To Örebro University

Background: Engaging parents in parent-delivered pain relief in routine postnatal care is aligned with evidence-informed infant pain care and should be encouraged. This is part two of the mixed-methods SWEpap research project investigating combined parent-delivered pain management. Skin-to-skin contact (SSC) and breastfeeding are among the most studied parental pain-relieving interventions and are often combined for better effects. Live parental lullaby singing has not previously been investigated in combination with SSC and breastfeeding during painful procedures. This study investigated the efficacy of combined parent-delivered pain management versus standard care with oral glucose in healthy newborn infants during routine venipuncture.

Methods: This was a multicenter randomized controlled trial with three parallel groups. Parent–infant dyads (n= 225) were recruited from three healthcare regions in Sweden and randomized to one of the following three groups during routine venipuncture: 1) standard care with glucose; 2) SSC with parent; and 3) combination of SSC, breastfeeding (if applicable), and parents’ live singing. The primary outcome was pain expression assessed using Premature Infant Pain Profile—Revised (PIPP-R); the secondary outcomes were galvanic skin response (GSR) and parents’ evaluations of pain, stress, and meaningfulness using a visual analogue scale (VAS).

Results: The 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 GSR. Parents’ VAS-assessment of infant pain ranged from a median of 9.5 to 17 mm, significantly higher in groups 2 and 3 (p= 0.017). The parents rated their own stress 4.5 - 6.5 (n.s.) and meaningfulness 93 - 96 (n.s.).

Conclusion: Pain scores remained within the mild to moderate range across all groups, with the infants receiving oral glucose having significantly lower pain scores. This was the first study combining SSC, breastfeeding, and parents’ live lullaby singing, and more research is needed to optimize parent-delivered pain management. Parent-delivered pain management combining SSC, breastfeeding, and parents’ live lullaby singing is a feasible and safe intervention with potential pain alleviating properties offering the parents a strong sense of meaningfulness and stress relief.