Heel Prick Procedure Research Articles

The Effect of Mother's Voice and Father's Voice Listened by Newborns During Heel Blood Collection on Pain Level and Physiological Parameters: A Randomized Controlled Study.

The newborn can learn the voices of its mother and father during intrauterine life, and the reencounter with these familiar voices after birth has a relaxing and calming effect on the baby. The purpose of this study was to determine the effect of mother's voice and father's voice that newborns listened to during the heel blood collection procedure on pain level and physiological parameters. The study was a randomized controlled trial. The study consisted of a total of 90 newborns as participants (mother voice group=30, father voice group=30, and control group=30) at the Düzce Atatürk State Hospital Gynecology Service, Türkiye. Newborns randomly assigned to the intervention groups were made to listen to the mother's voice/father's voice during the heel prick procedure. The newborn in the control group received standard heel blood collection procedures. When the pain level of newborns was examined, it was determined that the lowest Newborn Infant Pain Scale score was in the mother's voice group (P <.05). When the physiological parameter results were evaluated, it was determined that the highest oxygen saturation value and the lowest heart rate were found in the mother's voice group (P <.05). It was determined that the mother's voice was the most effective method in relieving the pain that occurred during the heel prick procedure and in the positive course of physiological parameters in newborns. According to the results of the study, it is recommended to use the mother's voice in order to reduce the pain caused by the heel prick attempt in newborns and to regulate their physiological parameters.

Impact of breast milk on cortical pain response in newborns during the heel prick procedure: a randomized controlled trial

ObjectiveTo investigate the effects of breast milk on cortical pain response and behavioral response in newborns during heel-prick procedure.Study designA prospective, randomized controlled trial was conducted on healty-term newborns, undergoing heel blood sampling. Infants were randomly assigned to study group with receive orally 2 ml breast milk (n = 45) or a control group with no intervention (n = 45). A near-infrared spectroscopy device was used to monitor regional cerebral oxygen saturation (rScO2), while neonatal pain expression was assessed by Neonatal Pain, Agitation, and Sedation Scale (N-PASS).ResultsThe N-PASS score (p = 0.001) and the crying time (p = 0.017) were significantly lower in the study group compared to the control group. Although the mean rScO2 values decreased in both groups during the procedure, the percent change in rScO2 was not significant difference between two groups.ConclusionBreast milk administration decreases behavioral responses to a noxious stimulus without reducing the cortical response to pain.Clinical trial registrationThis trial was registered under ClinicalTrials.gov identifier no. NCT05961904.

The Effect of Yakson Touch on Pain and Physiological Parameters of the Newborn

Background: The stressors faced by the newborn can directly affect the newborn’s sensory development, brain development and organization by causing pain in the newborn. Yakson touch, a traditional Korean cultural practice, is known to reduce the pain in the newborn. Aims: The aim of this study is to examine the effect of Yakson touch applied to the newborn on pain and physiological parameters during the heel prick procedure. Methods: The study was conducted using a randomized controlled trial design (experimental, control). The study sample consisted of 80 newborns (experimental group = 40, control group = 40), all born between 35-40 gestational weeks and considered suitable for clinical conditions. Yakson touch is a technique that involves warm, pressure less, slow, and compassionate touch, following a fixed fifteen-minute protocol. The Yakson touch protocol was initiated for the experimental group before the heel prick procedure. Research data were obtained using the Parent and Baby Information Form, Physiological Parameters Observation Form and Newborn Baby Pain Scale. Data analysis was performed using IBM SPSS V23 and the significance level was taken as p &lt; .05. Results: There was no difference between the experimental and control groups in terms of neonatal oxygen saturation, heart rate, and pain score before, during, and after the procedure (p &gt; .05). There was no difference in cry duration between the two groups before and after the heel prick procedure, but the newborns in the experimental group cried less during the heel prick procedure compared to the control group (p = .007). Conclusion: The newborns in the experimental group, who receives Yakson touch during the heel pricking procedure, had shorter crying times than those in the control group. Therefore, it is recommended to include Yakson touch in nursing interventions during this procedure.

Comparison of 25% Dextrose versus Expressed Breast Milk in Reducing Pain while Heel Prick Procedure in Preterm Neonates in a Tertiary Care Hospital, Vadodara, Gujarat, India: A Randomised Clinical Trial

Introduction: Preterm infants undergo repeated painful procedures during a period of rapid brain development and programming of stress systems. Newborn babies including preterm infants do feel pain. Although different interventions, such as skin-to-skin contact, glucose solutions, breastfeeding, and local anaesthetic agents, have been evaluated to reduce infants’ pain, there is no clinical trial available to identify the best method. Aim: To compare the dectrose 25% versus Expressed Breast Milk (EBM) in reducing pain while heel prick procedure in preterm neonates in a tertiary care hospital. Materials and Methods: The present randomised clinical trial was conducted at Neonatal Intensive Care Unit (NICU) of Kashiben Gordhandas Patel Children Hospital, Vadodara, Gujarat, India, from September 2019 to May 2020. Total 125 neonates with Gestational age between 28 weeks to 36 weeks were included in the study. Babies were divided into two groups by randomisation: Group-A: EBM and Group-B: Dextrose 25%. Premature Infant Pain Profile (PIPP) score was calculated from worst state of individual recovery period (0-½ minute, 1-1½ minute, 3-3½ minute) and compared to baseline period PIPP. Results: Mean gestational age on examination in Group-A was 34.48±6.14 weeks and in Group-B were 34.51±5.89 weeks. Out of total 125 preterm babies (Group-A-62, group B-63), 71 (56.8%) were male and 54 (43.2 %) were females. Comparison of PIPP at 1-1½ min of heel prick in EBM and Dextrose 25% group was statistically significant (p-value &lt;0.003) suggestive of continued analgesic effect of dextrose 25% better than EBM and PIPP scores after 3-3½ min of heel prick having no statistically significant difference. (p&gt;0.05) Mean difference between the PIPP score in the dextrose 25% and EBM groups was -1.25 and -1.33 at 0 and 1 minute after procedure (p-value,&lt;0.001), so pain relief was better in dextrose 25% group than EBM group. Conclusion: Dextrose 25% was better effective in reducing mean crying duration than EBM. Dextrose 25% had a better analgesic effect than EBM in 28 to 36 weeks gestational age neonates.

The Effects of Different Strategies on the Painful Procedure Management, and the Physiological Parameters in Preterm Infants: A Systematic Review

Background: Since preterm infants are subjected to numerous painful and stressful procedures, various strategies reducing the effects during and after painful procedures are required; we aimed to review the effectiveness of the use of different strategies as a primary or adjunctive treatment on the painful procedures, and the physiological parameters in preterm infants. Materials and Methods: In this systematic review, English databases such as PubMed, Scopus, ISI Web of Science, Cochrane Library and EMBASE were systematically searched without any time limitation up to February 2019. The search keywords were (Aromatherapy OR Olfactory OR Amniotic Fluid OR Milk or odor) AND (Pain OR Venipuncture). Results: Finally, four articles were included. The first study conducted on four groups indicates that the pain profile score and the crying time slightly differed during and after the heel prick procedure. In the second study, having pricked the heel, the breast milk group in comparison with the formula milk group embodied the lower premature infant pain profile (PIPP) score. According to the third study, both the vanilla and the breast milk odors groups indicated soothing effects on the premature infants during sampling; and only the breast milk odor is the soothing factor affecting the infants after the sampling termination. The fourth study found that the infants, who were exposed to their own mother’s milk odor, when compared with the control group, encompassed the lowest median PIPP score during venipuncture. Conclusion: Amniotic fluid, the mother’s milk, vanilla and the mother’s odor were determined as reduction and enhancement factors affecting painful procedures and physiological parameters in preterm infants, respectively.

Repeating a dose of sucrose for heel prick procedure in preterms is not effective in reducing pain: a randomised controlled trial.

Oral sucrose is included in almost all recommendations for treatment of pain in newborns, but evidence if multiple doses might be more effective than a single standard dose is lacking. We designed a single-centre, double-blind, randomised, controlled trial. We enrolled preterm infants needing the heel prick procedure. Each enrolled infant was randomised to receive a single standard dose of sucrose 2 min before or a double dose of sucrose 2 min before, and 30 s after heel prick. Primary outcome was the efficacy of the two interventions tested by the premature infant pain profile-PIPP scale obtained at 30 s, 60 s, and 120 s after heel prick. Secondary outcome was the evaluation of the concordance between the PIPP scale and other pain scores more feasible in clinical practice. Seventy-two infants were randomised. No difference in pain perception as measured by the PIPP scale was found between the groups: median PIPP values 4.0(IQR 3.0-4.0) vs 3.0(IQR 3.0-4.0) at baseline; 6.0(IQR 5.0-10.0) vs 6.0(IQR 4.0-8.5) at 30 s; 6.0(IQR 4.0-7.0) vs 5.0(IQR 4.0-8.5) at 60 s and 5.0(IQR 4.0-7.0) vs 5.0(IQR 4.0-7.5) at 2 min, in the experimental and standard treatment groups, respectively (p = 0.9020). There was no correlation between PIPP scores and other pain scales.Conclusion: We do not recommend doubling the dose during heel prick.What is Known:• Oral sucrose is included in almost all international position papers and recommendations for the treatment of mild to moderate pain in newborns, associated with non-nutritive sucking and facilitated tucking• Premature infant pain profile (PIPP) scale is the gold standard for evaluation of pain in preterms but it is difficult to use in clinical practiceWhat is New:• Repeating a dose of 24% sucrose is not effective in reducing pain during the recovery phase of a skin breaking procedure• Other pain scales, easier to use in clinical practice, are not comparable with PIPP for the evaluation of procedural pain in preterms.

Analgesic effect of non-nutritive sucking in term neonates: A randomized controlled trial

Newborns commonly experience pain due to a variety of reasons. Non-nutritive sucking (NNS) is thought to be an effective non-pharmacological method of pain-relief. However, the significant heterogeneity in some systematic reviews limited the certainty of the findings about NNS. Hence, this study was aimed at evaluating the analgesic effect and safety of NNS in healthy term neonates during the heel prick test, using the Neonatal Pain Agitation and Sedation Scale (N-PASS). In this randomized controlled trial, 42 term infants were included: 22 infants in the intervention group (receiving NNS) and 20 infants in the control group (not receiving NNS). In the intervention group, neonates were given a silicone pacifier 120s before, during, and 120s after the heel puncture, while neonates in the control group received routine care. Pain-related outcomes were assessed using the N-PASS at 30s, 60s, 90s, and 120s after the heel prick. Any adverse events during the procedure were noted. The Spearman correlation coefficients between the pain scores on the N-PASS and two other scales (NFCS and NIPS) were calculated at all four moments of evaluation. The mean N-PASS pain scores at 30s, 60s, 90s, and 120s after heel prick were significantly lower in the NNS group than in the control group: 4.73±2.78 vs. 7.90±1.52 (p=0.0002); 3.64±3.06 vs. 5.55±2.95 (p=0.052); 2.59±3.08 vs. 5.25±3.51 (p=0.011); and 2.05±2.94 vs. 4.90±3.99 (p=0.013), respectively. No adverse events were detected in either group. Our findings revealed a strong positive correlation between the pain scores on the N-PASS and two other scales (NFCS and NIPS), which was statistically significant (p<0.01). NNS is considered a safe and effective pain-relief method during the heel prick procedure in term neonates, demonstrated using the N-PASS. These findings were correlated with the pain evaluation by NFCS and NIPS.

Trial of Music, Sucrose, and Combination Therapy for Pain Relief during Heel Prick Procedures in Neonates

To compare the effectiveness of music, oral sucrose, and combination therapy for pain relief in neonates undergoing a heel prick procedure. This randomized, controlled, blinded crossover clinical trial included stable neonates >32 weeks of postmenstrual age. Each neonate crossed over to all 3 interventions in random order during consecutive heel pricks. A video camera on mute mode recorded facial expressions, starting 2 minutes before until 7 minutes after the heel prick. The videos were later analyzed using the Premature Infant Pain Profile-Revised (PIPP-R) scale once per minute by 2 independent assessors, blinded to the intervention. The PIPP-R scores were compared between treatment groups using Friedman test. For the 35 participants, the postmenstrual age was 35 weeks (SD, 2.3) with an average weight of 2210 g (SD, 710). The overall median PIPP-R scores following heel prick over 6 minutes were 4 (IQR 0-6), 3 (IQR 0-6), and 1 (IQR 0-3) for the music, sucrose, and combination therapy interventions, respectively. The PIPP-R scores were significantly lower at all time points after combination therapy compared with the groups given music or sucrose alone. There was no difference in PIPP-R scores between the music and sucrose groups. In relatively stable and mature neonates, the combination of music therapy with sucrose provided better pain relief during heel prick than when sucrose or music was used alone. Recorded music in isolation had a similar effect to the current gold standard of oral sucrose. www.anzctr.org.au ACTRN12615000271505.

The cortical response to a noxious procedure changes over time in preterm infants

The aim of the study was to investigate whether cortical response to a repeated noxious procedure may change over time in preterm infants. Possible reasons for change are: (1) advancing maturation of central nervous system; and (2) increasing experience with noxious procedures during hospital stay. Sixteen preterm infants were recruited, with a postmenstrual age (PMA) ranging between 29 and 36 weeks. Newborns were assessed during a heel-prick procedure, once a week for at least 3 consecutive times. Multichannel near-infrared spectroscopy was used to detect cortical activation, by measuring increase in cortical oxy-haemoglobin (HbO2). Parietal, temporal, and posterior frontal areas were monitored bilaterally. By regression analysis, we studied the effect of (1) increasing PMA and (2) increasing number of heel pricks, on the magnitude of cortical activation. We observed a bilateral nociceptive event-related activation of the posterior frontal cortex, mainly contralateral to the side pricked. Additionally, we found a significant positive effect of PMA, as HbO2 progressively increased in the posterior frontal cortex (P < 0.001), bilaterally, over time. Conversely, the degree of cortical activation decreased as the number of noxious events increased (P < 0.002). We conclude the following: (1) Preterm newborns showed a significant activation of the posterior frontal cortex in association with noxious stimuli; (2) Cortical activation was progressively greater with increasing PMA; (3) There was an inverse relationship between cortical activation and the number of heel pricks. We speculate that such findings may be due to both endogenous cortical maturation and experience-dependent neuroplasticity of the developing brain (eg, synaptogenesis, synaptic pruning).

Kangaroo Mother Care in Reducing Pain in Preterm Neonates on Heel Prick

To determine the effect of Kangaroo Mother Care (KMC) of small duration of 15 min in decreasing pain in preterm neonates between 32-36 wk 6 d on heel prick by a 26 gauge needle. Randomized controlled double masked crossover trial involving 50 neonates, between 32 wk and 36 wk 6 d gestation and weighing less than 2500 g, within 10 d of birth, vitally stable, breathing without assistance or on Continuous positive airway pressure (CPAP), without any clinically evident neurological signs, not having received analgesics/sedatives within last 24 h and not fed within last 30 min and requiring heel pricking were eligible. Outcome measured was the Premature Infant Pain Profile (PIPP). Analysis was done using independent sample t test, with Bonferroni correction applied for comparing individual components of PIPP score. The heart rate, behaviour and facial scores were statistically significant and lower in KMC group. But there was no statistically significant difference in oxygen saturation (SpO(2)). The difference(4.85) in PIPP score was clinically and statistically significant (p < 0.0001). The findings suggest that short duration KMC (15 min) has stress reducing benefits. Preterm neonates above 32 wk gestational age can benefit from KMC to decrease pain from heel prick procedure.

Efecto analgésico de la lactancia materna en la toma sanguínea del talón en el recién nacido

Objective To compare the analgesic effectiveness of breastfeeding when taking blood by the heel-lance procedure in healthy newborns, as opposed to other procedures. Patients and methods We studied 228 term infants from the Maternity Unit of our Hospital. The study was developed in two consecutive phases. In the first stage, 150 newborns were distributed into three randomised groups, the first group (50 newborns) did not receive any specific analgesic intervention; the second and third groups (50 newborns) received non-nutritive sucking-placebo or non-nutritive sucking-24% sucrose respectively. In the second phase, 78 newborns participated, and the blood was taken during breast-feeding. The results on a discomfort scale were compared with those obtained in the rest of examined analgesic procedures. Results The group that received analgesia with breast-feeding showed a score on the discomfort scale of 0′62 and an average time of crying of 0′19 s. The comparative analysis of the results obtained during breastfeeding, as opposed to the rest of procedures, showed that breast-feeding is the best analgesic option, with a reduction in the discomfort of 51% and of 98% in the time of crying ( P<0,001). Conclusions Breast-feeding during the blood test by heel-prick procedure represents the most effective analgesic method. A containment procedure along with non-nutritive sucking is the analgesic method of choice in the newborn that does not receive maternal lactation.

Analgesia en la toma sanguínea de talón en los recién nacidos

To evaluate the pain in healthy newborns requiring blood test by a heel-prick procedure and compare different pain management methods.We studied 150 term infants, in three randomised groups, from the Maternity Unit of our Hospital for a period of three months. The first group of 50 newborns, received no specific analgesic intervention during blood tests, except our usual nursing intervention ("facilitated tucking"). The second and third group (50 newborns), received non-nutritive sucking-placebo and non-nutritive sucking-24% sucrose respectively.In the control group, the average score on the scale of discomfort was 3.92, moderate pain, causing a crying time of 51.72 seconds; the group receiving a non-nutritive sucking-placeboscored 2.1, slight pain, 10.68 seconds crying, while the group receiving non-nutritive sucking-24 % sucrose, expressed a level of discomfort of 1.5 points, slight, with an average crying time of 10.70 seconds. The comparative results between the control group and groups of non-nutritive sucking on placebo and 24% sucrose, both showed significant differences in the scores of the scale of discomfort, as well as in the time crying (p < 0.001). The comparative analysis between groups of non-nutritive sucking sucrose and placebo showed no significant differences.The blood test by heel lance represents a painful procedure of moderate intensity capable of analgesic treatment. A proper nursing method, along with a complement of non-nutritive sucking during extraction, significantly decreases the discomfort and crying, it being unnecessary to consider other analgesics.

Effects of human contact and vagal regulation on pain reactivity and visual attention in newborns

In two experiments we examined the effects of human contact and vagal regulation on newborns' pain reactivity and visual attention. Baseline cardiac vagal tone was measured during quiet sleep and during the experiment, and vagal withdrawal was indexed as change in vagal tone from baseline to pain (study 1) or attention (study 2). In study 1, 62 healthy newborns were videotaped during a heel-prick procedure and pain reactivity was assessed from micro-level coding of facial expressions, cry behavior, and body movements. Infants were randomly assigned to a contact condition, held by a female assistant, or a no contact condition, on an infant-seat in a similar angle. In study 2, 62 additional healthy newborns, randomly assigned to contact and noncontact conditions, were presented with 2 visual stimuli for a 60 s familiarization period, which were then paired with a novel stimulus. Visual interest, alertness, and novelty preference were coded. Human contact had no effect on the newborns' pain response. Visual attention increased with human contact and newborns in the contact condition looked at the stimuli more frequently, with higher alertness, for longer durations, and had a higher novelty preference. Autonomic reactivity-as indexed by vagal withdrawal-differentiated newborns with intense and mild pain response. Discussion focused on proximity to conspecifics as a contributor to emerging regulatory and adaptive functioning in the human infant.

What influence does experience play in heel prick blood sampling?

The objective of this study was to investigate the role of ‘experience’ in performing the heel prick test. Babies ( n = 340) were randomly allocated to be tested with either the Tenderfoot or Genie Lancet heel prick device. Testing was conducted by nine midwives ( n = 4, experienced, more than 20 years qualified) who performed the heel prick procedure routinely and rotational midwives ( n = 5, less experienced, 4–8 years qualified) who only performed the heel prick procedure when working in the community. Test technique outcomes investigated included (1) cleaning of heel, (2) babies position, (3) feeding at test, (4) use of soothing words. Other test outcomes (1) quality of the blood sample, (2) number of heel pricks required to take sample, (3) blood flow, (4) presence of bruising (5) time taken to collect sample, (6) time squeezing the heel and (7) time baby cried were also studied. The experienced midwives were more likely to hold the baby during testing but less likely to clean the infants heel prior to the incision. The experienced midwives collected a better quality sample, in less time and required fewer heel pricks than the less experienced midwifery group.

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.

Does change in skin perfusion provide a good index to monitor the sympathetic response to a noxious stimulus in preterm newborns?

Skin perfusion was measured using laser Doppler fluximetry (LDF) in 16 preterm babies undergoing a standardised heel prick procedure. Although there was a significant reduction in skin blood flow following the heel prick, this was variable and dependent on basal skin blood flow. This, together with loss of data due to movement artefact, makes this technique unreliable in quantifying the sympathetic response to a noxious stimulus in preterm infants.

Can topical lignocaine reduce behavioural response to heel prick?

In a randomised, double blind, controlled study the ability of 5% lignocaine ointment to reduce the behavioural response to heel lance in 30 healthy neonates was assessed. Five per cent lignocaine ointment applied to the heel under an occlusive dressing for one hour before heel prick did not reduce the infants' behavioural response to the heel prick procedure.