The Effect of Different Kangaroo Mother Care Positions on Newborns During Heel Lancing

The Effect of Different Kangaroo Mother Care Positions Given During Heel Lance Procedure on Newborns Pain, Comfort, and Physiological Parameters

Newborn screenings are crucial preventive health services within public health programs worldwide. In our country, as part of this program, heel blood is taken from newborns between the 48th and 72nd hours after birth, which causes pain and discomfort in newborns. Non-pharmacological methods are frequently utilized to relieve the pain caused by heel blood collection in newborns and to improve comfort during the procedure. One of these methods is kangaroo care, also known as skin-to-skin contact. Kangaroo care involves placing the baby in direct skin contact with the mother, which helps regulate the babys body temperature, calm the baby, and fosters bonding between mother and baby. This method, also described as human incubator care requires no special skills, is cost-effective, and is reported to have significant benefits in reducing procedural pain. In the literature, apart from the classic kangaroo position where the babys chest touches the mothers chest, there are studies describing alternative positions such as side kangaroo (kangaroo-supported diagonal flexion) and reverse kangaroo (supine kangaroo). The side kangaroo position differs from the classic kangaroo care in that the baby is held crosswise with its neck supported by the mother, allowing mother and baby to face each other. The reverse kangaroo position is a modified version of the classic kangaroo position, where the baby, wearing only a diaper, is placed upright with its back in contact with the mothers bare chest. Skin-to-skin contact during kangaroo care has a calming effect, reducing both physiological and behavioral pain responses in the baby. Therefore, it is thought that different kangaroo positions, which maintain skin-to-skin contact between the baby and the mother, may affect pain, comfort, physiological parameters, and crying durations during the heel blood collection procedure. Additionally, in cases where the classic kangaroo position cannot be used, these positions may serve as alternative methods. Upon reviewing national and international literature, no studies were found comparing the effectiveness of different kangaroo positions during heel blood collection in term newborns. Thus, this study aims to compare the effects of classic kangaroo, side kangaroo, and reverse kangaroo positions on pain, comfort, and physiological parameters (heart rate, oxygen saturation) in term newborns. Secondary outcomes of the study include evaluating the crying duration of newborns and the procedure duration for heel blood collection.

Study Overview

• Status: Completed
• Conditions: Heel Lancing; Skin to Skin Contact; Heel Lance Procedures; Kangaroo Mother Care
• Intervention / Treatment: Behavioral: Lateral Kangaroo Mother Care Position; Behavioral: Reverse Kangaroo Mother Care Position

• Study Type: Interventional
• Enrollment (Actual): 63
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Istanbul Provincial Directorate of Health Kanuni Sultan Suleyman Training and Research Hospital
  • Istanbul, Turkey (Türkiye)
    • Istanbul University-Cerrahpasa (IUC)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria

• Born between 37-42 weeks of gestation
• Birth weight of 2500 grams or more
• APGAR score over 6 at 5 minutes
• Fed at least one hour prior to the procedure
• Postnatal age of 24-72 hours
• Successful heel blood collection performed in a single attempt
• No invasive procedures performed after birth, except for vitamin K and Hepatitis B vaccination
• Term newborns whose mothers have agreed to participate in the study

Exclusion Criteria for the Study

• Genetic or congenital anomalies
• Neurological, cardiological, or metabolic diseases
• Requirement for respiratory support
• Use of analgesics, sedatives, antiepileptics, or muscle relaxants within 24 hours prior to the procedure
• Mothers with physical barriers preventing kangaroo care
• Newborns whose mothers cannot communicate or do not speak Turkish

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Classic kangaroo mother care position group (control group)
Experimental: Lateral kangaroo mother care position group	Behavioral: Lateral Kangaroo Mother Care Position; Newborns in the lateral kangaroo position group will be positioned diagonally on their mothers chests, with their heads placed between the mothers breast and collarbone.
Experimental: Reverse kangaroo mother care position group	Behavioral: Reverse Kangaroo Mother Care Position; Newborns in the reverse kangaroo position group will be positioned vertically with their backs in contact with the mothers chest.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of crying	It will be measured in seconds.	From the heel lancing until the end of the blood collection procedure
Time taken for heel blood collection	It will be measured in seconds.	From the heel lancing until the end of the blood collection procedure
Neonatal Infant Pain Scale - NIPS	It evaluates the baby's pain through six criteria: facial expression, crying, breathing pattern, arms, legs, and alertness. Five of these criteria are scored as either 0 or 1, while crying is scored from 0 to 2, ranging from good to poor. According to this scale, a newborn's pain is assessed on a total score where the highest score is 7 and the lowest is 0. If the pain score is between 0 and 2, it is considered no pain, and no intervention is needed. If the pain score is between 3 and 4, it is assessed as moderate pain, non-pharmacological interventions are applied, and pain is re-evaluated after 30 minutes. If the pain score is above 4, non-pharmacological interventions are conducted, possibly alongside pharmacological treatments, and pain is re-evaluated after 30 minutes.	Before the procedure (-3rd minutes), during the procedure (0 minutes), and after the procedure (10th second, 1st and 5th minutes)
Newborn Comfort Behavior Scale - COMFORTneo	The Newborn Comfort Behavior Scale is a Likert-type scale consisting of six parameters: alertness, calmness/agitation, respiratory response, crying, body movements, facial tension, and muscle tone. For newborns receiving mechanical ventilator support, the "Respiratory Response" parameter is evaluated, while for those not on mechanical ventilator support, the "Crying" item is assessed.	Before the procedure (-3rd minutes), during the procedure (0 minutes), and after the procedure (10th second, 1st and 5th minutes)
Heart rate	It will be measured using a pulse oximeter.	Before the procedure (-3rd minutes), during the procedure (0 minutes), and after the procedure (10th second, 1st and 5th minutes)
Oxygen saturation	It will be measured using a pulse oximeter.	Before the procedure (-3rd minutes), during the procedure (0 minutes), and after the procedure (10th second, 1st and 5th minutes)

Collaborators and Investigators

• Sponsor: Maltepe University
• Collaborators: Istanbul University - Cerrahpasa
• Investigators: Principal Investigator: Tuğba Erener Ercan, PhD, Maltepe University; Study Director: Zeynep Aközlü, Istanbul University - Cerrahpasa; Study Chair: Seda Çağlar, PhD, Istanbul University - Cerrahpasa

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2025
• Primary Completion (Actual): December 31, 2025
• Study Completion (Actual): December 31, 2025

Study Registration Dates

• First Submitted: October 1, 2024
• First Submitted That Met QC Criteria: October 2, 2024
• First Posted (Actual): October 4, 2024

Study Record Updates

• Last Update Posted (Actual): May 15, 2026
• Last Update Submitted That Met QC Criteria: May 13, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: reverse kangaroo mother care; lateral kangaroo mother care; kangaroo positions
• Other Study ID Numbers: 2024/13-03; 125S107 (Other Identifier: TUBİTAK)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No