later , research showed that the fibers that transfer the pain stimuli are organized in the fetus .
the nerve pathway myelinization begins in the 2 and 3 trimesters and finishes between 30 to 37weeks of gestational age .
mkoban et al ( 2003 ) also showed that insufficient pain control results in hypoxia and stimuli reaction .
kazak et al compared effect of pharmacologic and non - pharmacologic treatment on pain and concluded that non - pharmacological methods are more effective than pharmacological methods for pain relief .
this has helped the mother - infant bond and increased the mother 's self - esteem and skills .
studies have shown that kangaroo mother care ( kmc ) is effective on infant pain[710 ] .
kangaroo care originated in bogot , colombia because of a lack of incubators for preterm infants . during kmc the adult holds the diapered infant against his / her skin .
. a breastfeeding mother may allow the infant self - regulatory access to her breast .
the adult is without clothing from the waist up ; a blanket covers both the infant and adult .
kmc has three provisions : 1 ) skin to skin contact , 2 ) exclusive breastfeeding , 3 ) support to the mother and infant .
care - giving and analgesia is in the domain of nursing activities and must be a priority in nursing standards .
this was a semi - experimental double blind , double group , and clinical trial study approved by the research ethics committee of mashhad university of medical sciences .
sixty infants born during march to july 2006 with the following inclusion criteria : born at term with a weight between 2500 to 4000 g , type of delivery nvd , apgar score 1=7 - 10 , at earliest 24 hr after birth , not fed since 30 minutes and lack of skin lesions in mother or infant , were studied .
the mother was requested to put the baby under her gown between her breasts with maximum skin to skin contact .
the time of skin to skin contact was 2 minutes before vaccination and 3 minutes afterwards .
behavioral changes were scored according to neonatal / infant pain scale ( nips ) recommended for children less than 1 year old . in this
scoring a score greater than 3 indicates pain.facial expression : relaxed muscles 0 , grimace 1crying : no cry 0 , whimper 1 , vigorous crying 2breathing patterns : relaxed 0 , change in breathing 1arms : relaxed / restrained 0 , extended 1legs : relaxed / restrained 0 , flexed / extended 1state of arousal : sleeping / awake 0 , fussy 1 
  facial expression : relaxed muscles 0 , grimace 1 crying : no cry 0 , whimper 1 , vigorous crying 2 breathing patterns : relaxed 0 , change in breathing 1 arms : relaxed / restrained 0 , extended 1 legs : relaxed / restrained 0 , flexed / extended 1 state of arousal : sleeping / awake 0 , fussy 1 babies in the control group were wrapped in a blanket and put near the bed of their mothers .
we recorded the physiologic and behavioral reactions of these infants to pain using the same method as for the case group .
data were analyzed using chi - square , fisher exact test , paired t - test and independent t - test and mann - whitney test .
the case group consisted of 53% were males and 47% females whereas in controls 60% were females and 40% males ; 80% of the case group and 73.3% of the control group had 40 weeks gestational age ; 83.3% of the infants in the case group and 96.7% in the control group had a first minute apgar score of 9 .
mean birth weight in the case group was 3242306.6 and in the control group 3151331.5 grams . according to the results obtained from the nips score , during intervention 30% of the infants had a pain score of 6 and 70% in the case group 7 , while 96.6% of the neonates in the control group had a score of 7 and 3.3% had a score of 6 .
comparison of pain severity before and during intervention three minutes after intervention 93.3% of the infants in the case group had pain score 0 and only 6.6 had 6 to 7 pain scores while in the control group 70% had a zero pain score and more than 26% had a 6 or 7 pain scores .
this was also significant ( p=0.021 , table 2 ) . mean pain intensity 3 minutes after intervention was significantly lower in the case than control group(p=0.008 , table 3 ) . according to mann - whitney test
there was a significant statistical difference in the cry interval times between the 2 groups ( p<0.001 ) during intervention . 
 
comparison of pain severity after intervention comparison of pain severity during and after intervention there was a significant statistical difference between the 2 groups in the time interval of crying after intervention ( p=0.008 ) .
the preinterventional o2 saturation in the case group was 95.802.78 and 94.073.18 in the control group , during intervention 96.172.61 in the case group and 94.532.64 in control group and after intervention 95.602.19 in case group and 95.101.72 in the control group .
mean pain intensity during intervention was significantly lower in the case group than in control group .
mean pain intensity 3 minutes after intervention was significantly lower in the case than control group .
this was compatible with the results of the gray et al and johnston et al[8 , 13 ] .
gray et al showed that pain reaction was 65% less in their case group compared to the control group .
the results of johnston et al showed that the efficacy of the kmc was significant in relieving pain in infants of 32 weeks gestational age .
the results of anderson et al showed that skin to skin contact is a factor that relieves infant pain and reduces behavioral and physiological reactions to painful stimulations .
moreover , luedington investigated the effect of skin to skin contact on painful nursing procedures .
he concluded that infants who had skin to skin contact showed less pain related reactions such as change in grimace .
our study was compatible with johnson 's with regard to pulse rate in the two groups which was insignificant .
gray reported that hugging neonates during vaccination decreased the crying interval compared to the control group in which the neonates were placed on a bed during vaccination .
the present investigation showed that the skin to skin contact group had a crying interval time shorter than that of controls .
according to the results of this study kmc decreased pain severity in neonates of the case group during the intervention and 3 minutes afterwards .
 objectiveit has been demonstrated that newborns feel pain completely . 
 thus , they should be treated with this in mind . 
 recent research showed that non - pharmacological interventions such as  kangaroo care  may be useful for decreasing pain in newborns . 
 we tried to determine the effect of kangaroo care on the pain intensity of vaccination in healthy newborns.methodsthis study was a randomized case - control clinical trial . 
 subjects were 60 healthy full - term newborns delivered in a general hospital , in iran , from march to july 2006 . 
 they were randomly assigned to case and control groups . 
 the case group received 30 minutes skin to skin contact , whereas infants in the control group were put , wrapped in a blanket , aside the mothers . 
 behavioral changes of newborns were evaluated and observed 2 minutes before , during , and 3 minutes after the intervention . 
 all procedures were filmed . 
 an assistant who was blinded to the study , scored behavior changes using neonatal / infant pain scale . 
 heart rate and oxygen saturation levels as displayed on the pulse monitor and duration of crying were recorded using a stopwatch.findingsmean pain intensity during the intervention v was significantly lower in the case group ( p<0.006 ) . 
 mean pain intensity 3 minutes after intervention was also significantly lower in the case group ( p<0.021 ) . 
 mean duration of crying was significantly lower in case group as well ( p<0.001).conclusionkangaroo care may be used to decrease pain intensity in newborns undergoing painful procedures . 
Introduction
Subjects and Methods
Findings
Discussion
Conclusion
Conflict of Interest