# Effects of hydrotherapy and hammock positioning on pain reduction in preterm neonates

## TL;DR

This study shows that hydrotherapy and hammock positioning can reduce pain in preterm babies during medical procedures.

## Contribution

The novel finding is that combining hydrotherapy and hammock positioning provides the greatest pain reduction in preterm neonates.

## Key findings

- Hydrotherapy significantly reduced pain scores and prevalence in preterm neonates.
- Hammock positioning also significantly reduced pain scores and prevalence.
- The combined intervention of hydrotherapy and hammock positioning resulted in the greatest pain reduction.

## Abstract

To evaluate the effects of hydrotherapy and hammock positioning, applied individually or in combination, on pain reduction in preterm neonates.

This randomized clinical trial included 45 preterm neonates under 37 weeks of gestation and weighing less than 2,500g, admitted to the neonatal intensive care unit or intermediate care unit at Santa Casa Hospital in Sobral, Brazil. Palliative interventions were performed during routine invasive and painful procedures, specifically heel lances and handling of the orogastric tube during feeding. Neonates were randomized into three groups: hydrotherapy, hammock positioning, or a combined intervention, with 15 participants per group. Interventions were applied once daily for 15 consecutive days. Pain was assessed using the Neonatal Facial Coding System before and after each session, totaling 1,350 evaluations. Continuous variables were analyzed using Student’s t-test, and categorical variables were analyzed using Fisher’s exact test. The study was registered in the Brazilian Registry of Clinical Trials.

The sample consisted of 53.3% male neonates, with a mean gestational age of 32.4±2.1 weeks. Hydrotherapy significantly reduced pain scores and pain prevalence. Hammock positioning also produced significant reductions in pain scores and prevalence. The combined intervention resulted in the greatest reduction in pain scores and pain prevalence. All within-group comparisons showed statistically significant improvements. No statistically significant differences were observed when the three intervention groups were compared directly.

Hydrotherapy and hammock positioning, applied individually or in combination, are effective, safe, and feasible strategies for reducing pain in preterm neonates and may complement standard neonatal care in NICUs.