Evaluation of Methods to Minimize Pain in Newborns during Capillary Blood Sampling for Screening: A Randomized Clinical Trial

Magdalena Napiórkowska-Orkisz,Aleksandra Gutysz-Wojnicka,Iwona Sadowska-Krawczenko,Mariola Tanajewska

doi:10.3390/ijerph19020870

Abstract

Aim: The aim of the study was to assess the severity of pain experienced by a newborn during a heel puncture for screening using the Newborn Pain Scale (NIPS), measure the heart rate and compare the effectiveness of non-pharmacological methods of pain control. Design: Randomized clinical trial. No experimental factors. The test was performed during routine screening. Surroundings: Provincial Specialist Hospital in Olsztyn. Patients/Participants: Pain was assessed in 90 full-term newborns. The newborns were rooming in with their mothers in the hospital. Interventions: Newborns were divided into three groups. Three different methods of pain relief were used: breastfeeding, 20% glucose administered orally and non-nutritional sucking. Main Outcome Measures: The primary pain outcome was measured using the NIPS and the secondary pain outcome measures (heart rate, oxygen saturation) were measured using a pulse oximeter. Results: During capillary blood sampling from the heel, most newborns, n = 56 (62.2%), experienced no pain or mild discomfort, severe pain occurred in n = 23 (25.6%) and moderate pain occurred in n = 11 (12.2%). No significant statistical differences were found between the degree of pain intensity and the intervention used to minimize the pain p = 0.24. Statistically significant relationships were demonstrated between heart rate variability and the degree of pain intensity (p = 0.01). There were no statistically significant differences between the newborn’s pain intensity and the mother’s opinion on the effectiveness of breastfeeding in minimizing pain. Conclusions: This study did not answer the question of which pain management method used during the heel prick was statistically more effective in reducing pain. However, the results indicate that each of the non-pharmacological interventions (breastfeeding, oral glucose dosing and non-nutritive sucking) applied during heel puncture resulted in effective pain management in most of the newborns enrolled in the study. The relationship between heart rate variability and the severity of pain was confirmed. Mothers of newborns in the breastfeeding group were satisfied with the pain relief methods used in the child and the opportunity to console their newborn during painful procedures in a technologically invasive environment.

Highlights

The newborn screening program is the only procedure that enables early detection, diagnosis and treatment of several dozen congenital diseases that are life-threatening, disturb development and lead to irreversible neurological changes and severe intellectual disability
The results showed that using dextrose water D10W was more effective than using facilitated tucking by parents (FTP) [9]
During capillary blood sampling from the heel, the pain experiences of newborns, according to the Neonatal Infant Pain Scale (NIPS) scale, were as follows: most newborns, n = 56 (62.2%), experienced no pain or mild discomfort, severe pain occurred in n = 23 (25.6%), and moderate pain occurred in n = 11 (12.2%) (Table 1)

Summary

Introduction

The newborn screening program is the only procedure that enables early detection, diagnosis and treatment of several dozen congenital diseases that are life-threatening, disturb development and lead to irreversible neurological changes and severe intellectual disability. The collection of capillary blood for a screening test by a puncture of the medial lateral side of the heel is associated with pain experienced by newborns [1,2]. This technique is popular because it enables the collection of a very small volume of blood (0.2–0.5 mL). The use of this technique requires proper preparation of the child’s foot, adherence to the principles of infection control measures before and during the procedure, and the use of non-pharmacological methods of pain relief before starting the procedure [4]. There are numerous scales that have been validated in both term and preterm neonatal populations, including the Premature Infant Pain Profile (PIPP), the Neonatal Infant Pain Scale (NIPS), CRIES, the COMFORT scale, Neonatal Pain, the Agitation and Sedation Scale (N-PASS)

Methods

Results

Discussion

Conclusion