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Updated: Jul 12, 2026
A Preterm Rat Model for Pain Studies
Published on: February 9, 2024
Skin-to-skin contact for painful procedures in younger preterm infants: A systematic review and meta-analysis
Estreya Cohen1, Haleh Hashemi1, Nichaela Garvey1
1Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
Insights
Skin-to-skin contact for pain (SSCP) offers mixed results for pain management in preterm infants. Evidence for its effectiveness is low, suggesting a need for higher-quality research to clarify benefits for this vulnerable population.
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.
Abstract:
Skin-to-skin contact for pain (SSCP) has been recommended as a pain management strategy broadly for infants but no systematic reviews have focused exclusively on the youngest of preterm infants. These infants are subjected to increased number of painful procedures over longer hospitalizations, are less physiologically stable, and may have more fragile skin integrity than older preterm infants. Thus, the objective of the present study was to conduct a meta-analysis and narrative synthesis to examine the effectiveness of skin-to-skin contact for pain in younger preterm infants. Four pain-related distress outcomes (Premature Infant Pain Profile/Premature Infant Pain Profile-Revised [PIPP/PIPP-R], cry duration, heart rate, oxygen saturation), across four time points surrounding an acutely painful procedure (pre-procedure [baseline], during procedure, within 2-minutes post-procedure, greater than 2-minutes post procedure) were examined. Twenty-four studies were included in our review. In our meta-analyses, SSCP showed mixed evidence of significantly reduced pain-related outcomes, but the magnitude of the effects varied significantly according to outcome and time point. Our narrative syntheses examined heterogeneous, 'non-standard care' comparisons. Results suggest SSCP may not provide better pain management than sweet-tasting solutions. Overall, the certainty of the evidence base, using GRADE criteria, ranged from very low to low. Certainty was downgraded due to small numbers of studies, heterogeneity among studies, and poor reporting. These findings call for better quality trials. This extremely vulnerable group deserves special attention as the evidence is unclear about the benefits of SSCP, a critical pain management intervention for infants of a higher gestational age. REGISTRATION: INPLASY protocol 202470099 (doi:10.37766/inplasy2024.7.0099). PERSPECTIVE: This systematic review and meta-analysis examined the effectiveness of skin-to-skin contact for pain in younger preterm infants across four time points and four outcomes. The certainty of our findings was downgraded due to small numbers of studies, heterogeneity in study methodology, and biased methodologies, calling for better quality trials.
