Kangaroo Mother Care for Pain Relief During Heel Lance in Preterm Neonates: A Network Meta-Analysis

Abstract

Introduction: Kangaroo Mother Care (KMC)—skin-to-skin contact—is promoted for thermoregulation and bonding. Evidence also suggests analgesic effects, but comparative efficacy relative to other non-pharmacological interventions (sucrose, breastfeeding) during painful procedures is unknown. This network meta-analysis compares KMC for heel lance pain.

Methods: We searched PubMed, Embase, and CENTRAL for RCTs enrolling preterm infants (≤34 weeks) undergoing heel lance. Interventions: KMC, sucrose (24%–30%), expressed breast milk, facilitated tucking, or combination. Comparator: standard care (swaddled in cot). Primary outcome: Premature Infant Pain Profile (PIPP) score at 30 seconds post-lance (range 0–21, higher=more pain). Network meta-analysis using frequentist graph-theoretical method.

Results: Twenty-four RCTs (n=2,189 infants) compared 8 interventions. All active interventions reduced PIPP scores versus standard care. Ranking by P-score: KMC+sucrose (P-score 0.94, mean difference –5.2, 95% CI –6.8 to –3.6); KMC alone (0.82, –4.1, –5.7 to –2.5); sucrose alone (0.79, –3.9); expressed breast milk (0.65, –2.8). Heterogeneity moderate (I²=45%). No intervention eliminated pain entirely (lowest mean PIPP 7.2/21).

Discussion: KMC alone is as effective as sucrose, and combination is additive. Mechanisms likely involve oxytocin-mediated descending inhibition and tactile gating. Preterm infants have immature pain pathways, making complete analgesia unattainable with non-pharmacological means. Implementation is feasible during routine care.

Conclusions: KMC is a potent non-pharmacological analgesic for heel lance in preterm infants. Combining KMC with sucrose yields maximal pain reduction. Units should adopt KMC as first-line procedural pain management.