Background: High levels of stress caused by various medical procedures can affect developmental outcomes in preterm infants. Therefore, clustered care and direct observation of infant behaviors during care provision have been emphasized. The present study aimed to compare the behavioral responses of preterm infants to clustered care with four and five noninvasive procedures.

Methods: This randomized crossover clinical trial was performed in Al-Zahra Teaching Hospital (Tabriz, Iran) during 2013. The behavioral symptoms of 31 preterm 32-week old infants were assessed following the administration of clustered care with four procedures (taking axillary temperature, changing the location of the pulse oximeter probe, gavage, and position change) and five procedures (the four mentioned procedures plus weighing). Data were analyzed with generalized linear mixed models and negative binomial link function in STATA 10. P values less than 0.05 were considered significant.

Result: The mean scores of behavioral symptoms indicating stability during clustered care with four and five procedures were 4.23 ± 2.33 and 4.03 ± 3.67, respectively. The mean scores of behavioral symptoms indicating stress during clustered care with four and five procedures were 4.03 ± 3.01 and 3.29 ± 2.67, respectively. There were no significant differences between the two groups before, during, or after the two interventions (P > 0.05).

Conclusion: Clustered care with four and five noninvasive procedures led to behavioral symptoms indicative of acceptable stability in infants. Therefore, both care methods could be equally recommended for preterm infants.