Heel Stick Procedure Research Articles

Heel Warming in Very-Low-Birth-Weight Newborns for Capillary Blood Sampling

ObjectiveTo determine if performing heel stick procedures for capillary blood sampling without prior heel warming is noninferior to the standard practice of warming the heel in very-low-birth-weight newborns. DesignNoninferiority randomized control trial. SettingThe study took place in two Level 3 NICUs in The Netherlands. ParticipantsNewborns born at less than 32 weeks gestation in their second or third week of life without an arterial line in situ or known coagulopathy (N = 100). MethodsWe randomized participants to undergo a heel stick procedure in one of two groups: without heel warming (n = 50) and heel warming with a washcloth warmed with 37 °C tap water (n = 25) or with a microwaved hot pack (n = 25). The primary outcome was length of time for obtaining the required blood sample. The secondary outcomes were number of attempts, reliability of the blood sample, newborn comfort, and adverse events. ResultsWe observed no differences in background characteristics between groups and found no statistically significant or clinically relevant differences in primary or secondary outcomes. ConclusionAmong participants, not warming the heel before a heel stick was noninferior to warming the heel. Therefore, preheating the heel as a standard of care may be an unnecessary nursing intervention.

Effectiveness of facilitated tucking on reducing pain during heel stick in neonates: a randomized controlled experimental study.

Pain in neonates is associated with adverse neurodevelopmental outcomes in the later days of life. Facilitated tucking is a nonpharmacological method of pain relief. The study aims to compare the effect of facilitated tucking in pain reduction in neonates. This was a randomized controlled experimental study conducted in the neonatal ward of a tertiary care center. There were 25 neonates randomized each in the experimental and control groups (total of 50), based on computer-generated random tables. The experimental group was placed in a facilitated tucking position during heel stick, while the control group was kept in the usual position, as done routinely. A self-structured questionnaire and Neonatal Infant Pain Scale were used. The main outcome measures were the mean Neonatal Infant Pain Scale score, and change in preprocedure and postprocedure heart rate and oxygen saturation in the two groups. Ethical clearance and informed written consent were sought. Neonates in the experimental group had significantly lesser pain (less Neonatal Infant Pain Scale score) than the neonates in the control group (P<0.001). There was also a significant increment in the mean heart rate and a decrease in the oxygen saturation after the procedure in the control group, indicating significantly more pain perception (P<0.001) in the control group. Facilitated tucking was found to be effective in reducing the pain during heel stick procedures in neonates.

Comparison of the efficacy of non-pharmacological interventions during the heel stick procedure on pain level, duration of crying, and voice decibel of newborns: a randomized controlled trial

Objective: To compare the efficacy of different non-pharmacological interventions (kangaroo care, cuddling, playing white noise, ambient sound) applied to newborns during the heel stick procedure on newborns’ pain level, duration of crying, and voice decibel. Methods: This is a prospective, randomized controlled trial including pre- and post-tests of four groups. The setting is a neonatal intensive care unit in Türkiye. One hundred and thirty-six newborns were recruited. Newborns were randomly assigned to four groups (i) kangaroo care, (ii) cuddling, (iii) white noise, and (iv) ambient sound. Pain measures were recorded 1 minute before, during, and 3 minutes after blood collection based on the Neonatal Infant Pain Scale (NIPS). Results: There was a significant difference between the pain levels (χ2=16.910, p=.001) and durations of crying (χ2=13.888, p=.003) during the heel stick procedure of the newborns depending on the non-pharmacological intervention. The pain levels of newborns who received kangaroo care were significantly lower compared to those who were listened to ambient sound during the procedure. The newborns’ durations of crying who received kangaroo care and who were lapped by their mothers during the heel stick procedure were also lower than those who are listened to ambient sound. There was no significant difference between the highest sound decibel levels of newborns after the procedure due to the non-pharmacological intervention applied during the heel stick procedure. Conclusion: Kangaroo care was more effective in reducing pain level and duration of crying. The non-pharmacological interventions had no effects on the highest sound decibel levels of newborns.

ALPS-Neo pain and stress assessment scale for neonates-A measure for procedural pain.

The aim of this study was to investigate psychometric properties, reliability and validity, of Astrid Lindgren and Lund Children's Hospitals Pain and Stress Assessment Scale for Preterm and Sick Newborn Infants (ALPS-Neo), as a measure for procedural pain. This observational, prospective study with a repeated measures design, explored inter-rater reliability by two raters assessing 21 neonates during non-pain and pain events. Construct validity was explored, that is, ability to discriminate between non-pain and pain, and criterion validity by correlating ALPS-Neo with Premature Infant Pain Profile-Revised (PIPP-R) and Skin Conductance Algesimeter (SCA) in 54 neonates without ventilator support and sedation undergoing routine heel-stick procedure in a tertiary neonatal intensive care unit. Mean gestational and assessment age of 54 infants was 33.8 weeks and 12.7 days respectively. Inter-rater reliability from baseline, skin wiping, heel-stick events for 21 infants demonstrated intraclass correlations with 95% confidence intervals (CI) of 0.49 (-0.27 to 0.79), 0.86 (0.65-0.94) and 0.73 (0.34-0.89) respectively. ALPS-Neo discriminated significantly between baseline, non-pain and heel-stick (mean differences from pain event -2.3 and -1.0 respectively) and correlated during heel-stick with PIPP-R (r = 0.56, 95% CI: 0.34-0.72), not with SCA. ALPS-Neo may be used as a measure for procedural pain.

Effect of Non-nutritive Sucking during Heel-stick Procedure in Pain Management of Term Infants in the Neonatal Intensive Care Unit: A Systematic Review and Meta-analysis.

This study aimed to evaluate the efficacy of non-nutritive sucking for analgesia in term infants undergoing heel-stick procedures. Randomized controlled trials and non-randomized studies based on the PICO framework were included in the study. Review articles, commentary, pilot, and non-English articles were excluded. Databases, such as PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane, were searched until January 31st, 2021, using the keywords "Pain management", 'Non-nutritive sucking", and "Heel stick". All studies were reviewed and retrieved by two authors independently using a standardized form according to the inclusion criteria, and any disagreements were examined by a third scholar. Quality assessment was evaluated by using the ROB-2 tool. Data were analyzed using Stata version 12.0 software, and a random-effects model was used for analysis. A total of 5,629 articles were retrieved from all databases, and after the screening, finally, 6 relevant articles were included in the analysis. The tools used to control pain in infants in the articles included PIPP, NFCS, NIPS, and NPASS. The results showed that the pain scores were significantly lower in the NNS group compared to the control group (MD, -1.05; 95% CI, -1.53 to -0.57) and NNS had a significant effect on oxygen saturation (O2 Sat) increasing in newborns compared to the control group, but no significant reduction in the heart rate (HR) between two groups was observed. NNS effectively provides analgesia in full-term neonates undergoing heel-stick procedures; however, its effects on the long-term outcomes of infants are unclear. The results showed that NNS was effective in improving heel-stick pain in infants.

Effect of Olfactory Stimulation with Breast Milk on Pain Responses to Heel Stick in Premature Infants: A Randomized Controlled Trial.

Purpose: This study aimed to evaluate the effect of breast milk olfactory stimulation on pain response in premature infants during heel stick tests. Methods: A quasi-experimental randomized controlled trial was conducted in the neonatal intensive care unit of a tertiary-level hospital in Seoul, Korea. A breast milk group was provided olfactory stimulation with breast milk 30 seconds before the start of heel stick sampling, and a control group underwent heel stick sampling without olfactory stimulation. To evaluate infants' pain response, the heel stick procedure was video recorded, and pain response was assessed separately by two blinded research assistants using the Premature Infant Pain Scale (PIPS) through behavioral response, heart rate on physiological monitoring, and blood oxygen saturation on pulse oximetry through the video recording. Results: Forty-eight premature infants (gestational age, within 28-37 weeks, n = 24; control) were included in this study. The pain scores of the breast milk group were significantly lower than those of the control group (z = -2.04, p = 0.021). Conclusion: Breast milk odor may reduce pain in premature infants during heel stick tests.

Effects of maternal voice on pain and mother–Infant bonding in premature infants in Taiwan: A randomized controlled trial

PurposeThis study aimed to examine the effectiveness of maternal voice in alleviating premature infants' pain during the heel sticks and facilitating mother–infant bonding during hospitalization. Design and methodsA randomized controlled trial with a parallel group design was conducted in which 64 premature infant–mother dyads were randomly assigned to an intervention group or a control group. Voice recordings of the mother reading a children's book were created and subsequently played for the infant during a heel stick procedure once daily for 3 consecutive days. The primary outcomes were heart rate, respiratory rate, oxygen saturation, and pain response assessed using the Neonatal Infants Pain Scale before, during, and after the procedure. The secondary outcome was mother–infant bonding evaluated using the Mother–Infant Bonding Inventory on the seventh postnatal day. Data were analyzed using generalized estimation equations. ResultsThe two groups did not significantly differ in length of gestation, sex, weight, or other demographic characteristics. At 1 min after the procedure, the intervention group had a lower heart rate (p < 0.001) and Neonatal Infants Pain Scale score (p < 0.001) than the control group did. ConclusionsThe maternal voice intervention slowed the heart rate and alleviated the pain response of the hospitalized premature infants. Practice implicationsThis intervention has clinical potential to provide mothers with an opportunity to care for their infants and infants with an opportunity to be soothed during health care, thus enhancing the infant–mother connection.The clinical trial registration number is NCT04158206.

The effectiveness of swaddling and maternal holding applied during heel blood collection on pain level of healthy term newborns; randomized controlled trial

ABSTRACT This study was a prospective, randomized controlled trial. The study sample consisted of 105 healthy neonates who conformed to the case selection criteria. Neonates were randomly assigned to the following groups: swaddling (S), maternal holding (MH), and controls (C). The study data were obtained using an information form and the Neonatal Infant Pain Scale (NIPS). There were no statistically significant differences between total crying times (C: 81.14 ± 44.93; S:79.28 ± 40.74; MH: 69.42 ± 31.10 sec.) and the time to first calming (C: 71.28 ± 50.87; S: 59.74 ± 42.40; MH: 54.85 ± 35.61) of heel stick procedures between all groups (p>.05). It was observed that procedural pain levels were the lowest in the maternal holding group (5.57 ± 1.24), followed by swaddling (5.82 ± 0.92), and the control group (6.40 ± 0.91). As a result, both swaddling and maternal holding are effective at reducing pain felt during heel stick procedures, but mother holding may be preferred as a priority rather than swaddling. Trial registration: ClinicalTrials.gov identifier: NCT04625010.

Effects of Kangaroo Mother Care on Repeated Procedural Pain and Cerebral Oxygenation in Preterm Infants.

The study aimed to investigate the effects of kangaroo mother care (KMC) on repeated procedural pain and cerebral oxygenation in preterm infants. Preterm infants of 31 to 33 weeks of gestational age were randomly divided into an intervention group (n = 36) and a control group (n = 37). Premature infant pain profile (PIPP) scores, heart rate, oxygen saturation, regional cerebral tissue oxygenation saturation (rcSO2), and cerebral fractional tissue oxygen extraction (cFTOE) were evaluated during repeated heel stick procedures. Each heel stick procedure included three phases: baseline, blood collection, and recovery. KMC was given to the intervention group 30 minutes before baseline until the end of the recovery phase. Compared with the control group, the intervention group showed lower PIPP scores and heart rates, higher oxygen saturation, and rcSO2 from the blood collection to recovery phases during repeated heel sticks. Moreover, there were significant changes in cFTOE for the control group, but not the intervention group associated with repeated heel stick procedures. The analgesic effect of KMC is sustained over repeated painful procedures in preterm infants, and it is conducive to stabilizing cerebral oxygenation, which may protect the development of brain function. · KMC stabilizes cerebral oxygenation during repeated heel sticks in preterm infants.. · The analgesic effect of KMC is sustained over repeated painful procedures in preterm infants.. · KMC may protect the development of brain function..

The Effect of 3 Positions Given to Preterm Infants During Heelstick Procedure on Pain and Durations of Crying and Procedure.

The purpose of this randomized controlled study was to determine the effect of 3 positions given to preterm infant during heelstick procedure on the pain and durations of crying and procedure. The sample of the study consisted of 90 preterm infants (30 in each group). The heelstick procedure was video recorded. Data from the pain scores, durations of crying, and procedure were collected watching the video recordings. It was determined that the pain mean score of the infants in the control group (supine on the crib) (5.50 ± 2.13) was statistically significantly higher than that of the infants in the positions of upright (3.00 ± 2.17) and supine on the lap (3.20 ± 2.46) (P < .01), and there was no difference between the positions of upright and supine on the lap (P > .05). Giving the positions of upright or supine on the lap during heelstick is effective in reducing pain, shortening the duration of crying, and calming down the infant. Heelstick in the position of upright on the lap shortened the procedure duration and allowed the infants to be subjected to less painful procedure. It is recommended for nurses to take the preterm infants on their laps during heel lancing and give them the upright position, in particular.

Vanilla essence non-nutritive sucking, an effective alternative for pain relief during heel-stick procedure in healthy term neonates: A randomized clinical trial

Vanilla essence non-nutritive sucking, an effective alternative for pain relief during heel-stick procedure in healthy term neonates: A randomized clinical trial

The Effect of Non-Nutritive Sucking During Heel Stick Procedure on Pain Management of Preterm Infants in Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis

The Effect of Non-Nutritive Sucking During Heel Stick Procedure on Pain Management of Preterm Infants in Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis

Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors.

Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates' pain responses and may lead to inaccurate pain assessment when not appropriately considered. We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN. We videotaped 154 full-term and preterm neonates of different GAs during 1-5 capillary heel sticks in their first 14days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models. Premature birth (b=-0.721), caffeine (b=-0.302), and the behavioural states quiet and awake (b=-0.283), active and asleep (b=-0.158), and quiet and asleep (b=-0.498) were associated with changes in behavioural pain scores. Premature birth (b=-0.232), mechanical ventilation (b=-0.196), and duration of the heel stick procedure (b=0.0004) were associated with changes in physiological pain scores. Premature birth (b=-0.907), Caffeine (b=-0.402), the behavioural states quiet and awake (b=-0.274), and quiet and asleep (b=-0.459), and duration of the heel stick procedure (b=0.001) were associated with changes in the modified BPSN total scores. Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates' pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs. We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population.

Acute Pain Assessment in Prematurely Born Infants Below 29 Weeks: A Long Way to Go.

Neonates born extremely prematurely are at high risk of acute and prolonged pain. Effective treatment requires reliable pain assessment, which is currently missing. Our study explored whether existing pain assessment tools and physiological indicators measure pain and comfort accurately in this population. We prospectively collected data in 16 neonates born at less than 29 weeks' gestational age during 3 conditions: skin-to-skin care, rest, and heelstick procedure for capillary blood sampling in the incubator. The neonates were video recorded in these situations, and recordings were coded using 5 observational pain assessment tools and numeric rating scales for pain and distress. We simultaneously collected heart rate, respiratory rate, arterial oxygen saturation, regional cerebral oxygenation, and the number of skin conductance peaks. All measures across the 3 conditions were compared using general linear modeling. The median gestational age was 27.1 weeks (range: 24.1 to 28.7). Forty measurement periods across the 3 conditions were analyzed. Heart rate was significantly higher during heelstick procedures compared with during rest, with a mean difference of 10.7 beats/min (95% confidence interval [CI]: 2.7-18.6). Oxygen saturation was significantly higher during skin-to-skin care compared with during heelstick procedures with a mean difference of 5.5% (95% CI: 0.2-10.8). The Premature Infant Pain Profile-revised (PIPP-R) score was significantly higher during heelstick procedures compared with skin-to-skin care with a mean difference of 3.2 points (95% CI: 1.6-5.0). Pain measurement in clinical practice in prematurely born infants below 29 weeks remains challenging. The included behavioral and physiological indicators did not adequately distinguish between a painful situation, rest, and skin-to-skin care in premature neonates.

Effects of breastfeeding and heel warming on pain levels during heel stick in neonates.

To determine the effects of two different methods, breastfeeding and heel warming, during heel stick procedures on pain levels in healthy term neonates. This study was a prospective, randomized controlled trial. The sample of the study consisted of 150 healthy newborns who matched the case selection criteria and were brought to the nursery for the heel stick procedure. Fifty neonates were randomly assigned to each group: breastfeeding (n = 50), heel warming (n = 50), and control (n = 50), using computer-based randomization. The study data were obtained using an Information Form and the Neonatal Infant Pain Scale (NIPS). The pre-procedural pain scores of the breastfeeding group (mean 4.44 SD 1.21seconds) were lower than in the heel warming (mean 6.10 SD 1.07seconds) and the control group (mean 6.42 SD 0.91seconds) (P<0.01). Both the total crying time and the first calming time of the breastfeeding group were shorter than the heel warming and control group. The first calming time of the heel warming group was shorter than in the control group. Both breastfeeding and heel warming are effective in reducing the calming time during heel stick procedures. However, breastfeeding is more effective than heel warming in reducing pain during heel stick and should be preferred as the first choice.

Effects of Yakson Therapeutic Touch and Heel Warming on Pain Caused by Heel Stick Procedure, Vital Signs, and Cry Duration in Full-term Neonates

Background: Neonates are more sensitive to pain and likely to suffer from its long-term complications. Therefore, various methods including non-nutritive sucking, sensory stimulations, and various supportive interventions are employed to relieve pain in newborns. Aim: This study aimed to compare the effects of Yakson therapeutic touch and heel warming on pain caused by heel stick procedure, vital signs, and cry duration in full-term neonates. Method: This randomized clinical trial was conducted among 78 full-term newborns referred to healthcare centers in Mashhad, Iran, 2017. They were assigned into three groups of Yakson theraputic touch, heel warming using a hot-water bottle with the temperature of 40°C, and control receiving routine care, through randomized block method. Then, vital signs before and after and pain intensity after heel-stick procedure were measured using Neonatal Infant Pain Scale (NIPS). Data analysis was performed using Kruskal-Wallis and Wilcoxon tests in SPSS software, version 16. Results: The study groups were homogeneous considering demographic characteristics. The results of Kruskal-Wallis test showed a significant difference between the groups regarding the mean scores of the NIPS at the post-intervention phase (P=0.02). However, no significant difference was observed between pre- and post-intervention phases in the groups considering respiratory and heart rates. Additionally, cry duration significantly reduced in the group that received Yakson therapeutic touch (P=0.03). Implications for Practice: The use of Yakson therapeutic touch could relieve pain, soothe the neonates, and shorten cry duration in newborns after heel stick procedure. Nevertheless, heel warming only increased up blood flow for easier blood sampling.

Efficacy of facilitated tucking combined with non-nutritive sucking on very preterm infants’ pain during the heel-stick procedure: A randomized controlled trial

BackgroundReducing acute pain in premature infants during neonatal care improves their neurophysiological development. The use of pharmacological and non-pharmacological analgesia, such as sucrose, is limited per day, particularly for very preterm infants. Thus, the usual practice of non-nutritive sucking is often used alone. Facilitated tucking could be an additional strategy to non-nutritive sucking for reducing pain. To the best of our knowledge, no randomized trial has compared the combination of facilitated tucking and non-nutritive sucking to non-nutritive sucking alone. ObjectivesTo compare the efficacy of facilitated tucking in combination with non-nutritive sucking (intervention group) to non-nutritive sucking alone (control group) in reducing pain during the heel-stick procedure in very preterm infants. DesignProspective, randomized controlled trial. SettingsLevel III and II neonatal care units, including the neurosensory care management program. MethodsVery preterm infants (gestational age between 28 and 32 weeks) were randomly assigned by a computer programme to the intervention or control group during a heel-stick procedure within the first 48 h of life. In both groups, infants were placed in an asymmetric position on a cushion; noise and light were limited following routine care. A heel-stick was performed first in the care sequence. In the intervention group, facilitated tucking was performed by a nurse or nursing assistant. The procedure was video recorded from 15 s (T-15 s) before the procedure until three minutes (T + 3 min) after the end of the procedure. Pain was blindly assessed by two independent specialist nurses. The primary outcome was the pain score evaluated 15 s before the procedure and 30 s immediately after by the premature infant pain profile (PIPP) scale. The secondary outcome was the pain score evaluated between T-15 s and T + 3 min by the DAN scale (a French acronym for the acute pain of a newborn). ResultsSixty infants were included (30 in each group). The PIPP pain scores did not differ between the intervention group (median: 8.0; interquartile range (IQR): 6.0–12.0) and the control group (median: 9.5; IQR: 7.0–13.0, p = 0.32). Pain assessed by the DAN scale at T + 3 min was lower in the intervention group than in the control group (median: 0.3; IQR: 0.0–1.0 and 2.0; IQR: 0.5–3.0, respectively, p = 0.001). ConclusionsThe combined use of facilitated tucking and non-nutritive sucking did not significantly alleviate pain during the heel-stick procedure. However, the addition of facilitated tucking facilitated faster pain recovery following the heel-stick procedure.

Effect of non-nutritive sucking and sucrose alone and in combination for repeated procedural pain in preterm infants: A randomized controlled trial

BackgroundSucrose combined with non-nutritive sucking provided better pain relief than sucrose or non-nutritive sucking alone in a single painful procedure. However, whether the combination of non-nutritive sucking with sucrose could obtain a significant difference in analgesic effect of the repeated procedural pain than any single intervention has not been established. ObjectiveTo compare the effect of non-nutritive sucking and sucrose alone and in combination of repeated procedural pain in preterm infants. DesignRandomized controlled trial. SettingA level III neonatal intensive care unit of a university hospital in China. MethodPreterm infants born before 37 weeks of gestation were randomly assigned to four groups: routine care group (routine comfort through gentle touch when infants cried; n = 21), non-nutritive sucking group (n = 22), sucrose group (0.2 ml/kg of 20%; n = 21), sucrose (0.2 ml/kg of 20%) plus non-nutritive sucking group (n = 22). Each preterm infant received three nonconsecutive routine heel sticks. Each heel stick included three phases: baseline (the last 1 min of the 30 min without stimuli), blood collection, recovery (1 min after blood collection). Three phases of 3 heel stick procedures were videotaped. Premature infant pain profile (PIPP) score, heart rate, oxygen saturation and percentage of crying time were assessed by five independent evaluators who were blinded to the purpose of the study at different phases across three heel sticks. Data were analyzed by analysis of variance, with repeated measures at different evaluation phases of heel stick. Results86 preterm infants completed the protocol. During the blood collection and recovery phases, combination group, had lower PIPP score (4.4 ± 1.5; 3.0 ± 0.8), lower heart rate (138.6 ± 7.9; 137.4 ± 4.7), higher oxygen saturation (95.2 ± 1.6; 96.0 ± 1.2), and smaller percentage of crying time (11.5 ± 8.6; 4.6 ± 3.4), compared with the group has given non-nutritive sucking (9.3 ± 1.3, 6.8 ± 1.4; 154.2 ± 9.0, 148.0 ± 9.3; 92.9 ± 2.4, 94.1 ± 1.0; 44.2 ± 9.6, 31.2 ± 10.5; respectively) or sucrose (10.1 ± 2.0, 7.4 ± 1.6; 151.6 ± 9.6, 147.9 ± 6.9; 93.5 ± 1.7, 94.5 ± 1.2; 53.8 ± 16.7, 35.2 ± 13.9; respectively) or routine care (13.3 ± 1.6, 10.6 ± 1.9; 156.8 ± 7.2, 151.7 ± 7.9; 92.9 ± 2.1, 93.8 ± 1.6; 80.6 ± 7.6, 68.2 ± 9.9; respectively). Both non-nutritive sucking and sucrose were more effective in reducing preterm infants’ PIPP score and percentage of crying time than routine care. There was no difference in PIPP score, heart rate, oxygen saturation and percentage of crying time between the non-nutritive sucking and sucrose groups. ConclusionThe combination of non-nutritive sucking with sucrose provided better pain relief during repeated painful procedures than when non-nutritive sucking or sucrose was used alone. The effect of non-nutritive sucking was similar to that of sucrose on repeated procedural pain.

Non-nutritive sucking, oral breast milk, and facilitated tucking relieve preterm infant pain during heel-stick procedures: A prospective, randomized controlled trial

BackgroundPreterm infant pain can be relieved by combining non-nutritive sucking (sucking), oral sucrose, and facilitated tucking (tucking), but the pain-relief effects of oral expressed breast milk (breast milk) are ambiguous. AimsWe compared the effects of combined sucking+ breast milk, sucking+breast milk+tucking, and routine care on preterm infant pain during and after heel-stick procedures. DesignA prospective, randomized controlled trial. SettingsLevel III neonatal intensive care unit and a neonatal unit at a medical center in Taipei. Participants/subjectsPreterm infants (N=109, gestational age 29–37 weeks, stable disease condition) needing procedural heel sticks were recruited by convenience sampling and randomly assigned to three treatment conditions: routine care, sucking+ breast milk, and sucking+breast milk+ tucking. MethodsPain was measured by watching video recordings of infants undergoing heel-stick procedures and scoring pain at 1-min intervals with the Premature Infant Pain Profile. Data were collected over eight phases: baseline (phase 1, 10min without stimuli before heel stick), during heel stick (phases 2 and 3), and a 10-min recovery (phases 4–8). ResultsFor infants receiving sucking+ breast milk, pain-score changes from baseline across phases 2–8 were 2.634, 4.303, 2.812, 2.271, 1.465, 0.704, and 1.452 units lower than corresponding pain-score changes of infants receiving routine care (all p-values <0.05 except for phases 6 and 7). Similarly, for infants receiving sucking +breast milk+ tucking, pain-score changes from baseline were 2.652, 3.644, 1.686, 1.770, 1.409, 1.165, and 2.210 units lower than corresponding pain-score changes in infants receiving routine care across phases 2–8 (all p-values <0.05 except for phase 4). After receiving sucking +breast milk +tucking and sucking +breast milk, infants’ risk of mild pain (pain score ≥6) significantly decreased 67.0% and 70.1%, respectively, compared to infants receiving routine care. After receiving sucking +breast milk +tucking and sucking +breast milk, infants’ risk of moderate-to-severe pain (pain score ≥12) decreased 87.4% and 95.7%, respectively, compared to infants receiving routine care. ConclusionThe combined use of sucking+breast milk +tucking and sucking+breast milk effectively reduced preterm infants’ mild pain and moderate-to-severe pain during heel-stick procedures. Adding facilitated tucking helped infants recover from pain across eight phases of heel-stick procedures. Our findings advance knowledge on the effects of combining expressed breast milk, sucking, and tucking on preterm infants’ procedural pain.

Effects of Having Preterm Infants Smell Amniotic Fluid, Mother's Milk, and Mother's Odor During Heel Stick Procedure on Pain, Physiological Parameters, and Crying Duration

The study aims to assess effects of having preterm infants smell amniotic fluid, mother's milk, and mother's odor during heel stick procedure on pain, physiological parameters, and crying duration. The study was a randomized controlled experimental research. The population of the study was made up of preterm infants receiving treatment and care at a neonatal intensive care unit, where the study was conducted between January 2015 and March 2016. The study was performed with 85 preterm infants who met the selection criteria. Infants were randomized into four groups: amniotic fluid, mother's milk, mother's odor, and control group. Data obtained were analyzed by percentage distributions, means, standard deviation, chi-square test, Kruskal-Wallis, and Dunnett's test. While no significant difference was found between the groups in terms of total preterm infant pain profile score before, during, and after the heel stick procedure (p > 0.05), a significant difference was found in terms of SO2 values (p < 0.05) and the difference was caused by the amniotic fluid group. Although no significant difference was found between the groups in terms of crying duration (p > 0.05), the amniotic fluid group had the lowest score, followed by the mother's milk group, the mother's odor group, and the control group. Amniotic fluid, mother's milk, and mother's odor were not effective in preterm infants during painful procedures.