Skin-to-skin contact for painful procedures in younger preterm infants: A systematic review and meta-analysis.

Skin-to-skin contact for pain (SSCP) has been recommended as a pain management strategy broadly for infants but no systematic reviews have focused exclusively on the youngest of preterm infants. These infants are subjected to increased number of painful procedures over longer hospitalizations, are less physiologically stable, and may have more fragile skin integrity than older preterm infants. Thus, the objective of the present study was to conduct a meta-analysis and narrative synthesis to examine the effectiveness of skin-to-skin contact for pain in younger preterm infants. Four pain-related distress outcomes (Premature Infant Pain Profile/Premature Infant Pain Profile-Revised [PIPP/PIPP-R], cry duration, heart rate, oxygen saturation), across four time points surrounding an acutely painful procedure (pre-procedure [baseline], during procedure, within 2-minutes post-procedure, greater than 2-minutes post procedure) were examined. Twenty-four studies were included in our review. In our meta-analyses, SSCP showed mixed evidence of significantly reduced pain-related outcomes, but the magnitude of the effects varied significantly according to outcome and time point. Our narrative syntheses examined heterogeneous, 'non-standard care' comparisons. Results suggest SSCP may not provide better pain management than sweet-tasting solutions. Overall, the certainty of the evidence base, using GRADE criteria, ranged from very low to low. Certainty was downgraded due to small numbers of studies, heterogeneity among studies, and poor reporting. These findings call for better quality trials. This extremely vulnerable group deserves special attention as the evidence is unclear about the benefits of SSCP, a critical pain management intervention for infants of a higher gestational age. REGISTRATION: INPLASY protocol 202470099 (doi:10.37766/inplasy2024.7.0099). PERSPECTIVE: This systematic review and meta-analysis examined the effectiveness of skin-to-skin contact for pain in younger preterm infants across four time points and four outcomes. The certainty of our findings was downgraded due to small numbers of studies, heterogeneity in study methodology, and biased methodologies, calling for better quality trials.