The Effects of Kangaroo Care on the Sleep and Wake States of Preterm Infants

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Developing interventions that improve deep sleep and quit awake is important to improve the quality of care that is provided to preterm infants.


The aim of this study was to compare the effects of kangaroo care and in-arms-holding on the sleep and wake states of preterm infants.


A randomized controlled trial design was employed in 2011–2012. Seventy-two stable preterm infants with gestational ages of 32–37 weeks and their mothers were recruited from the neonatal intensive care unit of Valiasr Hospital in Tehran, Iran. Seventy participants completed the trial. In the preintervention phase, nurses placed all of the infants, clad only in diapers, in supine position in their incubator for 20 minutes. Next, the infants in the kangaroo care group were placed onto their mothers’ bare chest, whereas those infants in the in-arms-holding group were cradled in their mothers’ arms, with the head and back supported by the mother’s left arm. The intervention period lasted for 70 minutes. In the postintervention phase, the infants were returned to their incubators and placed in supine position for 20 minutes. The observer recorded the status of the infants during the three phases of study.


There were no significant differences between the two groups in terms of state distribution in the preintervention phase. However, the kangaroo care group had longer periods in deep sleep (p < .001) and in the quiet awake/alert state (p = .004) during the intervention phase and less time in the light sleep or drowsy state (p < .001) and in the actively awake state (p = .02) than the in-arms-holding group. No significant group differences were found in terms of crying.


Kangaroo care appears to increase the length of time that preterm infants spend in deep sleep and quiet awake states as compared with simply being held in their mothers’ arms. Replication of this research will strengthen the results.

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