The effect of reverse kangaroo care position and ROP position on pain during retinopathy examination in premature infants: A randomized controlled trial

PURPOSE: This study aimed to compare the Reverse Kangaroo Care position with the ROP position in terms of pain and related physiological responses during retinopathy examination in premature infants. METHODS: The research was carried out at the Premature Retinopathy Outpatient Clinic of a university-affiliated medical institution during the period spanning from February 2024 to July 2025. Data were obtained from 25 in the Reverse Kangaroo Care position group and 25 in the ROP position group. For each infant, heart rate, SpO₂, PIPP-R score, and crying duration were recorded around the ROP examination at three procedural moments: before, during, and after the examination. Generalized estimating equations were used because the same infants contributed repeated measurements over time. RESULTS: PIPP-R pain scores differed significantly between groups and at the time of measurement (p < 0.001). One minute after examination, mean pain scores were lower in both the Reverse Kangaroo Care and ROP position groups (0.08 ± 0.40 and 1.04 ± 1.77, respectively; p < 0.01 for within-group variation). Heart rate was lower in the Reverse Kangaroo Care position group one minute after examination (p < 0.05). Crying duration increased during examination and then decreased afterward; however, the Group × Time interaction was not statistically significant. CONCLUSION: Both positions resulted in lower pain scores after ROP examination. Changes in pain score and crying duration over time were not statistically different between groups, whereas heart rate recovery one minute after examination was more positive in the Reverse Kangaroo Care position group. IMPLICATIONS TO PRACTICE: The Reverse Kangaroo Care position and the ROP position are two practical and effective, non-pharmacological methods that enable parental involvement in pain management during ROP examinations. The Reverse Kangaroo Care position is more effective at improving physiological parameters. The Reverse Kangaroo Care position, which also promotes parental involvement through skin-to-skin contact, is recommended to be preferred whenever feasible. CLINICAL TRIALS NUMBER: NCT06694103.