Does daily kangaroo care provide sustained pain and stress relief in preterm infants?

A.J. Mitchell∗, C.C. Yates, D.K. Williams, J.Y. Chang, R. Whit Hall | JNPM 2013;

Abstract. OBJECTIVES: 1. Determine whether stress in preterm infants, measured with salivary cortisol, decreases after five days of Kangaroo Care (KC) compared to five days of Standard Care (SC). 2. To determine whether kangaroo care provides sustainable pain relief beyond the period of skin-to-skin holding. STUDY DESIGN: Preterm infants (n = 38) born at 27–30 weeks gestational age were randomized to either the KC or the SC group and received the allocated intervention starting on day of life (DOL) five and continuing for five days. Salivary cortisol was collected on DOL five and again on DOL ten. Differences were analyzed using repeated measures ANOVA and t tests. Pain during nasal suctioning over five days was assessed using the Premature Infant Pain Profile (PIPP). RESULT: 1. Adequate saliva samples for salivary cortisol were collected for 13 KC infants and 11 SC infants. Therewas no main effect of group (p = 0.49), but there was a significant main effect of age (DOL five versus DOL ten), with salivary cortisol levels decreasing in both groups (p = 0.02). 2. Pain scores for both groups (n = 38) indicated mild to moderate pain during suctioning, with no significant difference in pain scores between groups. CONCLUSION: 1. KC did not affect salivary cortisol levels in preterm neonates, but levels in both the KC and SC groups decreased over time from DOL five to ten. Salivary cortisol may vary with age of infant. 2. Infants experience pain during routine suctioning and may require pain management.

*Corresponding Author: 

Dr. Anita J. Mitchell, College of Nursing, University of Arkansas for Medical Sciences (UAMS), 4301 West Markham, Slot 529, Little Rock, AR 72205, USA. Tel.: +1 501 266 1551; Fax: +1 501 686 8350; E-mail: