A Novel Approach for Reducing Stress in Preterm Infants

Lead: Liisa Holsti & Karon MacLean

Baby laying on bed with blue blanket
Baby laying on the Calmer (blue pad)

Each year worldwide, over 15 million infants are born preterm (March of Dimes, 2009). In Canada more than 30,000 preterm infants are born annually and have associated direct and indirect health care costs of more than $1 billion. These infants can be so small that they fit in the palm of one's hand and may remain in hospital for days, weeks or months. While in the neonatal intensive care unit (NICU), preterm infants repeatedly experience stressful, but essential care-related procedures (e.g., mechanical ventilation, heel lance for blood sampling). Early pain/stress is associated with brain injury in preterm infants and has negative long term effects on growth and on neurodevelopment.

For treating pain during routine procedures, behavioural treatments are recommended, such as encouraging parents to hold their babies skin-to-skin. However, parents may not be available 24 hours/day, and many of these infants are very medically fragile, and so may not be well enough for skin-to skin holding. Calmer is designed to provide the key parts of skin-to-skin holding, including touch, heart beat sounds, and breathing motion.

The idea of Calmer was derived from the Haptic Creature, a social human robot that mimics a small pet that interacts through touch (Yohanan & MacLean, 2011). Calmer was designed to be used in a safety-critical environment and to have an utterly non-humanoid appearance to avoid a user perception that it is "replacing the mother". Calmer has 4 components: the moving platform, the “skin”, the hand-held control and the motor which is external to the platform. Calmer fits directly into our most modern incubators and the heart and breathing rates are adjustable so that Calmer can use the rates that match each infant’s parent.  Early results from our pilot research shows that infants on Calmer have 80-90% less stress during a blood test than infants in a who received the standard of care treatment, facilitated tucking.


Holsti, L, MacLean K, Voss H.

Related Papers:

Williams N, Holsti L, MacLean K, Collet JP.  Calmer: A novel approach for reducing stress in preterm infants.  Pediatric Academic Society, E-PAS2016:2881.620. Baltimore USA, May, 2016.

Holsti L, Williams N, MacLean K, Collet JP.  Calmer: A novel approach for reducing stress in preterm infants.  Canadian Association of Occupational Therapy. Accepted-Platform Presentation. Vancouver, BC. June 23, 2018.