Impact of skin-to-skin contact on acute procedural pain in newborns: a systematic review and meta-analysis.

OBJECTIVE

To systematically evaluate the effectiveness of Skin-to-Skin Contact (SSC) in reducing procedural pain in neonates, compared to standard care and other non-pharmacological interventions.

DATA SOURCES: A comprehensive search was conducted in major electronic databases and gray literature up to July 2025. The review followed PRISMA and MECIR guidelines and included randomized controlled trials (RCTs) that used validated neonatal pain scales. Risk of bias was assessed using RoB 2.0, and the certainty of evidence was rated using the GRADE approach.

SUMMARY OF FINDINGS: Twenty-nine RCTs involving 2995 neonates were included. SSC significantly reduced procedural pain compared to standard care (SMD = -1.13; 95 % CI: -1.54 to -0.72; p < 0.00001), although heterogeneity was high (I² = 93 %). Subgroup analyses suggested that heterogeneity was partially due to differences in pain assessment timing and study design. Compared to other interventions, SSC showed similar efficacy to carbohydrate solutions (SMD = 0.05; 95 % CI: -0.34 to 0.23), superior efficacy to swaddling (SMD = -0.86; 95 % CI: -1.38 to -0.34), and inferior efficacy to breastfeeding (SMD = 0.44; 95 % CI: 0.21 to 0.66).

CONCLUSION

SSC is an effective intervention for reducing procedural pain in neonates, particularly when compared to standard care and swaddling. However, its equivalence to carbohydrate solutions and inferiority to breastfeeding should be interpreted with caution due to methodological limitations and variability across studies. Further high-quality, large-scale RCTs are needed to improve the certainty of the evidence and guide clinical practice.