263 - The early and delayed effects of Kangaroo-Care (K-care) during retinopathy screening examination in preterm infants who received family-centered care in China: A randomized controlled trial

Publication Number: 263.6675

Hai-BO Huang, the University of Hongkong-Shenzhen hospital, Shenzhen, Guangdong, China (People's Republic); Yin Xue, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China (People's Republic); Yanxia Liang, University of Hong Kong-Shenzhen Hospital, Shen Zhen, Guangdong, China (People's Republic); Xueqing Wan, Hongkong University Shenzhen Hospital, Shenzhen, Guangdong, China (People's Republic); Jing Wu, Hong Kong University Shenzhen Hospital, Shenzhen, Guangdong, China (People's Republic); Po-Yin Cheung, University of Alberta, Edmonton, AB, Canada

Background: Fundal screening examination for retinopathy of prematurity causes pain, discomfort and stress which may affect the clinical status of preterm infants. Providing K-care helps comfort infants through procedures and interventions, but little information is available regarding the effects of K-care in pain-related and inflammatory responses in preterm infants during and after retinopathy screening examinations.

Objective: To compare the early pain-related and delayed inflammatory effects of K-care during the first retinopathy screening examination in preterm infants.

Design/Methods: In 2023-2024, following informed parental consents, preterm infants who required retinopathy screening examinations were enrolled in this randomized controlled trial (registration# ChiCTR2300068697). In our family-centered NICU, fundal examinations were performed by an ophthalmologist experienced in diagnosing and treating retinopathy of prematurity. Infants were randomly assigned to K-care provided by mother or father during the fundal examination or to control group in supine position on an examination table. The Premature Infant Pain Profile (PIPP) score during the first minute of fundal examination was measured as the primary outcome by nursing staff who was not involved in the clinical care of infants. Salivary samples (>110 uL) were collected before, at 1 and 6-8 h after fundal examination for assays of salivary cortisol IL-1β, IL-6 and TNF-α levels by ELISA methods in a blinded fashion.

Results: Neonates in the K-care and control groups had similar gestational age (GA), birthweight and demographics (n=50/group). Infants of K-care group had lower PIPP score and 1h salivary cortisol levels than those of controls with no difference in salivary cortisol levels after 6-8 h (Table 1). Compared to those in control infants at 6-8 h after screening examination, infants in the K-care group had a lower salivary IL-6 and TNF-α, but not IL-1β levels (Table 1). K-cared preterm infants with GA>32 weeks(n=24) had lower PIPP scores and salivary cortisol, IL-1β, IL-6, and TNF-α levels at the respective time point compared to those of control infants(n=18) (Table 2). The differences were not significant between K-care (n=26) and control groups (n=32) in infants with GA≤32 weeks, except PIPP scores.

Conclusion(s): Providing K-care during retinopathy screening examination in preterm infants helps alleviate early and delayed responses including pain score, cortisol and inflammatory markers. Further studies are required to confirm our findings in other units and understand the mechanisms of stress and inflammatory responses in fundal examinations.

Table 1: Comparison between Kangaroo-care (K-care) and control groups in 100 preterm infants
Data are expressed in median (IQR) or mean ± SD and analyzed by Mann-Whitney or Student t test for non-parametric and parametric variables, respectively.
Note: CPAP, continuous positive airway pressure; IL, interleukin; TNF, tumor necrosis factor.

Table 2: Comparison between Kangaroo-care (K-care) and control groups in infants of > 32 weeks gestation
Data are expressed in median (IQR) or mean ± SD and analyzed by Mann-Whitney or Student t test for non-parametric and parametric variables, respectively.
Note: CPAP, continuous positive airway pressure; IL, interleukin; TNF, tumor necrosis factor.