J Compr Ped. 2014 December; 5(4): e22214. Published online 2014 December 6. Research Article The Effect of Kangaroo Mother Care on Pain From Heel Lance in Preterm Newborns Admitted to Neonatal Intensive Care Unit: a Crossover Randomized Clinical Trial Ziba Mosayebi 1 ; Maliheh Javidpour 2,* ; Maryam Rahmati 3 ; Hamid Hagani 4 ; Amir Hossein Movahedian 5 1 Children Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran 2 Neonatal Intensive Care Unit, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, IR Iran 3 Department of Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran 4 Department of Statistics and Mathematics, Tehran University of Medical Sciences, Tehran, IR Iran 5 Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran *Corresponding author: Maliheh Javidpour, Neonatal Intensive Care Unit, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, IR Iran. Tel: +98-9127456700, E-mail: mjavidpour5@gmail.com Received: July 25, 2014; Revised: November 5, 2014; Accepted: November 17, 2014 Background: The heel-lancing procedure is a common tissue damaging procedure routinely performed in premature neonates and causes pain. Therefore, efforts should be made to relieve this pain. Objectives: This study aimed to assess the effect of kangaroo mother care (KMC) for a brief duration of 15 minutes on pain intensity of heel lance in preterm newborns admitted to neonatal intensive care units. Patients and Methods: In this clinical trial with crossover design, 64 vitally stable preterm neonates between 30-36 weeks of gestational age, who needed at least two heel lances, were randomly allocated to two groups. In group A, neonates received KMC 15 minutes before, during, and two minutes after the first heel lancing procedure. In group B, neonates were kept in prone position in incubator 15 minutes before lancing. For second heel lancing, the neonates in group A were put in incubator and group B received KMC. Premature Infant Pain Profile (PIPP) was scored during and within two minutes after finishing the procedure in both conditions. Results: The mean score of pain intensity during the intervention was significantly lower in the KMC position (P < 0/000). Mean score of pain intensity at two minutes after intervention was also significantly lower in the KMC position (P < 0/000). Conclusions: KMC before and during heel lancing is a natural, easy to use, and cost-effective method to decrease pain in premature neonates. It is consistent with modern strategy of family-centered care in neonatal units. Keywords:Kangaroo Mother Care; Pain; Preterm Neonate; Neonatal Intensive Care Units; Heel Stick Copyright © 2014, Iranian Society of Pediatrics. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. 1. Background Preterm and sick full-term neonates admitted to the neo- natal intensive care unit (NICU) are routinely subjected to many invasive diagnostic and therapeutic procedures, which are associated with pain (1-3). The heel-lancing pro- cedure is the most common tissue damaging procedure that premature neonates undergo. In the NICU, preterm neonates are subjected to an average of 10 to 16 painful invasive procedures per day with repeated heel sticks ac- counting for 55% to 86% of these procedures. Neonates have more pain response to heel sticks than to venipunc- ture for blood sampling (2, 3). The fibers that transfer the pain stimuli are organized in the fetus. Nerve fibers, which form the peripheral nervous system, begin migration from the neural crest at seven weeks of gestation and are completely developed by 20th week of gestation. By 28 th to 30 th weeks, the density of noci- ceptive nerve endings is equal to that of adults. Thus, new- borns are able to feel and remember the pain (4-6). Pain increases the demand for oxygen and causes disturbances in cerebral blood flow and intracranial pressure, which in- creases the risk of intracranial hemorrhage (7). Repetitive painful stimuli have been associated with behavioral and emotional problems during childhood, major psychosis, altered responses to pain, and intractable pain states in lat- er life (8). Despite the increased knowledge of physicians and caregivers regarding neonatal pain, 40% to 90% of neo- nates do not receive preventive and/or effective treatment to reduce procedural pain. Pain is a major public health concern throughout the world (9). Alleviation of pain is a human right regardless of age. Prevention and alleviation of pain is important not only because of being an impera- tive issue but also because of potential deleterious effects of repeated painful exposures. Thus, the goal of all caregiv- ers should be prevention of pain in neonates (10, 11). Pain assessment is the foundation of all pain treatment (12). The pain assessment tool used for neonates should be multidi- mensional, including measurements for both physiologic and behavioral indicators of pain, because neonates can-