Cradle hold alleviates pain, reduces fear behavior, and stabilizes oxygenation in preterm infants during ROP screening: a randomized controlled trial

Objective: To evaluate cradle hold—a nurse-performed kangaroo care variant—on procedural pain, behavioral stress, and physiological stability during retinopathy of prematurity (ROP) screening in preterm infants. ROP screening is essential for preventing blindness yet causes significant acute pain and physiological stress in vulnerable preterm infants.

Methods: Prospective randomized controlled trial. Eighty preterm infants were randomized to intervention (cradle hold by trained nurse throughout mydriasis and eye examination, n=40) or control (standard wrapping and physical restraint, n=40). In cradle hold, the infant's head and neck rest in the nurse's elbow crook with trunk and limbs held close to the body in a secure, non-restrictive manner. Primary outcome: PIPP-R pain scores at baseline, during, and 5 min post-procedure. Secondary: crying duration, heart rate, SpO₂, hypoxemia (SpO₂<85%) incidence and duration.

Results: No baseline differences. Intervention had lower PIPP-R during procedure (10.18±2.10 vs 14.50±2.38, P<0.01) and at 5 min (7.80±1.88 vs 11.20±2.05, P<0.01); shorter crying (44.8±12.1s vs 78.2±15.4s, P<0.01); lower hypoxemia incidence (17.5% vs 37.5%, P=0.045) and duration (12.1±5.0s vs 23.2±7.6s, P<0.01); comparable screening success (97.5% vs 95.0%, P=0.556).

Conclusion: Cradle hold alleviates pain and fear behaviors, stabilizes physiology, and reduces oxygen fluctuations during ROP screening—safe, non-invasive, easy to perform, and child-centered.