Heel Lance Procedure Research Articles

Treatment of Pain and Stress in the Neonate

After completing this article, readers should be able to: 1. Describe the pain assessment tools used for preterm and term neonates. 2. List painful procedures in the neonatal intensive care unit (NICU). 3. Describe nonpharmacologic interventions for alleviating neonatal pain. 4. Describe pharmacologic methods used for neonatal analgesia. 5. Delineate the adverse effects of the common forms of pain relief. Neonates are sensitive to pain and vulnerable to both its short- and long-term effects. However, there is a lack of consistency in both attitudes and practices among NICU staff with regard to pain assessment and management in neonates. Recognition of the clinical importance of neonatal pain and stress has been delayed and hampered by the lack of awareness that newborns are capable of experiencing pain, insufficient knowledge about the developing nervous system, difficulty in assessing neonatal pain, lack of evidence for the safety and efficacy of different modalities available for the treatment of pain, and fears about adverse effects associated with analgesic use. Neonatal pain has been of minimal concern until the last 25 years. For example, at one time, neonates were given paralytic drugs without anesthesia for major surgical procedures because physicians believed that neonates were incapable of interpreting or remembering pain. Further, there was no understanding of the consequences of untreated pain. Newer technologies to sustain life have exposed neonates to multiple invasive procedures and prolonged hospital stays that are associated with acute and chronic pain and stress. In 2001, an international evidence-based group for neonatal pain developed guidelines for the assessment, prevention, and treatment of neonatal pain in an effort to standardize practices for physicians and health care facilities. Within the consensus statement, the group defined general principles to prevent and treat pain and listed the most commonly performed diagnostic, therapeutic, and surgical procedures in the NICU. The guidelines also indicated the …

27 Pain Control and Nursing During Minor Painful Procedure in Newborns: A Randomized Controlled Trial

Background: Minor painful procedure are very frequent in nursery; control of pain can be obtained by farmacological and non farmacological methods. We investigated the effect of different nursing during procedure with a randomized controlled trial. Methods: Forty-four healthy, full term (2500–4000 g) newborns (21 male, 23 female) were assessed during heel lance procedure for newborn screening. The newborns were randomly allocated with a computer-generated random numbers list to receving “nurse care” or “mother care” for the procedure. In both cases newborns were nursed in a standard way before, during and after the procedure, the person giving care being the only difference between the two groups. In order to obtain blindness of assessors, video tapes of the face of the baby were recorded. A nurse unaware of the person who gave care analyzed the tapes and gave a validated score of pain (Neonatal Facial Code System, NFCS [Grunau & Craig 1987]) 4 times (at the beginning of the procedure, during blood sampling, at the end of the procedure, and 10 minutes after). Results are expressed as mean and SD (table); analysis were performed with Mann-Whitney U non parametric test because of skweness of distributions. Results: Facial scores at the end of the procedure were reduced in the “mother group” compared to the “nurse group” (3.00 ±2.77 vs 0.45±1.33, P < 0.001). At other observation points, the differences in facial scores between the two groups of newborns did not reach statistical significance. Duration of crying during the blood collection was not significantly different (96.0±58.2 vs 73.8±43.5). Mother care was effective in reducing responses to pain upon heel lance in the period following completion of the procedure in healthy full term newborns. Conclusion: This non farmacological strategy can be useful for reducing behavioural responses to minor procedural pain in newborns.

Heel lancing in term new-born infants: an evaluation of pain by frequency domain analysis of heart rate variability

The aim of the investigation was to assess pain by frequency domain analysis of heart rate variability (HRV) during a routine heel lancing procedure in term new-born infants. Beat-to-beat heart rate (HR) was recorded in 23 healthy new-born infants on the maternity ward during blood sampling for neonatal screening. A sham heel prick prior to the sharp lancing procedure was performed randomly in half of the infants. Spectral analysis of HRV was assessed for each of the following sequences: (1) baseline (2) sham heel prick (3) sharp heel prick and (4) squeezing the heel for blood sampling. The response to the sham prick did not differ significantly from the sharp prick. Compared with the baseline, sharp lancing gave rise to minor increases in HR and variability in the low frequency band of the spectral analysis. A clear stress response was provoked when the heel was squeezed for blood sampling, indicated by an increased HR and a decreased spectral power in the high frequency band (i.e. lower vagal tone). The different stress responses during the lancing and the squeezing of the heel were clearly illustrated when principal component analysis was applied and the vectors for the changes in HR and spectral pattern were indicated. In conclusion, the squeezing of the heel is the most stressful event during the heel prick procedure.

Factors that influence the behavioral pain responses of premature infants

The responses of preterm neonates to acute tissue-damaging stimuli have been described. However, factors which influence these responses have received little attention. In this study, we observed 124 premature infants before, during and after a routine heel lance and determined how two contextual variables (severity of illness and behavioral state) influenced their behavioral responses. Significant changes in facial actions occurred between baseline and the most invasive phase of the heel lance procedure, stick. The fundamental frequency, harmonic structure and peak spectral energy of the infant's cry were also significantly increased during the stick phase. Behavioral state was found to influence the facial action variables and severity of illness modified the acoustic cry variables. Accurate identification of pain in premature infants requires consideration of factors that influence their response.