Skin-to-Skin Contact: An Intervention for Reducing

Neonatal Pain

Merisa AkuszewskiAzusa Pacific University

The Importance of Managing Neonatal Pain• Infants encounter painful stimuli as a result

of routine medical procedures

• Because of their undeveloped pain-inhibiting pathways, infants experience more pain during painful procedures than children and adults do

• Unrelieved pain in infants can lead to decreased pain tolerance in adulthood

(Cong et al., 2012; Esfahani et al., 2013)

The Importance of Managing Neonatal PainMany medications

are useful in treating pain, but are associated with adverse side effects

It is important to determine non-pharmacological interventions

Skin-to-Skin ContactSkin-to-skin contact (SSC)

is achieved when an unclothed infant is placed on its mother's bare chest

Benefits of SSC:Accelerates brain

developmentImproves oxygenationTemperature regulationStimulates digestion and

weight gainStrengthens bond between

parent and infant

Davidson, London, & Ladewig, 2012; Phillips, 2013)

Skin-to-Skin ContactUseful for minimizing infants’ pain duringImmunizations

Heel lances

Skin-to-Skin Contact Reduces Infants’ Autonomic Pain Responses

Infants' who received SSC had:

More stable heart rates throughout the procedures

Cried for shorter periods of time

Lower mean pain scores

(Chermont, et al., 2009; Cong et al., 2012; Esfahani et al., 2013; Kostandy, Anderson, & Good, 2013; Razek & El-Dein,

2009)

Skin-to-Skin Contact is More Effective than Other Interventions

SSC is superior to other non-pharmacological interventions at reducing neonatal pain

Infants who received SSC reached relaxed behavioral states more quickly compared to infants who received no intervention, massage therapy or an oral sweetener.

(Chermont, et al., 2009; Esfahani et al., 2013; Kostandy et al., 2013)

Breastfeeding

Breastfeeding reduced infants' pain, cry time, and increased heart rate stability.

(Esfahani et al., 2013; Razek & El-Dein, 2009)

Implementing Skin-to-Skin Contact into Nursing Practice

SSC should be implemented into nursing practice as a standard hospital protocol for labor and delivery and neonatal intensive care units (NICU).

Breastfeeding should be used as the primary intervention for infants undergoing painful procedures

Basic SSC should be used as a secondary or replacement therapy

(Chermont, et al., 2009; Cong et al., 2012; Esfahani et al., 2013; Kostandy et al., 2013; Razek & El-Dein, 2009)

Implementing Skin-to-Skin Contact into Nursing Practice

Educate and motivate nursing staff

Educate parents/families

Provide privacy and space

Using Breastfeeding to Reduce Infants’ Pain During Immunization

https://www.youtube.com/watch?v=8Wzjxvrl91U

(Children’s Hospital of Eastern Ontario, 2013)

ReferencesChermont, A.G., Falcão, L., Silva, E., Balda, R., & Guinsburg, R. (2009). Skin-to-skin contact

and/or 25% oral dextrose for procedural pain relief for term newborn infants. Pediatrics, 124(6), 1101-1107. doi: 10.1542/peds.2009-0993

Children’s Hospital of Eastern Ontario. [Cheovideos]. (2013, October 21). Baby vaccination; the secret to a calm and peaceful immunization [Video file]. Retrieved from https://www.youtube.com/watch?v=8Wzjxvrl91U

Cong, X., Cusson, R. M., Walsh, S., Hussain, N., Ludington-Hoe, S. M., & Zhang, D. (2012). Effects of skin-to-skin contact on autonomic pain responses in preterm infants. The Journal of Pain, 13(7), 636-645. doi: 10.1016/j.jpain.201202008

Davidson, M., London, M., & Ladewig, P. (2012). Old's maternal-newborn nursing & women's health across the lifespan. Upper Saddle River, NJ: Pearson.

Esfahani, M. S., Sheykhi, S., Abdeyazdan, Z., Jodakee, M., & Boroumandfar, K. (2013). A comparative study on vaccination pain in the methods of massage therapy and mothers' breast feeding during injection of infants referring to Navabsafavi Health Care Center in Isfahan. Iranian Journal of Nursing and Midwifery Research, 18(6), 494-498.

Kostandy, R., Anderson, G. C., & Good, M. (2013) Skin-to-skin contact diminishes pain from hepatitis B vaccine injection in healthy full-term neonates. Neonatal Network: Journal of Neonatal Nursing, 32(4), 274-280. doi: 10.1891/0730-0832.32.4274

Phillips, R. (2013). Uninterrupted skin-to-skin contact immediately after birth. Newborn and Infant Nursing Reviews, 13 (2), 67-72.

Razek, A. A., & El-Dein, N. A. Z. (2009). Effect of breast-feeding on pain relief during infant immunization injections. International Journal of Nursing Practice, 15, 99-104. doi: 10.1111/j.1440-172X.2009.01728.x