Skin-to-skin contact for painful procedures in younger preterm infants: A systematic review and meta-analysis

Area of Science:

• Neonatal care
• Pain management
• Evidence-based practice

Background:

• Skin-to-skin contact for pain (SSCP) is broadly recommended for infant pain management.
• Younger preterm infants face unique challenges, including increased painful procedures and fragile skin.
• Existing systematic reviews have not exclusively focused on the youngest preterm infants' response to SSCP.

Purpose of the Study:

• To conduct a meta-analysis and narrative synthesis on the effectiveness of SSCP for pain in younger preterm infants.
• To examine pain-related distress outcomes across four time points surrounding painful procedures.
• To assess the certainty of evidence for SSCP in this population.

Main Methods:

• Systematic review and meta-analysis of 24 studies.
• Examination of four pain-related distress outcomes: PIPP/PIPP-R, cry duration, heart rate, and oxygen saturation.
• Analysis across four time points: pre-procedure, during procedure, and 2- and >2-minutes post-procedure.

Main Results:

• Meta-analyses showed mixed evidence for SSCP significantly reducing pain-related outcomes.
• The magnitude of SSCP's effects varied significantly by outcome and time point.
• Narrative syntheses suggested SSCP may not be superior to sweet-tasting solutions for pain management.

Conclusions:

• The certainty of evidence for SSCP in younger preterm infants is very low to low, primarily due to study heterogeneity and poor reporting.
• Findings indicate a need for higher-quality trials to better understand SSCP's benefits in this vulnerable group.
• Current evidence is unclear, necessitating special attention and further research for this critical pain management intervention.