, SSC mother vs. control (no intervention) | Lower PIPP score |
| Mosayebi et al. (107), Iran | Randomized crossover | 64 preterm infants, GA 30–36 weeks, NICU | Heel lance, SSC mother vs. incubator care (swaddled) | Lower PIPP score |
| Gao et al. (108), China | RCT | 75 preterm infants, GA <37 weeks, NICU | Repeated heel stick, repeated SSC mother vs. incubator group | Lower heart rate, shorter crying time and facial grimacing. Stable effect over repeated heel sticks |
| Padhi et al. (71), India | Prospective pilot study | 20 premature infants, mean GA 30.8 weeks, NICU | Eye examination, reversed SSC mother | Significantly lower change in RR during reversed SSC |
| Liu et al. (109), China | RCT | 40 full-term newborns, obstetric ward | Heel stick, SSC mother vs. control (wrapped in clothes) | Reduced DAN score, lower HR, better SaO2 and shorter crying time |
| Rad et al. (110), Iran | Case-control | 55 newborn infants, 15–60 days old, children's clinic | Infantile colic, SSC mother at home at least 2 h/day vs. no intervention | Reduced restlessness and fussiness |
| Choudhary et al. (111), India | Crossover | 140 preterm infants GA <37 weeks, NICU | Heel lance, SSC mother vs. no intervention | Shorter duration of cry, lower PIPP score |
| Dezhdar et al. (112), Iran | RCT | 90 preterm infants, GA >37 weeks, NICU | Venipuncture, SSC mother vs. swaddling vs. no intervention group (control) | Lower PIPP score 60 s after venipuncture |
| Hoxha et al. (113), Albania | RCT | 40 term infants, NICU | Heel lance, SSC mother vs. sucrose vs. non-nutritive sucking vs. no intervention group (control) | Shorter cry duration, lower HR and RR, and higher SaO2 |
| Leite et al. (75), Brazil | RCT | 55 full-term newborns, maternity ward | Hepatitis B vaccination, SSC vs. breastfeeding with SSC | Breastfeeding in combination with SSC showed lower HR than breastfeeding alone. Lower NFCS after the injection |
| Olsson et al. (114), Sweden | Randomized crossover | 10 premature infants, GA 26–35 weeks, NICU | Venipuncture, SSC mother with oral glucose vs. lying in cot with oral glucose | Lower increase in NIRS variables |
| Seo et al. (115), South Korea | Unclear | 56 full-term infants, nursery | Heel stick, SSC mother vs. control (no intervention) | Lower PIPP score, shorter duration of crying, lower HR |
| Fallah et al. (45), Iran | RCT | 120 term neonates, maternity ward | BCG vaccination, SSC mother vs. breastfeeding vs. swaddling | NIPS score was lower with breastfeeding than in the SSC and swaddling groups |
| Ferrara et al. (116), Uganda | Pilot study | 131 full-term infants, maternity ward | Vitamin K injection, SSC mother vs. routine care (examination table) | Bigger proportion had low NIPS score |
| Murmu et al. (117), India | Crossover | 51 preterm neonates, GA 30–36 weeks, NICU | Heel lance, SSC mother vs. SSC alternative female vs. swaddling | Lower PIPP score in both groups compared to swaddling |
| Shukla et al. (68), India | RCT | 100 preterm neonates, GA 29–36 weeks, NICU | Heel stick, SSC mother vs. sucrose | No difference in PIPP score compared with sucrose |
| Soltani et al. (51), Iran | RCT | 161 full-term infants, pediatric ward | Heel prick, SSC vs. breastfeeding vs. oral dextrose vs. EMLA cream | Higher NIPS score than in the breastfeeding group |
| Hurley et al. (118), Canada | RCT | 242 preterm infants, GA <37 weeks, NICU | Heel lance, SSC mother vs. SSC with sucrose vs. sucrose | No difference in PIPP score compared with sucrose |
| Kristoffersen et al. (66), Norway | RCT | 35 preterm infants, GA <32 weeks, NICU | Eye examination, SSC mother/father vs. standard care with supportive positioning by parents | No difference in PIPP score |
| Campbell-Yeo et al. (119), Canada | RCT | 242 preterm infants, GA <37 weeks, NICU | Heel stick, SSC mother vs. sucrose vs. SSC mother and sucrose combined | No difference in PIPP score compared with sucrose |
| Jones (2020), UK | Observational | 27 infants, GA 23–41 weeks, neonatal unit | Heel lance, SSC mother vs. held by parent with clothing vs. control (lying in cot) | Reduced magnitude in noxious-related cortical activity (EEG) more than did holding or no intervention |
| Nimbalkar et al. (120), India | RCT | 100 preterm neonates, GA 28–36 weeks, NICU | Heel stick, SSC mother vs. sucrose | No difference in PIPP score compared with sucrose |
RCT, randomized control trial; SCC, skin-to-skin contact; NICU, neonatal intensive care unit; GA, gestational age; NFCS, Neonatal Facial Coding System; PIPP, premature infant pain profile; NIPS, Neonatal Infant Pain Score; VLBW, very low birth weight; HR, heart rate; SaO2, oxygen saturation; RR, respiration rate; DAN, Douleur Aiguë Nouveau-né; EEG, electroencephalogram.