Impacto do contato pele-a-pele na dor procedural aguda em recém nascidos: uma revisão sistemática e meta-análise

Abstract

Title: 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. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Methodological Expectations of Cochrane Intervention Reviews (MECIR) and PRISMA guidelines. Searches were performed in major electronic databases and gray literature up to February 2024, including studies using validated pain scales. The risk of bias was assessed with RoB 2.0, and the certainty of evidence was rated using the GRADE methodology. The primary outcome was neonatal procedural pain intensity, analyzed using random-effects meta-analysis. Results: Twenty-nine RCTs (n = 2,995 neonates) were included. SSC significantly reduced neonatal pain compared to standard care (SMD = −1.13; 95% CI: −1.54 to −0.72; p < 0.00001). High heterogeneity was present (I2 = 93%), partially explained by variations in pain assessment timing and study methodology. Compared to other interventions, SCC demonstrated 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), but inferior to Breastfeeding (SMD = 0.44; 95% CI: 0.21 to 0.66). Conclusion: SSC effectively reduces neonatal procedural pain compared to standard care and swaddling. Its equivalence to Carbohydrate Solutions and inferiority to Breastfeeding suggests that combining SSC with other non-pharmacological methods may optimize pain relief. Methodological limitations highlight the need for high-quality, larger studies to increase the certainty and clinical applicability of these findings.