Advertisement

An integrative review of clinician-administered comforting touch interventions and acute stress responses of preterm infants

Published:September 19, 2022DOI:https://doi.org/10.1016/j.pedn.2022.08.020

      Highlights

      • Comforting touch helps decrease preterm infant stress responses.
      • Comforting touch could be an adjunct for pain relief during painful procedures.
      • Comforting touch is insufficient pain management for highly intrusive procedures.

      Abstract

      Problem

      Preterm infants experience numerous stressors in the neonatal intensive care unit. Non-pharmacological interventions, including maternal comforting touch, reduce stress responses of preterm infants; however, the effects of clinician-administered comforting touch are unclear. The purpose of this integrative review was to synthesize findings from clinical trials to determine the effect of clinician-administered comforting touch on preterm infants' acute stress responses.

      Eligibility criteria

      Eligible clinical trials were published in English between 2001 and October 2021 and reported effects of clinician-administered comforting touch on acute stress responses in preterm infants.

      Sample

      Thirty clinical trials were included.

      Results

      Researchers tested the effect of comforting static touch, massage, massage with kinesthetic stimulation, sensorial saturation, and Yakson. There was significant heterogeneity in study design, comparison condition, and context of intervention delivery. Results varied; some studies demonstrated efficacy of comforting touch in reducing acute stress responses and others showed no effect. Generally, comforting touch provided during stressful procedures was associated with lower stress responses compared to standard care and was an effective adjunct to other stress management strategies. However, comforting touch alone was insufficient for managing pain, especially during skin-breaking procedures.

      Conclusions

      While comforting touch may be a useful part of stress management plans for preterm infants, additional research is needed to determine when comforting touch is appropriate and effective.

      Implications

      Comforting touch is beneficial to preterm infants and should be provided for stress management. For highly intrusive or painful procedures, comforting touch can be provided as part of a comprehensive stress management plan.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Abdelmageed R.I.
        • Youssef A.M.
        • El-Farrash R.A.
        • Mohamed H.M.
        • Abdelaziz A.W.
        Measurement of cumulative preterm neonatal and maternal stressors during neonatal intensive care unit admission.
        Journal of Pediatric Psychology. 2021; (Advance online publication)
        • Alinejad-Naeini M.
        • Mohagheghi P.
        • Peyrovi H.
        • Mehran A.
        The effect of facilitated tucking during endotracheal suctioning on procedural pain in preterm neonates: A randomized controlled crossover study.
        Global Journal of Health Science. 2014; 6: 278-284
        • Alvarez M.J.
        • Fernandez D.
        • Gomez-Salgado J.
        • Rodriguez-Gonzalez D.
        • Roson M.
        • Lapena S.
        The effects of massage therapy in hospitalized preterm neonates: A systematic review.
        International Journal of Nursing Studies. 2017; 69: 119-136
        • Angeles D.M.
        • Boskovic D.S.
        • Tan J.C.
        • Shih W.
        • Hoch E.
        • Forde D.
        • Phillips R.M.
        • Hopper A.
        • Deming D.D.
        • Goldstein M.
        • Truong G.
        • Febre A.
        • Pegis P.
        • Lavery A.
        • Kadri M.
        • Banerji A.
        • Mousselli I.
        • Farha V.
        • Fayard E.
        Oral dextrose reduced procedural pain without altering cellular ATP metabolism in preterm neonates: A prospective randomized trial.
        Journal of Perinatology. 2020; 40: 888-895
        • Bagheri F.
        • Vashani H.B.
        • Baskabadi H.
        • Tabriz E.R.
        An investigation of the effects of massage therapy on pain caused by umbilical vein catheter insertion in premature neonates: A clinical trial.
        Pakistan Journal of Medical and Health Sciences. 2020; 14: 1600-1603
        • Bales K.L.
        • Witczak L.R.
        • Simmons T.C.
        • Savidge L.E.
        • Rothwell E.S.
        • Rogers F.D.
        • Manning R.A.
        • Heise M.J.
        • Englund M.
        • Arias Del Razo R.
        Social touch during development: Long-term effects on brain and behavior.
        Neuroscience and Biobehavioral Reviews. 2018; 95: 202-219
        • Bellieni C.V.
        • Bagnoli F.
        • Cordelli D.M.
        • Perrone S.
        • Nenci A.
        • Buonocore G.
        Analgesia for premature children.
        Italian Journal of Pediatrics. 2003; 29: 286-290
        • Bellieni C.V.
        • Buonocore G.
        • Nenci A.
        • Franci N.
        • Cordelli D.M.
        • Bagnoli F.
        Sensorial saturation: An effective analgesic tool for heel-prick in preterm infants: A prospective randomized trial.
        Biology of the Neonate. 2001; 80: 15-18
        • Brummelte S.
        • Grunau R.E.
        • Chau V.
        • Poskitt K.J.
        • Brant R.
        • Vinall J.
        • Gover A.
        • Synnes A.R.
        • Miller S.P.
        Procedural pain and brain development in premature newborns.
        Annals of Neurology. 2012; 71: 385-396
        • Cameron E.C.
        • Raingangar V.
        • Khoori N.
        Effects of handling procedures on pain responses of very low birth weight infants.
        Pediatric Physical Therapy. 2007; 19: 40-47
        • Carozza S.
        • Leong V.
        The role of affectionate caregiver touch in early neurodevelopment and parent-infant interactional synchrony.
        Frontiers in Neuroscience. 2020; 14613378
        • Cascio C.J.
        • Moore D.
        • McGlone F.
        Social touch and human development.
        Developmental Cognitive Neuroscience. 2019; 35: 5-11
        • Chang S.O.
        The conceptual structure of physical touch in caring.
        Journal of Advanced Nursing. 2001; 33: 820-827
        • Cignacco E.L.
        • Sellam G.
        • Stoffel L.
        • Gerull R.
        • Nelle M.
        • Anand K.J.
        • Engberg S.
        Oral sucrose and "facilitated tucking" for repeated pain relief in preterms: A randomized controlled trial.
        Pediatrics. 2012; 129: 299-308
        • Cirik V.A.
        • Efe E.
        The effect of expressed breast milk, swaddling and facilitated tucking methods in reducing the pain caused by orogastric tube insertion in preterm infants: A randomized controlled trial.
        International Journal of Nursing Studies. 2020; 104103532
        • Coviello C.
        • Popple Martinez M.
        • Drovandi L.
        • Corsini I.
        • Leonardi V.
        • Lunardi C.
        • Antonelli C.
        • Pratesi S.
        • Dani C.
        Painful procedures can affect post-natal growth and neurodevelopment in preterm infants.
        Acta Paediatrica. 2018; 107: 784-790
        • Cruz M.D.
        • Fernandes A.M.
        • Oliveira C.R.
        Epidemiology of painful procedures performed in neonates: A systematic review of observational studies.
        European Journal of Pain. 2016; 20: 489-498
        • Davari S.
        • Borimnejad L.
        • Khosravi S.
        • Haghani H.
        The effect of the facilitated tucking position on pain intensity during heel stick blood sampling in premature infants: A surprising result.
        The Journal of Maternal-Fetal & Neonatal Medicine. 2019; 32: 3427-3430
        • Dehghani K.
        • Ahmadabadi A.B.
        • Fallahzade H.
        • Salimi T.
        Comparison of the effect of Yakson touch and oral glucose on the severity of phlebotomy pain in preterm infants.
        Iranian Journal of Neonatology. 2019; 10: 25-32
        • Diego M.A.
        • Field T.
        • Hernandez-Reif M.
        Procedural pain heart rate responses in massaged preterm infants.
        Infant Behavior and Development. 2009; 32: 226-229
        • van Dokkum N.H.
        • de Kroon M.L.A.
        • Reijneveld S.A.
        • Bos A.F.
        Neonatal stress, health, and development in preterms: A systematic review.
        Pediatrics. 2021; 148e2021050414
        • Dur Ş.
        • Çağlar S.
        • Yıldız N.U.
        • Doğan P.
        • Güney Varal İ.
        The effect of Yakson and gentle human touch methods on pain and physiological parameters in preterm infants during heel lancing.
        Intensive & Critical Care Nursing. 2020; 61102886
        • Fatollahzade M.
        • Parvizi S.
        • Kashaki M.
        • Haghani H.
        • Alinejad-Naeini M.
        The effect of gentle human touch during endotracheal suctioning on procedural pain response in preterm infant admitted to neonatal intensive care units: A randomized controlled crossover study.
        The Journal of Maternal-Fetal & Neonatal Medicine. 2020; 21: 1-7
        • Fitri S.Y.R.
        • Lusmilasari L.
        • Juffrie M.
        • Bellieni C.V.
        Modified sensory stimulation using breastmilk for reducing pain intensity in neonates in Indonesia: A randomized controlled trial.
        Journal of Pediatric Nursing. 2020; 53: e199-e203
        • Gerull R.
        • Cignacco E.
        • Stoffel L.
        • Sellam G.
        • Nelle M.
        Physiological parameters after nonpharmacological analgesia in preterm infants: A randomized trial.
        Acta Paediatrica. 2013; 102: e368-e373
        • Gomes Neto M.
        • da Silva Lopes I.A.
        • Araujo A.
        • Oliveira L.S.
        • Saquetto M.B.
        The effect of facilitated tucking position during painful procedure in pain management of preterm infants in neonatal intensive care unit: A systematic review and meta-analysis.
        European Journal of Pediatrics. 2020; 179: 699-709
        • Hatfield L.A.
        • Murphy N.
        • Karp K.
        • Polomano R.C.
        A systematic review of behavioral and environmental interventions for procedural pain management in preterm infants.
        Journal of Pediatric Nursing. 2019; 44: 22-30
        • Herrington C.J.
        • Chiodo L.M.
        Human touch effectively and safely reduces pain in the newborn intensive care unit.
        Pain Management Nursing. 2014; 15: 107-115
        • Higgins J.
        • Li T.
        • Altman D.G.
        • Curtin F.
        • Senn S.
        Revised Cochrane risk of bias tool for randomized trials: Additional considerations for crossover trials.
        (Retrieved from)
        • Higgins J.P.T.
        • Savovic J.
        • Page M.J.
        • Sterne J.A.C.
        Revised Cochrane risk-of-bias tool for randomized trials (RoB 2).
        (Retrieved from)
        • Hill S.
        • Engle S.
        • Jorgensen J.
        • Kralik A.
        • Whitman K.
        Effects of facilitated tucking during routine care of infants born preterm.
        Pediatric Physical Therapy. 2005; 17: 158-163
        • Holsti L.
        • MacLean K.
        • Oberlander T.
        • Synnes A.
        • Brant R.
        Calmer: A robot for managing acute pain effectively in preterm infants in the neonatal intensive care unit.
        Pain Reports. 2019; 4e727
        • Huang C.M.
        • Tung W.S.
        • Kuo L.L.
        • Ying-Ju C.
        Comparison of pain responses of premature infants to the heelstick between containment and swaddling.
        The Journal of Nursing Research. 2004; 12: 31-40
        • Jain S.
        • Kumar P.
        • McMillan D.D.
        Prior leg massage decreases pain responses to heel stick in preterm babies.
        Journal of Paediatrics and Child Health. 2006; 42: 505-508
        • Johnson E.O.
        • Kamilaris T.C.
        • Chrousos G.P.
        • Gold P.W.
        Mechanisms of stress: A dynamic overview of hormonal and behavioral homeostasis.
        Neuroscience and Biobehavioral Reviews. 1992; 16: 115-130
        • Johnston C.
        • Campbell-Yeo M.
        • Disher T.
        • Benoit B.
        • Fernandes A.
        • Streiner D.
        • Inglis D.
        • Zee R.
        Skin-to-skin care for procedural pain in neonates.
        Cochrane Database of Systematic Reviews. 2017; 2017: Cd008435
        • Kutcher A.M.
        • LeBaron V.T.
        A simple guide for completing an integrative review using an example article.
        Journal of Professional Nursing. 2022; 40: 13-19
        • Löken L.S.
        • Wessberg J.
        • Morrison I.
        • McGlone F.
        • Olausson H.
        Coding of pleasant touch by unmyelinated afferents in humans.
        Nature Neuroscience. 2009; 12: 547-548
        • Lopez O.
        • Subramanian P.
        • Rahmat N.
        • Theam L.C.
        • Chinna K.
        • Rosli R.
        The effect of facilitated tucking on procedural pain control among premature babies.
        Journal of Clinical Nursing. 2015; 24: 183-191
        • Maitre N.L.
        • Key A.P.
        • Chorna O.D.
        • Slaughter J.C.
        • Matusz P.J.
        • Wallace M.T.
        • Murray M.M.
        The dual nature of early-life experience on somatosensory processing in the human infant brain.
        Current Biology. 2017; 27: 1048-1054
        • Mangat A.K.
        • Oei J.-L.
        • Chen K.
        • Quah-Smith I.
        • Schmölzer G.M.
        A review of non-pharmacological treatments for pain management in newborn infants.
        Children. 2018; 5: 130
        • Manzotti A.
        • Cerritelli F.
        • Esteves J.E.
        • Lista G.
        • Lombardi E.
        • La Rocca S.
        • Gallace A.
        • McGlone F.P.
        • Walker S.C.
        Dynamic touch reduces physiological arousal in preterm infants: A role for c-tactile afferents?.
        Developmental Cognitive Neuroscience. 2019; 39100703
        • Nist M.D.
        • Harrison T.M.
        • Steward D.K.
        The biological embedding of neonatal stress exposure: A conceptual model describing the mechanisms of stress-induced neurodevelopmental impairment in preterm infants.
        Research in Nursing & Health. 2019; 42: 61-71
        • Obeidat H.
        • Kahalaf I.
        • Callister L.C.
        • Froelicher E.S.
        Use of facilitated tucking for nonpharmacological pain management in preterm infants: A systematic review.
        The Journal of Perinatal & Neonatal Nursing. 2009; 23: 372-377
        • Pados B.F.
        • Hess F.
        Systematic review of the effects of skin-to-skin care on short-term physiologic stress outcomes in preterm infants in the neonatal intensive care unit.
        Advances in Neonatal Care. 2020; 20: 48-58
        • Parashar P.
        • Samuel A.J.
        • Bansal A.
        • Aranka V.P.
        Yakson touch as a part of early intervention in the neonatal intensive care unit: A systematic narrative review.
        Indian Journal of Critical Care Medicine. 2016; 20: 349-352
        • Pepino V.C.
        • Mezzacappa M.A.
        Application of tactile/kinesthetic stimulation in preterm infants: A systematic review.
        Jornal de Pediatria. 2015; 91: 213-233
        • Perroteau A.
        • Nanquette M.C.
        • Rousseau A.
        • Renolleau S.
        • Berard L.
        • Mitanchez D.
        • Leblanc J.
        Efficacy of facilitated tucking combined with non-nutritive sucking on very preterm infants' pain during the heel-stick procedure: A randomized controlled trial.
        International Journal of Nursing Studies. 2018; 86: 29-35
        • Peyrovi H.
        • Alinejad-Naeini M.
        • Mohagheghi P.
        • Mehran A.
        The effect of facilitated tucking position during endotracheal suctioning on physiological responses and coping with stress in premature infants: A randomized controlled crossover study.
        The Journal of Maternal-Fetal & Neonatal Medicine. 2014; 27: 1555-1559
        • Pillai Riddell R.R.
        • Racine N.M.
        • Gennis H.G.
        • Turcotte K.
        • Uman L.S.
        • Horton R.E.
        • Ahola Kohut S.
        • Hillgrove Stuart J.
        • Stevens B.
        • Lisi D.M.
        Non-pharmacological management of infant and young child procedural pain.
        Cochrane Database of Systematic Reviews. 2015; 2015: Cd006275
        • Pohlman S.
        • Beardslee C.
        Contacts experienced by neonates in intensive care environments.
        Maternal-Child Nursing Journal. 1987; 16: 207-226
        • Ranger M.
        • Synnes A.R.
        • Vinall J.
        • Grunau R.E.
        Internalizing behaviours in school-age children born very preterm are predicted by neonatal pain and morphine exposure.
        European Journal of Pain. 2014; 18: 844-852
        • Ranjbar A.
        • Bernstein C.
        • Shariat M.
        • Ranjbar H.
        Comparison of facilitated tucking and oral dextrose in reducing the pain of heel stick in preterm infants: A randomized clinical trial.
        BMC Pediatrics. 2020; 20: 162
        • Reynolds L.C.
        • Duncan M.M.
        • Smith G.C.
        • Mathur A.
        • Neil J.
        • Inder T.
        • Pineda R.G.
        Parental presence and holding in the neonatal intensive care unit and associations with early neurobehavior.
        Journal of Perinatology. 2013; 33: 636-641
        • Salmani N.
        • Karjoo Z.
        • Dehghani K.
        • Sadeghnia A.
        Effect of facilitated tucking with the nurse and a simulated hand on physiological pain index during vein puncture on premature infants.
        Journal of Babol University of Medical Sciences. 2018; 20: 14-19
        • Schneider J.
        • Duerden E.G.
        • Guo T.
        • Ng K.
        • Hagmann P.
        • Bickle Graz M.
        • Grunau R.E.
        • Chakravarty M.M.
        • Huppi P.S.
        • Truttman A.C.
        • Miller S.P.
        Procedural pain and oral glucose in preterm neonates: Brain development and sex-specific effects.
        Pain. 2018; 159: 515-525
        • Smith G.C.
        • Gutovich J.
        • Smyser C.
        • Pineda R.
        • Newnham C.
        • Tjoeng T.H.
        • Vavasseur C.
        • Wallendorf M.
        • Neil J.
        • Inder T.
        Neonatal intensive care unit stress is associated with brain development in preterm infants.
        Annals of Neurology. 2011; 70: 541-549
        • Smith J.R.
        Comforting touch in the very preterm hospitalized infant: An integrative review.
        Advances in Neonatal Care. 2012; 12: 349-365
        • Smith S.L.
        • Haley S.
        • Slater H.
        • Moyer-Mileur L.J.
        Heart rate variability during caregiving and sleep after massage therapy in preterm infants.
        Early Human Development. 2013; 89: 525-529
        • Sterne J.A.C.
        • Savović J.
        • Page M.J.
        • Elbers R.G.
        • Blencowe N.S.
        • Boutron I.
        • Cates C.J.
        • Cheng H.Y.
        • Corbett M.S.
        • Eldridge S.M.
        • Emberson J.R.
        • Hernan M.A.
        • Hopewell S.
        • Hrobjartsson A.
        • Junqueira D.R.
        • Juni P.
        • Kirkham J.
        • Lasserson T.
        • Li T.
        • Higgins J.P.T.
        RoB 2: A revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366l4898
        • Sun Y.
        • Zhang J.
        • Chen X.
        • Yang Y.
        • Qiu J.
        • Lu K.Y.
        • Cheng R.
        Effectiveness of gentle human touch for pain control during examination for retinopathy of pre-maturity: A randomized controlled trial.
        Frontiers in Pediatrics. 2020; 8608378
        • Sundaram B.
        • Shrivastava S.
        • Pandian J.S.
        • Singh V.P.
        Facilitated tucking on pain in pre-term newborns during neonatal intensive care: A single blinded randomized controlled cross-over pilot trial.
        Journal of Pediatric Rehabilitation Medicine. 2013; 6: 19-27
        • Taplak A.
        • Bayat M.
        Comparison the effect of breast milk smell, white noise and facilitated tucking applied to Turkish preterm infants during endotracheal suctioning on pain and physiological parameters.
        Journal of Pediatric Nursing. 2021; 56: e19-e26
        • Ullsten A.
        • Andreasson M.
        • Eriksson M.
        State of the art in parent-delivered pain-relieving interventions in neonatal care: A scoping review.
        Frontiers in Pediatrics. 2021; 9651846
        • Valeri B.O.
        • Holsti L.
        • Linhares M.B.
        Neonatal pain and developmental outcomes in children born preterm: A systematic review.
        The Clinical Journal of Pain. 2015; 31: 355-362
        • Vickers A.
        • Ohlsson A.
        • Lacy J.
        • Horsley A.
        Massage for promoting growth and development of preterm and/or low birth-weight infants.
        Cochrane Database of Systematic Reviews. 2004; 2004 (Article CD000390)
        • Vinall J.
        • Miller S.P.
        • Bjornson B.H.
        • Fitzpatrick K.P.
        • Poskitt K.J.
        • Brant R.
        • Synnes A.R.
        • Cepeda I.L.
        • Grunau R.E.
        Invasive procedures in preterm children: Brain and cognitive development at school age.
        Pediatrics. 2014; 133: 412-421
        • Walker S.C.
        • Trotter P.D.
        • Swaney W.T.
        • Marshall A.
        • McGlone F.P.
        C-tactile afferents: Cutaneous mediators of oxytocin release during affiliative tactile interactions?.
        Neuropeptides. 2017; 64: 27-38
        • Ward-Larson C.
        • Horn R.A.
        • Gosnell F.
        The efficacy of facilitated tucking for relieving procedural pain of endotracheal suctioning in very low birthweight infants.
        MCN: The American Journal of Maternal-Child Nursing. 2004; 29: 151-160
        • Weissmann G.
        The experimental pathology of stress: Hans Selye to Paris Hilton.
        The Journal of the Federation of American Societies for Experimental Biology. 2007; 21: 2635-2638https://doi.org/10.1096/fj.07-0901ufm
        • Werner N.P.
        • Conway A.E.
        Caregiver contacts experienced by premature infants in the neonatal intensive care unit.
        Maternal-Child Nursing Journal. 1990; 19: 21-43
        • Whittemore R.
        • Knafl K.
        The integrative review: Updated methodology.
        Journal of Advanced Nursing. 2005; 52: 546-553
        • Williams N.
        • MacLean K.
        • Guan L.
        • Collet J.P.
        • Holsti L.
        Pilot testing a robot for reducing pain in hospitalized preterm infants.
        OTJR: Occupation, Participation and Health. 2019; 39: 108-115