To Örebro University

Background Parents are a valuable but underutilizedresource in neonatal pain management. Involving parentshave shown to be efficient for pain relieving and combiningseveral parent-delivered methods could increase the effect.

Aim The aim of this study was to investigate the pain-relieving effects of parent-delivered pain managementcombining skin to skin contact (SSC), breastfeeding, andlive parental lullaby singing compared with SSC alone andwith standard care using oral glucose in healthy newborninfants.

Material and method Multicenter randomizedcontrolled trial with three parallel groups during routineblood sampling in postnatal care. Parent-infant dyads(n=225) were recruited from three health care regions inSweden and randomized to one of the three groups; 1 –standard care with oral glucose, 2- SSC 3 – a combinationof SSC, breastfeeding (if applicable) and live parentallullaby singing. Primary outcome was pain expressionassessed with Premature infant pain profile –Revised(PIPP-R), secondary outcomes were skin conductance andparents’ evaluation of pain, stress and meaningfulness.

Results Median PIPP-R was 5 (IQR 3–6) for group 1, 7(5–9) for group 2, and 7 (5–10) for group 3 (p < 0.001).There were no significant differences in skin conductance.Parents’ VAS-assessment (Figure 1) of infant pain rangedfrom a median of 9.5 to 17 mm, significantly higher ingroups 2 and 3 (p = 0.017). The parents rated their ownstress as low 4.5 - 6.5 mm and very high formeaningfulness 93 - 96 mm.

Conclusion This was the first large RCT to evaluate combined parent-delivered painmanagement including parents’ live singing. Pain scores remained within the mild to moderate range across all groups, with the infants receiving oral glucose having significantly lower pain scores. The results indicated that involving parents leads to low stress and high sense of meaningfulness. Combined parent-delivered pain management is feasible and safe.