Abstract
Introduction: Pain in neonates is largely underestimated and neglected. Pain experience can alter clinical outcome, brain development and subsequent behavior in newborns. Numerous newborns undergo blood sampling routinely in nurseries/NICUs and these procedures are often done without pain relieving measures. Heel lancing and venepuncture are two common procedures for blood sampling in neonates. The objective of this study was to compare pain response to venepuncture versus heel lance in full term neonates. Materials and Methods: A comparative observational study was conducted among 200 term neonates who were undergoing blood sampling for bilirubin or glucose estimation. Neonates were randomly assigned to heel lance (HL) and venepuncture (VP) groups with 100 babies in each group. During the procedure, pain was assessed by Neonatal/Infant pain Scale (NIPS). Heart rate (HR) and oxygen saturation (SpO2) were continuously monitored 5 minutes prior to procedure and upto 5 minutes after the procedure. Results: The median NIPS score in HL and VP were 7 and 3.5 respectively which showed statistically significant (p= 0.0001) higher level of pain experience in HL than in VP. During the procedure, both the groups (HL and VP) showed significant changes in heart rate and oxygen saturation i.e., increase in HR (p= 0.0001) and decrease in SpO2 (p= 0.0001), however the increase in heart rate and decrease in oxygen saturation were significantly more in HL than in VP (p= 0.0001). Conclusion: Neonates perceive pain as demonstrated by Neonatal Pain Scale and venepuncture is the less painful procedure than heel lancing for blood sampling in neonates. J. Nepal Paediatr. Soc. 32(2) 2012 99-104 doi: http://dx.doi.org/10.3126/jnps.v32i2.5477
Highlights
Pain in neonates is largely underestimated and neglected
Neonatal/Infant pain Scale (NIPS) score by both the observers for all neonates were computed
There was no significant difference in heart rate between both groups (p= 0.243) whereas during procedure, there was significant increment in heart rate in both groups (p= 0.0001), the increment was significantly more in heel lance (HL) group than in VP group (p=0.0001). (Fig. 1)
Summary
Pain in neonates is largely underestimated and neglected. Pain experience can alter clinical outcome, brain development and subsequent behavior in newborns. Numerous newborns undergo blood sampling routinely in nurseries/NICUs and these procedures are often done without pain relieving measures. Results: The median NIPS score in HL and VP were 7 and 3.5 respectively which showed statistically significant (p= 0.0001) higher level of pain experience in HL than in VP During the procedure, both the groups (HL and VP) showed significant changes in heart rate and oxygen saturation i.e., increase in HR (p= 0.0001) and decrease in SpO2 (p= 0.0001), the increase in heart rate and decrease in oxygen saturation were significantly more in HL than in VP (p= 0.0001). Numerous newborns routinely undergo blood-letting procedures in nurseries/NICU for diagnostic and therapeutic purposes but usually these procedures are done without pain preventing or relieving measures. Unrelieved pain in neonates may result in increased morbidity and length of stay in nurseries/ NICU, altered immune function, exaggerated pain in later life and altered psychosocial development[4,5,6]
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