Impact of Immediate Kangaroo Mother Care on Acute Prolonged Pain in Preterm Neonates Requiring Noninvasive Respiratory Support During the First 72 Hours of Life: A Prospective Cohort Study

Abstract

Background

Preterm neonates requiring noninvasive respiratory support are exposed to prolonged noxious stimuli, predisposing them to stress and adverse neurodevelopmental outcomes. Pharmacological interventions are limited by safety concerns, while nonpharmacological strategies, such as immediate Kangaroo Mother Care (iKMC), provide a promising alternative. However, evidence on iKMC’s effect on acute prolonged pain in ventilated preterm neonates is limited.

Objective

To assess acute prolonged pain in preterm neonates admitted to the neonatal intensive care unit using the Premature Infant Pain Profile (PIPP) scale at 12 and 72 h of noninvasive respiratory support, and to evaluate the role of iKMC in pain mitigation.

Methods

A prospective cohort study was conducted in preterm neonates (<37 weeks) requiring more than 72 h of noninvasive respiratory support. iKMC was initiated within 2 h of life as per protocol. Pain was assessed by the original PIPP scale at 12 and 72 h after initiating respiratory support, and cumulative iKMC hours were recorded. The exact timing of iKMC initiation (birth to skin-to-skin placement) was prospectively documented.

Results

Of 276 neonates enrolled, 26 were excluded (16 required invasive ventilation; 10 became unstable, needing inotropes). Of the remaining cohort, 72% received continuous positive airway pressure, 18% heated humidified high flow nasal cannula, and 10% oxygen via nasal cannula. The mean PIPP score was 15.94 ± 1.719 at 12 h, significantly reducing to 5.70 ± 1.843 at 72 h with iKMC. The mean daily iKMC duration was 5.70 ± 1.843 h, and the mean initiation age was 1.75 ± 0.17 h (median 1.7 h). No neonate discontinued iKMC due to intolerance.

Conclusion

Preterm neonates on noninvasive respiratory support who received iKMC had significantly lower PIPP scores. iKMC appears to be a safe, feasible, and effective nonpharmacological intervention for reducing acute prolonged pain in this vulnerable population.