![]() Due to immaturity of the nervous system during infancy, infants may actually have a pain threshold that is 30-50% lower than that of adults and a lower pain tolerance than older children ( Broome, Rehwaldt, & Fogg, 1998 Fitzgerald, Millard, & MacIntosh, 1988). The density of nerve endings or pain receptors in the skin of newborns is similar to or greater than that in adult skin ( Anand, 2000). The nerve pathways associated with pain transmission are functional at term birth, but myelination continues throughout infancy. The cortisol response to pain results in behavioral, autonomic, and hormonal responses ( Anand, 1998 Anand & Craig, 1996 Gitau, Fisk, & Glover, 2004). Therefore, by the end of the second trimester, the fetus posses both the neurochemical and anatomical capabilities of pain perception ( Anand & Hickey, 1987 Fitzgerald & Beggs, 2001 Gitau et al., 2001 Kostovic & Rakic, 1990). By 30 weeks gestation, pain transmission to the brain stem and thalamus known to occur even prior to complete myelinization of the pain pathways ( Anand & Hickey, 1992). The cortical capacity to interpret painful stimuli functions as early as 20 weeks of gestation and by 23 weeks gestation the human fetus and preterm infants can mount hormonal stress responses to painful stimuli ( Giannakoulopoulos, Sepulveda, Kourtis, Glover, & Fisk, 1994 Gitau et al., 2001) and receive some analgesia through the endogenous endorphin system ( Gibbins & Stevens, 2001). Premature infants perceive heel stick pain because peripheral and central structures necessary for nociception are present and functional by 12-16 weeks gestation ( Wolf, 1999). Infants in the NICU are routinely subjected to various diagnostic, surgical or therapeutic procedures which can result in pain ( Barker & Rutter, 1995 Evans, McCartney, Lawhon, & Galloway, 2005 Lago et al., 2005 F. The purpose of the proposed study was to test the effect of skin-to-skin contact (SSC) on the preterm infant's crying response to heel stick. Skin-to-skin contact, also known as Kangaroo Care, may be a useful intervention, but its usefulness is only beginning to be established. The management of preterm infant pain is a high priority ( Breau et al., 2006), and interventions to reduce pain and its responses are needed ( Bruce & Franck, 2005). ![]() Crying has many adverse physiological effects such as elevated heart rate ( Dinwiddie et al., 1979a), blood pressure ( Dinwiddie et al., 1979a), shunting of unoxygenated blood ( Dinwiddie et al., 1979b), and arteriovenous spasms causing cerebral blood flow changes ( Hirashi et al., 1991). When preterm infants experience pain, crying is a common response and is considered to be the most sensitive measure of pain ( Franck, 2002 Craig, Gilbert-MacLeod, & Lilley, 2000 Stevens et al., 2005).
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