Heel Lance Procedure Research Articles

Establishing a standardised approach for the measurement of neonatal noxious-evoked brain activity in response to an acute somatic nociceptive heel lance stimulus

BackgroundElectroencephalography (EEG) can be used in neonates to measure brain activity changes that are evoked by noxious events, such as clinically required immunisations, cannulation and heel lancing for blood tests. EEG provides an alternative approach to infer pain experience in infants compared with more commonly used behavioural and physiological pain assessments. Establishing the generalisability and construct validity of these measures will help corroborate the use of brain-derived outcomes to evaluate the efficacy of new or existing pharmacological and non-pharmacological methods to treat neonatal pain. This study aimed to test whether a measure of noxious-evoked EEG activity called the noxious neurodynamic response function (n-NRF), that was originally derived in a sample of term-aged infants at the Oxford John Radcliffe Hospital, UK, in 2017, can reliably distinguish noxious from non-noxious events in two independent datasets collected at University College London Hospital and at Royal Devon & Exeter Hospital. We aimed to reproduce three published results that use this measure to quantify noxious-evoked changes in brain activity. We used the n-NRF to quantify noxious-evoked brain activity to test (i) whether significantly larger noxious-evoked activity is recorded in response to a clinical heel lance compared to a non-noxious control heel lance procedure; (ii) whether the magnitude of the activity evoked by a noxious heel lance is equivalent in independent cohorts of infants; and (iii) whether the magnitude of the noxious-evoked brain activity increases with postmenstrual age (PMA) in premature infants up to 37 weeks PMA. Positive replication of these studies will build confidence in the use of the n-NRF as a valid and reliable pain-related outcome which could be used to evaluate analgesic efficacy in neonates. The protocol for this study was published following peer review (https://doi.org/10.17605/OSF.IO/ZY9MS). ResultsThe n-NRF magnitude to a noxious heel lance stimulus was significantly greater than to a non-noxious control heel lance stimulus in both the UCL dataset (n = 60; mean difference .88; 95% confidence interval (CI) .64–1.13; p < .0001) and the Exeter dataset (n = 31; mean difference .31; 95% CI .02–.61; p = .02). The mean magnitude and 90% bootstrap confidence interval of the n-NRF evoked by the heel lance did not meet our pre-defined equivalence bounds of 1.0 ± .2 in either the UCL dataset (n = 72; mean magnitude 1.33; 90% bootstrapped CI 1.18–1.52) or the Exeter dataset (n = 35; mean magnitude .92, 90% bootstrapped CI .74–1.22). The magnitude of the n-NRF to the noxious stimulus was significantly positively correlated with PMA in infants up to 37 weeks PMA (n = 65; one-sided Pearson's R, adjusted for site: .24; 95% CI .06–1.00; p = .03). ConclusionsWe have reproduced in independent datasets the findings that the n-NRF response to a noxious stimulus is significantly greater than to a non-noxious stimulus, and that the noxious-evoked EEG response increases with PMA. The pre-defined equivalence bounds for the mean magnitude of the EEG response were not met, though this might be due to either inter-site differences such as the lack of calibration of devices between sites (a true negative) or underpowering (a false negative). This reproducibility study provides robust evidence that supports the use of the n-NRF as an objective outcome for clinical trials assessing acute nociception in neonates. Use of the n-NRF in this way has the potential to transform the way analgesic efficacy studies are performed.

Effect of Acupoint Stimulation on Controlling Pain from Heel Lance in Neonates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

To evaluate the effect of acupoint stimulation compared to other interventions on pain control in neonates who underwent heel lance, we searched for randomized controlled trials across six databases (CINAHL, Cochrane Library, EMBASE, Medline, PubMed, and Web of Science) published up to January 2023. Studies comparing acupoint stimulation and other interventions for controlling heel lance pain in neonates were included. These reports measured at least one of the following variables: pain score, crying time, oxygenation saturation, heart rate, respiration rate, and duration of the procedure. The data were independently extracted by two authors, and the PRISMA guidelines for study selection were followed. A total of 79 articles were screened, and 10 studies, with results on 813 neonates, were included in the final selection. The pain scores recorded during the heel lance procedure were not significantly different between the acupoint stimulation cohort and the control cohort (SMD of -0.26, 95% confidence interval (CI) from -0.52 to 0.01; p = 0.06; I2 = 68%). After processing the subgroup analyses, significant differences were found in the comparisons of acupuncture vs. usual care (SMD of -1.25, 95% CI from -2.23 to 0.27) and acupressure vs. usual care (SMD of -0.62, 95% CI from -0.96 to -0.28); nonsignificant differences were found in other comparisons. Our results demonstrate that acupoint stimulation may improve pain score during the heel lance procedure.

25% Dextrose Versus 24% Sucrose for Heel Lancing in Preterm Infants: A Noninferiority RCT.

To compare the efficacy of 25% dextrose with 24% sucrose for heel-lance analgesia in preterm infants admitted to the NICU. In this noninferiority, double-blind, randomized controlled trial, preterm infants born at 28 weeks and 0 days to 35 weeks and 6 days of gestation who were due for a scheduled heel-lance procedure were enrolled. Infants randomly assigned to the intervention arm received 0.5 mL 25% dextrose, whereas infants in the active control group received 0.5 mL 24% sucrose orally just 2 minutes before the heel-lance procedure. The primary outcome was Premature Infant Pain Profile (PIPP) score 30 seconds after the procedure. Secondary outcomes included PIPP scores at 60 and 120 seconds, PIPP-Revised scores at 30, 60, and 120 seconds, and any adverse events. Sixty-four infants were enrolled (32 in each group). The mean (SD) PIPP score at 30 seconds was 6.41 (2.56) in the dextrose group and 7.03 (2.23) in the sucrose group (mean difference, -0.63 (95% confidence interval, -1.85 to 0.60; P = .31). The upper margin of the confidence interval did not cross the predefined noninferiority margin of 2. The mean PIPP scores at 60 (5.03 [2.18] vs 5.39 [1.48]) and 120 (4.75 [1.97] vs 4.94 [1.46]) seconds were also similar. The PIPP-Revised scores between the 2 groups at all time intervals were comparable. One infant in the intervention group had a transient coughing episode. In preterm infants under intensive care, 25% dextrose is noninferior to 24% sucrose for heel-lance analgesia as assessed by PIPP score.

The Effect of Vibration on Pain During Heel Lance Procedures in Newborns: A Randomized Controlled Trial.

The pain-reducing effect of applying vibration, which is used as a nonpharmacological method in pain management, is explained by the gate control theory developed by Melzack and Wall. Studies that are based on this theory have shown similar results to those of Melzack and Wall, indicating that pain-transmitting nerves are suppressed by vibrations, leading to higher pain thresholds. The study aimed to evaluate the effect of applying vibration to manage pain during heel lance procedures in newborns. This is a randomized, controlled experimental study. The study sample included 56 newborns determined using power analysis (vibration group = 28; control group = 28). For those in the vibration group, a vibrating device was used for approximately 30 seconds before the heel lance procedure and then continued throughout the procedure. No interventions were provided to the newborns in the control group. Pain in the newborns was evaluated by the nurse who performed the heel lance procedures, before the procedures and 15 to 20 seconds and 5 minutes after procedures, and by 2 specialists who viewed the video footage and conducted the Neonatal Infant Pain Scale examination. The pain scores were significantly lower at 15 to 20 seconds and 5 minutes after the heel lance procedures in the group that received vibrations than in the control group (P < .05). The application of vibration, which is effective, nonpharmacological, and noninvasive, could help nurses manage pain in newborns as a nonpharmacological method. The number of studies that examine the effect that vibration has on pain associated with heel lance procedures in newborns is very limited, and it is recommended that further studies be conducted with larger sample sizes.

Effect of expressed breast milk administration on pain response among newborns during heel lance procedure in a tertiary care hospital — A randomized controlled trial

Newborn’s pain is a great challenge to health professionals as well as to parents. Newborns are especially vulnerable to pain. The primary objective was to evaluate the effectiveness of expressed breast milk administration on pain response among newborns during heel lance procedure and the secondary objective was to find out association between selected sociodemographic variables and pain response among newborns during heel lance procedure. The research approach adopted was quantitative and the design was experimental - A randomized controlled trial. Sixty newborns after 48 to 72 hours of life who came to the Shalabham newborns screening unit for metabolic screening were selected according to the inclusion criteria. Samples were selected by using block randomization with fixed block size 4 and newborns divided into two groups, experimental and control group. Allocation concealment was done by using an opaque sealed envelope. The investigator, clinical data collected from the case record of the newborns and caregiver who came with newborns to Shalabham unit. After collecting clinical data, pain was measured by NIPS score 3 minutes before heel lance procedure for getting baseline data by an observer in both the groups by an observer. The investigator knows the newborns whether included in experimental or control group. Then for the experimental group, 5 ml expressed breast milk was given through gokarnam by the investigator and routine care was given by the staff nurse. For control group routine care given by staff nurse. After 1 minute performed heel lance procedure by a staff nurse who had adequate experience in neonatal care to minimize the variation in pain during the heel lance procedure, heel lance procedure was done using all sterile precautions and blood collected in the screening card and kept for drying process. The observer assessed the pain level of newborns by using NIPS score during heel lance procedure both experimental group and control group. After 30 minutes, pain level was reassessed by observer using NIPS score on experimental and control group and recorded. Results showed that the mean pain level was significantly improved in the experimental group (p&amp;#60;0.00) compared to the control group. Thus, it can be concluded that expressed breast milk administration is found to be effective in reducing pain during heel lance procedures.

Turkish validity and reliability of the COVERS pain scale.

The objective of this study is to determine the Turkish validity and reliability of COVERS. This study was conducted on 41 newborns as methodological design. The scales, such as newborn information form, COVERS, preterm infant pain profile (PIPP), and neonatal infant pain scale (NIPS), were used in the study. Validity (e.g., language, content concurrent, and construct) and internal consistency and inter-rater reliability of the scale were conducted. It was found that COVERS showed a high correlation with PIPP and NIPS, and the item-total correlation of COVERS was above 0.30 during and after heel lance procedure. The Cronbach's α values were 0.77 and 0.83 during and after heel lance procedure, respectively. The kappa values of the items of COVERS were between 0.38 and 0.78 during heel lance procedure. It was concluded in this study that there was a moderate correlation in intraclass correlation coefficients for scores of COVERS during both diaper change and heel lance procedures. It has been concluded that the scale is valid and reliable in 27-week-old and older newborns.

The effect on pain level and comfort of foot massages given by mothers to newborns before heel lancing: Double-blind randomized controlled study.

In addition to pharmacological methods, non-pharmacological methods can also be used for reducing pain and increasing comfort during invasive procedures in newborn babies. This study was conducted to determine the effect on pain level and comfort of foot massages given by mothers to newborns before heel lancing. This is a double-blind randomized controlled experimental study. The sample consisted of 128 newborns including 64 in the intervention group and 64 in the control group. The Newborn Infant Pain Scale (NIPS) and Newborn Comfort Behavior Scale (NCBS) were used to collect the data, along with questionnaires for information on the newborn and mother. The researcher explained to each mother in theory how to do a foot massage at least 2 h before the heel lancing procedure. Mothers then drew random assignments to either an intervention group that would give a foot massage for 3 min with baby oil, or a control group that simply waited 3 min, immediately prior to the lancing. It was determined that the foot massage performed by the mother reduced the pain level of babies, increased their comfort levels, and decreased their distress levels. Nurses play an active role in defining and evaluating the newborn's responses to pain. It is thought that this study will guide nurses working in the clinic in reducing the acute pain that develops with invasive interventions performed on newborns and in preventing the negative effects of pain on the newborn.

The effect of foot reflexology on procedural pain before heel lancing in neonates

ObjectiveThis study was designed to investigate the effect of foot reflexology on alleviating term neonates’ invasive pain caused by heel lance. MethodsIn this quasi-experimental study, 60 healthy neonates were recruited and divided into a reflexology group (n=30) and a control (n=30) group. The study design was quasi-experimental since the randomisation method was not used in the assignment of newborns to the groups. While the reflexology group received foot reflexology for an average of 20min before heel lance, the control group received no intervention. The elicited data were analysed using descriptive statistics and independent t-test. ResultsThe reflexology and the control groups were similar in terms of age, gestational week, Apgar score, weight, height, and sex (P>0.05). The Neonatal infant pain scale (NIPS) scores of the newborns in the reflexology group after the heel lance procedure were found to be significantly lower than those in the control group (P<0.05). It was also found that reflexology had a significant effect on the neonates’ heart rate before heel lance (P<0.05) and a borderline effect during heel lance. Moreover, it was observed that the application of foot reflexology shortened the experimental-group neonates’ crying periods after the procedural pain (P<0.05). However, reflexology had no statistically significant effect on the duration of heel lance in both groups (P>0.05). ConclusionThe application of foot reflexology before invasive procedures, such as heel lance in newborns, is an effective non-pharmacological method for reducing invasive pain. Thus, reflexology could be used to reduce neonates’ pain and soothe them during painful procedures such as heel lance.

Is Facilitated Tucking by Parents More Effective than Dextrose Water (10%) in Reducing Full-Term Neonatal Pain during the Heel-Lancing Procedure: A Randomized Controlled Trial

Neonates are exposed to pain as a result of routinely applied painful procedures which in many cases are poorly managed There are numerous non-pharmacologic interventions that could help manage procedural pain There still a lack of evidence supporting the use of several non-pharmacologic interventions, such as facilitated tucking by parents (FTP) for neonatal pain management A randomized controlled three-group experimental design was used to compare the effectiveness of oral dextrose water D10%W vs FTP among neonates whose ages ranged from 24 to 48 hours Three phases of (baseline, during, and after) heel stick procedures were videotaped Pain responses were measured using a behavioral pain scale, as well as physiological pain responses (heart rate, respiratory rate, and oxygen saturation) A total of 135 neonates were included in the study Both D10W and FTP groups were found to be effective in reducing behavioral scores (P=0 00) And physiological pain scores, including heart rate (P= 0 009), respiratory rate (P=0 01), and oxygen saturation (P=0 002) as compared to control group However, immediately (20sec) after the procedure, the total pain score was significantly lower in dextrose group compared to the other two groups (m= 2 8, SD= 0 7) D10%W and FTP had pain-relieving effects as compared to control in neonates who are 38-40 ± 2 weeks of gestation and are undergoing heel stick procedure However, an added advantage for D10%W, in these times, is reducing physical contact between neonate and parent during limited access of parent to NICUs units a s a result of COVID 19 transmission © 2020, Advanced Scientific Research All rights reserved

The Effect of Warm Compression Applied before Heel Lance on Pain Level, Comfort Level and Procedure Time in Healthy Term Newborns: A Randomized Clinical Trial

Background & aim: Warm compression is an effective method preferred in relieving pain. It enables procedures to be completed in a shorter time, and with less pain due to increasing blood flow in the area. This study aimed to investigate the effects of warm compress applied before heel lance on the procedure time, level of pain, and comfort level of healthy term newborns. Methods: This randomized controlled clinical was conducted on 80 neonates who were randomly divided into experimental and control groups. The data were collected using demographic questionnaire, observation checklist for procedure, Neonatal Infant Pain Scale (NIPS), and The Comfort Behaviour Scale (TCBS). The experimental group was subjected to local dry mild-warm compression to the heel before the heel lance procedure. The control group received routine heel lance procedure. Body temperature, peak heart rate, and oxygen saturation levels before, during, and after the procedure were recorded in both groups. Data were analyzed in SPSS software (version 16) using the Chi-square test and Mann-Whitney U test. Results: The results of the study showed shorter procedure time in the experimental group compared to the control group (P<0.05). Moreover, the mean NIPS and TCBS total scores were lower in the experimental group compared to control group, and this was found to be statistically significant (P<0.05). Conclusion: It was found that warm compression applied before heel lance decrease the length of the procedure and is effective in decreasing pain and providing comfort in newborns.

Historical roots of pain management in infants: A bibliometric analysis using reference publication year spectroscopy.

Retrospective evaluations of the historical role of previously published research are often fraught with subjective bias and misrepresentation, which leads to contested scientific claims. This paper investigates the historical roots of infant pain management using novel quantitative methods to identify the published literature and evaluate its relative importance. A bibliometric analysis named “reference publication year spectroscopy” (RPYS), was performed using the program CitedReferencesExplorer (CRExplorer) to avoid the subjectivity associated with comparative evaluations of individual research studies. Web of Science (WoS) search queries on infant‐related synonyms, pain‐related synonyms, and analgesia or anesthesia‐related synonyms were combined using the Boolean operator “AND,” to identify all publications related to pain management in infants. The RPYS analyses were based on 8697 papers in our publication set containing the citations for 86268 references. Selected cited publications were associated with peak citation years in 1951, 1954, 1957, 1965, 1987, 1990, 1997, 1999, and 2000. Subsequent analyses suggested that research on infant pain management made rapid progress during 1982‐1992. Landmark publications were defined as those belonging to the top 10% of the most frequently referenced publications for longer than 25 years. Through this analysis, we identified and ranked 24 landmark publications to illustrate the historical background and early research on infant pain management. From the first‐ever application of RPYS (an objective, reproducible approach to study the early history of any scholarly activity) to pain research, infant pain management appears rooted in the scientific rationale for neonatal pain perception, randomized trials of opioid anesthesia/analgesia, and studies describing the facial expressions and crying activity following heel‐lance procedures in newborns.

Effects of three different methods used during heel lance procedures on pain level in term neonates.

This study aims to experimentally determine effects of three different methods (swaddling; swaddling and holding; swaddling, holding and breastfeeding) used during heel lancing on pain levels in healthy term neonates. This study was a prospective, randomized controlled trial. The sample of newborns (n = 160) were allocated to the groups (group 1, control; group 2, swaddling; group 3, swaddling and holding; group 4, swaddling, holding and breastfeeding) by blocked randomization. The study data were obtained using an information form, and the Neonatal Infant Pain Scale (NIPS). The procedural pain scores of group 4 were lower than group 1, group 2 and group 3. Both the total crying time and the first calming time of the groups swaddling, holding and breastfeeding, were shorter than the swaddling, swaddling and holding and the control group. As a result, all the three methods are effective in reducing the pain felt during heel lancing in the newborn. However, swaddling, holding and breastfeeding is more effective than the other methods.

Maternal Voice on Alleviating Pain in Premature Undergoing Heel Lance Procedure and Enhancing Mother-Infant Bonding

Maternal Voice on Alleviating Pain in Premature Undergoing Heel Lance Procedure and Enhancing Mother-Infant Bonding

The effects of acupressure and foot massage on pain during heel lancing in neonates: A randomized controlled trial

ObjectiveTo determine the effects of foot massage and acupressure on pain during heel lancing in neonates. MethodsA randomized controlled trial was performed in a university hospital in Turkey between February and December 2018. The neonates were randomized into three groups as acupressure, massage, and control groups. Acupressure was applied to the neonates in the acupressure group, and massage was given to the neonates in the massage group for 2 min before the heel lancing procedure. Pain responses of the neonates in the groups was evaluated with the Neonatal Infant Pain Scale during and 1 min after the heel lancing procedure. ResultsThe study was completed with 139 neonates including 46 neonates in the acupressure group, 47 neonates in the foot massage group, and 46 neonates in the control group. There were statistically significant differences between the acupressure, massage and control groups in terms of their mean NIPS scores during (4.30 ± 2.25, 3.95 ± 2.63, 6.04 ± 1.26; respectively) and 1 min after the heel lancing procedure (1.46 ± 1.46, 1.66 ± 1.66, 3.85 ± 1.37; respectively). There was a significant difference in NIPS scores between the intervention groups and the control groups (p = 0.001). ConclusionsAcupressure and massage were effective in reducing pain in neonates during the heel lancing procedure. However, there was no statistically significant difference between acupressure and massage. Acupressure and massage techniques can be applied for procedural pain management in the newborn.

The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial

BackgroundOrally administered sucrose is effective and safe in reducing pain intensity during single, tissue-damaging procedures in neonates, and is commonly recommended in neonatal pain guidelines. However, there is wide variability in sucrose doses examined in research, and more than a 20-fold variation across neonatal care settings. The aim of this study was to determine the minimally effective dose of 24% sucrose for reducing pain in hospitalized neonates undergoing a single skin-breaking heel lance procedure.MethodsA total of 245 neonates from 4 Canadian tertiary neonatal intensive care units (NICUs), born between 24 and 42 weeks gestational age (GA), were prospectively randomized to receive one of three doses of 24% sucrose, plus non-nutritive sucking/pacifier, 2 min before a routine heel lance: 0.1 ml (Group 1; n = 81), 0.5 ml (Group 2; n = 81), or 1.0 ml (Group 3; n = 83). The primary outcome was pain intensity measured at 30 and 60 s following the heel lance, using the Premature Infant Pain Profile-Revised (PIPP-R). The secondary outcome was the incidence of adverse events. Analysis of covariance models, adjusting for GA and study site examined between group differences in pain intensity across intervention groups.ResultsThere was no difference in mean pain intensity PIPP-R scores between treatment groups at 30 s (P = .97) and 60 s (P = .93); however, pain was not fully eliminated during the heel lance procedure. There were 5 reported adverse events among 5/245 (2.0%) neonates, with no significant differences in the proportion of events by sucrose dose (P = .62). All events resolved spontaneously without medical intervention.ConclusionsThe minimally effective dose of 24% sucrose required to treat pain associated with a single heel lance in neonates was 0.1 ml. Further evaluation regarding the sustained effectiveness of this dose in reducing pain intensity in neonates for repeated painful procedures is warranted.Trial registrationClinicalTrials.gov: NCT02134873. Date: May 5, 2014 (retrospectively registered).

A study to assess the effectiveness of swaddling on pain among neonates undergoing heel lancing procedure in neonatal intensive care units

Neonates, infants and children often require examinations and investigations for admissions in the hospital. Even after admission frequent examinations and procedures will be carried out for further management. Pain during such investigations, treatments and procedures are called as procedural pain.1Appropriate pain relief can be achieved through administration of analgesics. But analgesics can cause different side effects and reaction to the newborns.2 Swaddling is the procedure of wrapping a baby in a blanket for warmth and security.3 swaddling provides stimulation across the proprioceptive, thermal, and tactile sensory systems that may reduce pain through gate control mechanisms.4

The effect of nesting positions on pain, stress and comfort during heel lance in premature infants

BackgroundNesting positions are commonly used in procedural analgesic administration in premature neonates. The effectiveness of nesting positions is questioned. The aim of the this study was to assess the pain, stress, comfort and salivary cortisol and melatonin values in nesting positions during the heel lance procedure in premature infants at the NICU. MethodsExperimental research; repeated measurement design. The sample comprised 33 premature neonates with gestational age of 31–35 weeks who had been hospitalized in the NICU. Nesting positions were given using linen or towels. The procedure of heel lance was recorded on camera. The camera recordings were evaluated according to the NIPS and the COMFORTneo scale. Saliva samples were obtained five minutes prior to and 30 min after the heel lance procedure. Salivary Cortisol and Melatonin were measured using the Salimetrics Cortisol Elisa Kit and the Salimetrics Melatonin Elisa Kit. ResultsThe crying time, the mean NIPS score, the COMFORTneo score, the COMFORTneo NRS-pain scores and the COMFORTneo NRS-distress scores for premature neonates who were in the prone position during the procedure were significantly lower than the scores in the supine position (p < 0.000). Furthermore, the level of salivary cortisol five minutes prior to and 30 min after the heel lance procedure had significantly decreased in the prone position; however, there were insignificant differences in the mean levels of salivary melatonin between the positions. ConclusionsNesting in the prone position has a pain reducing effect, enhancing comfort and reducing stress in premature infants.

Randomised study showed that recorded maternal voices reduced pain in preterm infants undergoing heel lance procedures in a neonatal intensive care unit.

Alleviating pain in neonates should be the goal of all caregivers. We evaluated whether recorded maternal voices were safe and effective in limiting pain in preterm infants undergoing heel lance procedures in the neonatal intensive care unit of an Italian children's hospital. This prospective, controlled study took place from December 2013 to December 2015. We enrolled 40 preterm infants, born at a 26-34 weeks of gestation, at a corrected gestational age 29-36 weeks and randomised them to listen or not listen to a recording of their mother's voice during a painful, routine heel lance for blood collection. Changes in the infants' Premature Infant Pain Profile, heart rate, oxygen saturation and blood pressure during the procedure were compared by analysis of variance. Possible side effects, of apnoea, bradycardia, seizures and vomiting, were also recorded. Both groups showed a marked increase in PIPP scores and decrease in oxygen saturation during the procedure, but infants in the treatment group had significantly lower PIPP scores (p = 0.00002) and lower decreases in oxygen saturation (p = 0.0283). No significant side effects were observed. Using recorded maternal voices to limit pain in preterm infants undergoing heel lance procedures appeared safe and effective.

Effect of Vibration on Pain Response to Heel Lance: A Pilot Randomized Control Trial.

Applied mechanical vibration in pediatric and adult populations has been shown to be an effective analgesic for acute and chronic pain, including needle pain. Studies among the neonatal population are lacking. According to the Gate Control Theory, it is expected that applied mechanical vibration will have a summative effect with standard nonpharmacologic pain control strategies, reducing behavioral and physiologic pain responses to heel lancing. To determine the safety and efficacy of mechanical vibration for relief of heel lance pain among neonates. In this parallel design randomized controlled trial, eligible enrolled term or term-corrected neonates (n = 56) in a level IV neonatal intensive care unit were randomized to receive either sucrose and swaddling or sucrose, swaddling, and vibration for heel lance analgesia. Vibration was applied using a handheld battery-powered vibrator (Norco MiniVibrator, Hz = 92) to the lateral aspect of the lower leg along the sural dermatome throughout the heel lance procedure. Neonatal Pain, Agitation, and Sedation Scale (N-PASS) scores, heart rate, and oxygen saturations were collected at defined intervals surrounding heel lancing. Infants in the vibration group (n = 30) had significantly lower N-PASS scores and more stable heart rates during heel stick (P = .006, P = .037) and 2 minutes after heel lance (P = .002, P = .016) than those in the nonvibration group. There were no adverse behavioral or physiologic responses to applied vibration in the sample. Applied mechanical vibration is a safe and effective method for managing heel lance pain. This pilot study suggests that mechanical vibration warrants further exploration as a nonpharmacologic pain management tool among the neonatal population.

The Validity and Clinical Utility of the COVERS Scale and Pain Assessment Tool for Assessing Pain in Neonates Admitted to an Intensive Care Unit.

Infants admitted to a neonatal intensive care unit (NICU) are routinely subject to a range of painful procedures. However, pain assessments in NICUs are under-utilized due to a lack of a gold standard pain measure. In this study we assessed the psychometric properties and clinical utility of the COVERS and Pain Assessment Tool (PAT), in a neonatal unit. We had 72 nurses use the scales to assess pain at baseline and during a heel-lance procedure in 80 NICU infants. An independent research observer and the infant's mother also completed pain ratings. After the study, we assessed nurse preference and clinical utility ratings for both scales. The COVERS had satisfactory internal consistency at baseline (Cronbach α=0.74) and heel lance (α=0.78), as did the PAT (baseline α=0.79, heel lance α=0.85). Intraclass correlation coefficients demonstrated good inter-rater reliability at baseline and heel lance, respectively, for both the COVERS (0.82 and 0.80) and the PAT (0.83 and 0.86). There were strong associations between total scores on the 2 scales at baseline (r=0.81, P<0.001) and heel lance (r=0.91, P<0.001), between researcher's ratings and total COVERS (ρ=0.75, P<0.001) and PAT scores (ρ=0.69, P<0.001), and between maternal ratings and total COVERS (r=0.74, P<0.05) and PAT scores (r=0.65, P<0.05). Both scales were sensitive to pain and nonpain events. Reliability and validity was mostly upheld across gestational age. Most nurses preferred the COVERS (52%) to the PAT (16%), and 32% had no preference. This study builds on evidence for the COVERS scale and the PAT; both scales were reliable and valid measures of acute pain in neonates as premature as 24-week gestational age.