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Enhanced kangaroo mother care for heel lance in preterm neonates: a crossover trial



To test if enhancing maternal skin-to-skin contact, or kangaroo mother care (KMC) by adding rocking, singing and sucking is more efficacious than simple KMC for procedural pain in preterm neonates.

Study Design:

Preterm neonates (n=90) between 32 0/7 and 36 0/7 weeks' gestational age participated in a single-blind randomized crossover design. The infant was held in KMC with the addition of rocking, singing and sucking or the infant was held in KMC without additional stimulation. The Premature Infant Pain Profile was the primary outcome with time to recover as the secondary outcome. A repeated-measures analysis of covariance was employed for analyses.


There were no significant differences in any of the 30 s time periods over the 2 min of blood sampling nor in time to return to baseline. Compared to historical controls of the same age in incubator, the pain scores were lower and comparable to other studies of KMC. There were site differences related to lower scores with the use of sucrose in one site and higher scores in younger, sicker infants in another site.


The sensorial stimulations from skin-to-skin contact that include tactile, olfactory sensations from the mother are sufficient to decrease pain response in premature neonates. Other studies showing that rocking, sucking and music were efficacious were independent of skin-to-skin contact, which, when used alone has been shown to be effective as reported across studies.

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This project was sponsored by the Canadian Institutes of Health Research (CIHR; MOP 117475-CHI-CFAA-23682 ) and additional support from Fonds de la Recherche en Santé du Québec (FRSQ). CJ is a member of the McGill University Health Centre Research Institute that is funded by FRSQ. We thank the babies, parents and staff of the NICUs at Hopital Ste Justine, Montreal, Royal Victoria Hospital, Montreal and IWK Children's Health Centre, Halifax. Canada. We especially thank research nurses Terry Suss and Kim Caddell for the meticulous attention to the protocol and sensitive recruitment of mothers. Thanks also to research assistants Indrayudh Ghoshal and Elaine Tam. We thank the 3M Company for the provision of red dot electrodes, and for the ‘puppy dog’ electrodes, we thank Tyco Medical Canada.

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Correspondence to C C Johnston.

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Authours' contributions. CJ was responsible for all stages of the study. FF, MCY, LB participated in the protocol development, oversaw data collection from one site, participated in data analysis and paper preparation and review. CG participated in study design, and KM, JB trained and oversaw data coding, data entry and verification, literature review update and paper preparation.

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Johnston, C., Filion, F., Campbell-Yeo, M. et al. Enhanced kangaroo mother care for heel lance in preterm neonates: a crossover trial. J Perinatol 29, 51–56 (2009).

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  • pain
  • kangaroo mother care
  • preterm neonates
  • heel lance

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