12 • 2024 • Developmental Observer A B S T R A C T — N I D C A P T R A I N E R S M E E T I N G 2 0 2 3 Introduction The protective effects of Kangaroo mother care (KC) on the neurodevelopment of preterm infants are well established, but we do not know whether the KC is safe on infants under 28 weeks gestational in the first days of life. Aims To describe safety in early KC on preterm infants under 28 postmenstrual weeks. Methods This study is part of a primary randomized parallel clinical trial conducted to evaluate the equivalence or non-inferiority of lateral kangaroo care posture versus prone conventional posture. (Cangulat Study. Trial registration at clinicaltrials.gov: NCT03990116) RCT was conducted at the Neonatal Intensive Care Unit (NICU) of the 12 de Octubre University Hospital (Madrid, Spain), from May 2019 to November 2021. A total of 105 infants < 28 GA (Gestational Age) at birth were assessed for eligibility; 35 of them were excluded and 70 were enrolled. During their first five days of life, all KC sessions were monitored. All infants in KC were covered by polyethylene bags to keep humidity and decrease hypothermia risk while keeping maximal skin-to-skin contact. Ethics Considerations The Clinical Research Ethics Committee of the Hospital 12 de Octubre approved the study (no. CEIM 19/206). Informed consent was obtained from the parents of all subjects involved in the study. Results During the study, 285 sessions of KC were taken throughout the first five days of life. The main results are shown in Table 1. Of the 285 sessions studied, 78% took place in a single room (SR) and 22% in an open bay room (OB). An umbilical catheter was present in 60% of the sessions (168/285) and pe- ripherally inserted central catheter in 58% (165/285). In 5.6% (16/285) of the sessions, infants were intubated and 94.4% were assisted on duopap/cpap. Two of the sessions lasted only 60 minutes due to infant temperatures < 36.5ºC and an accidental extubation occurred. In 80% (228/285) transference was performed by a health profes- sional, and in 20% (57/285) by the parents. Ultrasound fol- low-up detected 8.5% (6/70) of IVH I and 4.3% (3/70) of IVH II. Activity in the room during the kangaroo sessions was measured using the Profile of the Nursery Environment and of Care Components Template Score Sheet1. When children were in the SR the activity was calmer and quieter (>4-5) than OB (66% vs. 90.3% p< 0.005). As light and noise were softer (6.8 lux vs 3.7 lux p<0.005) and (62 dB vs 58 dB p<0.005). Relevance to NIDCAP As professionals working in neonatal units, we should have as much knowledge as possible about KC and be able to make parents as autonomous as possible in the KC. Conclusion Our findings suggest that extremely preterm infants keep normothermia during kangaroo care in their first days of life. Is Early Kangaroo Care Safe in Preterm Infants Under 28 Weeks Gestation? López Maestro M, Collados L, Jimenez L, Serrrano A, Melchor P, Martinez P 12 de Octubre Hospital Madrid Spain DOI 10.14434/do.v17i1.37045 Table 1 N=70 Media DS Min- Max GA (wk) 26.2 1.2 24-27.8 Weigt (g) 859 ± 63 196 510-1460 Apgar 5 min < 4 7 (10%) 2.3 2-10 Days of admissión 52.17 24 3-141 Sex (male) 46 (65,7%) C- section 39 (55,7%) 8.2 Hours of life of the 1st KC 38.1 8-99 Duration of KC sessions (min) 130 56 50 – 365 Oxygen saturation 95% 3.4 Oxygen supplementation % 25.4 8.5 Heart rate 153 12 Tª 60 min after beginning KC 36.7 ºC 0.4 Infants with apnea during the first KC session, % (n) 30% (21/70) 2024 • Developmental Observer • 13 A B S T R A C T — N I D C A P T R A I N E R S M E E T I N G 2 0 2 3 Introduction Newborns are exposed to many painful procedures in Neona- tal Intensive Care Units (NICUs). Neonatal pain has been rec- ognized in the eighties and many scales have been developed to assess and manage pain. Despite this, pain management in NICUs is often suboptimal and remains challenging. Over the last decades, parents have become more and more involved in the care of their babies. Aims The primary aim of this study is to compare the EDIN pain scale assessed by parents with the assessment made by caregiv- ers. This is to determine if parents could be reliable resources to optimize pain management in ill newborns. The secondary aim of the study is to evaluate the Swedish ALPS-Neo scale compared to the EDIN pain scale as a potential and more ap- propriate tool for assessing stress and pain in newborns. Methods A prospective study was conducted in the NICU of Saint-Pierre University Hospital in Brussels, Belgium. The study compared the EDIN pain scale assessed by parents to the one assessed by caregivers. From January 1st to May 31st, 2022, informed consent was obtained for fourteen newborns. Parents of these newborns who were enrolled in the study were trained (one hour) in assessing the EDIN scale by an experimented caregiver. Both parents and caregivers assessed the EDIN pain scale. EDIN scores of parents and caregivers were compared. Caregivers also assessed the ALPS-Neo pain scale for each EDIN score. Results The results showed that the EDIN scores assessed by par- ents were significantly higher in absolute value compared to the scores assessed by the caregivers. However, there was an agreement between parents and caregivers in identifying positive pain scores (EDIN≥ 5) in 77.8% of the cases. Parental pain assessments were particularly amplified during painful procedures. Parent’s pain assessment is more constant during the day while caregivers assess pain mostly during the morn- ing. The ALPS-Neo pain scale was found to be more efficient, precise, and supportive of nonpharmacological pain manage- ment compared to the EDIN scale. A larger study in the unit is currently underway to confirm these findings. Relevance to NIDCAP The study highlights that parents’ assessment of the EDIN pain scale is as reliable as those of caregivers. Furthermore, parents consistently evaluate pain throughout the day, indicating that their involvement can contribute to more optimal pain man- agement. This underscores the importance of a family-centred approach in NICUs. Conclusion To improve pain management in the NICU, parents should receive training in assessing pain and stress and become active collaborators in the assessment process. ALPS-Neo is suggest- ed as a validated, user-friendly pain scale that could be more suitable for use by parents compared to the EDIN scale. ALPS- Neo promotes nonpharmacological pain management and may offer a more appropriate tool for parents to assess their newborns’ pain. Time for Change: Let Parents Assess Neonatal Pain in the NICU Kottos E, Druart D, Van Herreweghe I NICU, Saint-Pierre University Hospital, Brussels, Belgium DOI 10.14434/do.v17i1.37044 And there are no risks concerning devices such as umbilical catheters and endotracheal tubes, IVH is not increased, as all IVH cases were grade 1 or 2. If KC takes place in a single room, a calmer environment and a more appropriate noise and light level surround children. References Als H, Buehler D, Gilkerson L, Smith K. Profile of the Nursery Environment and of Care Components Template Manual Part 1. NIDCAP Training Manual. NIDCAP Federation International, 2015. The editorial team of the Developmental Observer is looking for NFI Members who may be interested in becoming a reviewer for the DO. If interested please send an email and a copy of your CV to the Senior Editor at developmentalobserver@nidcap.org