276 - Randomized Crossover Trial to Compare Effect of Duration of Skin to Skin Care on Preterm Neonatal Pain Control

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 276
Publication Number: 276.428

Vivek Shukla, University of Alabama at Birmingham, Birmingham, AL, United States; Pratik Trivedi, Pramukh Swami Medical College, Karamsad,Gujarat, India, Ahmedabad, Gujarat, India; Jaiminkumar Rameshbhai. Patel, Shree Krishna Hospital, Kadi, Gujarat, India; Archana S. Nimbalkar, Bhiakaka University, Karamsad, Gujarat, India; Dipen V. Patel, Bhaikaka University, Karamsad, Gujarat, India; Ajay G. PHATAK, Bhaikaka University, Karamsad, Anand, Gujarat, India; Somashekhar M. Nimbalkar, Bhaikaka University, Karamsad, Gujarat, India

Presenting Author(s)

Vivek Shukla, MD (he/him/his)

Assistant Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States

Background:

Preterm neonates who receive intensive care undergo multiple painful procedures as a part of their medical management. Effective pain control has been shown to improve short and long-term neurodevelopmental outcomes. Skin-to-skin care (SSC) for 30 minutes before the painful procedure has been shown to provide effective pain control in preterm neonates.

Objective:

To compare the effect of varying SSC duration on pain control efficacy by the premature infant pain profile (PIPP) scale. We tested the hypothesis that SSC for shorter durations will be as effective as that for 30 minutes for preterm neonatal pain control.

Design/Methods: Study participants were stratified as per the gestational age into two strata, 28-32 weeks and 33-36 weeks. All neonates requiring heel-stick for glucose monitoring admitted to the study NICU from January 2019 to December 2022 were eligible. Those on the ventilator, hemodynamically unstable, exposed to analgesic/sedative medications within the last 24 hours of the procedure, and neurologically impaired were excluded. SSC was given by mothers by crossover design for 10, 15, 20, and 30 minutes by random sequence allocation generated by a computer-based randomization software. Blinded PIPP scores assessments at 0, 1, and 5 minutes of heel-stick were done using video recording. A clinically significant PIPP score difference was defined as a difference of ≥1 in the total PIPP score. The trial was cleared by the hospital ethics committee and was registered at the Clinical Trials Registry of India, registration number: CTRI/2019/05/019428.

Results:

A total of 136 neonates (68 in each stratum) were enrolled. One infant in the 28-32 week strata was excluded as the later 2 heel-stick procedures were not clinically indicated. The male: female ratio was 1.4:1. The mean (SD) days after birth was 17.6 (11.5) days in the 28-32 and 8.3 (5.8) days in the 33-36 weeks strata. The mean (SD) birthweight was 1.38 (0.33) and 1.68 (0.27) kg in the 28-32 and 33-36 weeks strata, respectively. There was no clinically significant difference between the groups for the PIPP score at 0,1 and 5 minutes in both strata (Figure 1). The PIPP score at 5 minutes was not significantly different from that at 0 minutes in all groups in both strata (Table 1).

Conclusion(s):

Skin-to-skin care for 10, 15, and 20 minutes were as effective as that for 30 minutes for preterm neonatal pain control. The result of this study will help in providing effective pain control in preterm neonates for moderately painful procedures that are needed urgently.