Neonatal Infant Pain Scale Research Articles

Comparison of Different Methods for Reducing Pain during Vaccination: A Randomized Study with Placebo and Control Groups

Background: Pain can cause deterioration in physiological, behavioural, and cognitive functioning. It is important to reduce perceived pain during painful procedures such as vaccination using pharmacological and non-pharmacological methods. Objectives: The study was carried out to compare the effectiveness of different non-pharmacological methods in pain management during vaccination. Methods: This randomised controlled study with placebo and control groups was conducted with 175 infants, who were randomly assigned to one of the ShotBlocker® (n = 35), ShotBlocker®-placebo (n = 35), sucrose (n = 35), sucrose-placebo (n = 35) or control (n = 35) groups. Pain levels of the infants were determined by assessors (nurses, parents, and observer) using the Neonatal Infant Pain Scale (NIPS) before and during vaccination. Results: There was no significant difference in infant age, weight, length, and gender among the five groups. There were statistically significant differences between the pain scores determined by the parents, nurses, and observer for the ShotBlocker®, sucrose, ShotBlocker®-placebo, sucrose-placebo, and control groups. The pain scores of infants in the ShotBlocker® and sucrose groups were statistically lower than those in the placebo and control groups (p < .001). Conclusion: It was concluded that the use of ShotBlocker® and sucrose reduced pain levels during vaccination according to all observers and that there was no statistically significant difference between these two methods. In order to minimize the perceived pain in infants during vaccination it is recommended that healthcare professionals (nurses and midwives) would use these methods in clinical practice.

Pain-Related Responses in Preterm Babies Using Automated and Laser Heel-Lancing Devices.

Purpose: This study aimed to compare the pain-related behavioral and physiological responses and puncture-related characteristics between automated and laser lancets and examine the correlation between infants' pain-related responses and facial expressions during heel lancing in a neonatal intensive care unit. Methods: Pain-related responses were assessed using the Neonatal Infant Pain Scale, heart rate, and oxygen saturation through pulse oximetry. Facial expressions were also analyzed using a facial recognition application. Puncture-related characteristics were assessed through puncture marks, number of punctures, and hemostasis. Results: There was a significantly higher puncture mark frequency at 3 min in the automated lancet group than in the laser lancet group. There were no interaction effects of time and group on pain-related behavioral response, heart rate, or oxygen saturation. There were significant positive correlations between the pain-related behavioral response and anger, disgust, fear, and sadness. Conclusion: The laser lancet had relatively good outcomes regarding puncture-related characteristics, although there was no significant difference in pain-related responses. A laser lancet is a novel option for preterm babies at risk of scar-related inflammation and coagulopathies.

Effect of application of the thoracoabdominal rebalancing (TAR) method in moderate premature children: randomized and controlled clinical trial.

To analyze the effect of the thoracoabdominal rebalancing (TAR) method on respiratory biomechanics, respiratory discomfort, pain sensation, and physiological parameters in moderate preterm newborns, compared to a control group. This randomized clinical trial was conducted in a neonatal intensive care unit. The evaluation included: Neonatal Infant Pain Scale, physiological parameters, Silverman-Andersen score, and biomechanics (thoracic cirtometry and Charpy angle). The newborns were randomized into the TAR group (n=17) or control group (n=13) and subjected to the slow expiratory flow acceleration technique (SEFA). The evaluation of a single session was performed three times: before, after, and 30 minutes after the intervention. In the intergroup comparison, there was a significant difference in respiratory rate 30 minutes after the intervention. There was no significant difference in intra- and intergroup comparisons for pain and respiratory discomfort. Regarding biomechanics, there was a significant difference in the TAR group in the Charpy angle (between assessments 1 and 2), in the axillary cirtometry (between assessments 1 and 3), and in the xiphoid process (between assessments 2 and 3). In the control group, a significant difference was observed in the axillary line (between assessments 1 and 2; 2 and 3). The TAR method showed a positive effect on respiratory rate and respiratory biomechanics when compared to the control group. In both groups, the techniques did not promote respiratory discomfort or pain sensation, making them safe techniques for this population.

Effects of White Noise and Therapeutic Touch on Pain and Comfort in Newborns during Heel Lance: A Randomized Controlled Study.

Nonpharmacological methods such as white noise and therapeutic touch can be used in pain management in neonates. This randomized controlled study evaluated the effects of white noise and therapeutic touch during heel lance procedures on pain, comfort levels, and physiological parameters in healthy neonates. This parallel, randomized controlled study was conducted in the Obstetrics and Gynecology Service of a regional hospital. The sample comprised 160 neonates with gestational ages of >35weeks randomly assigned to 4 groups (white noise [WN], therapeutic touch [TT], white noise+therapeutic touch [WT], and control [CG] group). Pain and comfort levels were evaluated according to the Neonatal Infant Pain Scale, and the COMFORTneo Scale. The primary outcomes were pain and comfort levels, and the secondary outcomes were heart rate and SpO2 levels. The Kruskal-Wallis test was used to compare the scale scores among groups. There were significant differences among groups in terms of Neonatal Infant Pain Scale and COMFORTneo scores (P <.05). The pain scores for the white noise, therapeutic touch, and white noise+therapeutic touch groups were 4.2±2.0, 5.2±1.6, and 3.3±1.7, respectively. There was a significant difference in average heart rate during the heel lance procedure among the groups (P <.05). Pain scores of the intervention groups were lower compared to the control group. The combination of white noise and therapeutic touch was more effective in reducing pain and increasing comfort levels. Nurses could reduce procedural pain by applying these pain relief methods.

ASSOCIATION BETWEEN THE NEONATAL PAIN SCALE AND SALIVARY CORTISOL LEVELS IN PRETERM NEONATES USING MECHANICAL VENTILATOR

Background: Preterm neonates have an increased risk of respiratory distress syndrome requiring mechanical ventilation. This medical procedure causes pain which increases the risk of stress and impaired brain development. Several studies have reported that serum cortisol increases in response to pain in neonates. Several methods can be used to assess pain including Neonatal Infant Pain Scale (NIPS) and the Premature Infant Pain Profile (PIPP). This study aims to determine the association of neonate pain scale with salivary cortisol levels of preterm neonates who use mechanical ventilators.Methods: This one-group pretest-posttest study was conducted from June 2022 to May 2023 at Dr. Wahidin Sudirohusodo Hospital, Indonesia. NIPS, PIPP, and salivary cortisol were assessed before intubation and 60 minutes after mechanical ventilator installation.Results: A total 28 subject was analyzed in this study. After 60 minutes of ventilator installation, the saliva cortisol value in the NIPS assessment of the non-pain group (n=29) was 1.349 (0.028-9.641) ng/dL and moderate pain (n=1) was 3.742 ng/dL with p&gt;0.05 and the PIPP assessment of the non-pain group (n=25) was 1.349 (0.028-9.641) ng/dL and moderate pain (n=3) was 1.651 (1.324-3.742) ng/dL with p&gt;0.05.Conclusion: There is no association NIPS or PIPP assessment and salivary cortisol levels in the use of mechanical ventilator. However, pain scales should be assessed to guide management and reduce morbidity.

Comparing the effects of oral sucrose and kangaroo mother care on selected physiological variables and pain resulting from venipuncture in premature newborns admitted to neonatal intensive care units

BackgroundPremature newborns admitted to neonatal intensive care units (NICUs) undergo numerous painful interventions during care and treatment. The purpose of this study was to compare the effects of using sucrose and kangaroo mother care by on selected physiological variables and pain resulting from venipuncture in premature infants admitted to NICUs affiliated with Shiraz University of Medical Sciences.MethodsThis clinical trial included premature infants admitted to 2 NICUs. The sample size consisted of 66 neonates, with 22 newborns in each group. Randomization was performed using the block allocation method. Data collection involved a demographic questionnaire, the neonatal infant pain scale, and a pulse oximetry device. Friedman, Kruskal–Wallis, and Dunn’s post hoc tests employed for data analysis, with a significance level of P < 0.05.ResultsThe use of oral sucrose and kangaroo care demonstrated significant differences in breathing rate, heart rate, and average arterial blood oxygen saturation during and after venipuncture (P < 0.05). Oral sucrose was found to be significantly more effective than kangaroo care. Neonates under kangaroo care exhibited more regular heart rates compared to the other group (P < 0.05). The utilization of oral sucrose and kangaroo care had varying effects on the average pain score resulting from venipuncture in premature neonates (P < 0.05).ConclusionsBoth methods proved effective in reducing pain and improving physiological variables. However, due to the superior effectiveness of sucrose administration, it is recommended as a cost-effective and easily implementable method in NICUs.Trial registration: Iranian Registry of Clinical Trials IRCT20191215045749N1. (29/03/2020).

Effect of Percussion Toy on Level of Pain Perception Among Infants Receiving Vaccination at Selected Health And Wellness Centre, Puducherry

Pain will affects the physiological and behavioural reactions in infants. It may cause permanent structural and functional changes in infants. Due to pain, infants experience acute measurable, physiologic, behavioural, metabolic and hormonal response to pain. This leads to long term negative effects on neurologic and behavioural evelopment of the child. METHODS True experimental post-test only control group design was adopted for the study. The study was conducted at Mettupalayam, Health and Wellness Centre, Puducherry. Study participants were infants aged between 6-20 weeks. 80 infants was selected by using consecutive sampling technique and computer generated randomization and divided into experimental and control group. Percussion toy – sound producing drum (a musical instruments that makes a sound) shown to the children of experimental group, 30 seconds before vaccination, during and 15 seconds after vaccination. Vaccination for control group with routine care (conventional intervention). The post-test data was collected by using the Neonatal Infant Pain Scale (NIPS) in experimental and control group. RESULT The study results revealed that 70% mild and 30% moderate pain in experimental group, 60% moderate and 40% severe pain in control group among infants receiving vaccination. The study showed that the difference in the level of pain perception was statistically significant at p&lt;0.05 level. This states that there is a significant difference between post-test level of pain perception among infants receiving vaccination in experimental and control group. CONCLUSION The study was done to assess the effect of percussion toys on level of pain perception among infants receiving vaccination at selected Health and Wellness Centre, Puducherry. Consecutive sampling technique and computer generated randomization was used to select the sample. The data was collected among 80 infants undergoing vaccination. Collected data was analyzed by descriptive and inferential statistics. The study findings revealed there was statistical significant difference in post-test level of pain perception among experimental and control group (p&lt;0.001). Hence it was concluded that the percussion toy reduces the level of pain perception among infants receiving vaccination.

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.

The Efficacy of General Anesthesia with Sevoflurane for Pain Management in Neonates and Infants with Idiopathic Clubfoot Treated with Ponseti Technique and Percutaneous Achilles Tenotomy

Background: Idiopathic clubfoot deformity is a relatively common congenital pediatric foot deformity. A percutaneous Achilles tenotomy (PAT) is required to correct the equinus deformity as it is the most resistant component of clubfoot deformity. Although this procedure is mainly performed with local anesthesia, performing this procedure with general anesthesia has significant advantages. Aims: The purpose of this study was to compare the safety and efficacy of post-procedural pain management of PAT in the treatment of clubfoot with the Ponseti method when performed in a clinic setting with local anesthetic or under general anesthesia Methods: This is a multicentric prospective observational evaluation on children less than one year of age with idiopathic clubfoot whom referred for Ponseti casting and PAT. This procedure was done in the control group with local anesthesia and in the intervention group with Sevoflurane mask 8% (MAC 2) and maintenance of anesthesia with Sevoflurane mask 4% (N2O/O2, 50%). The neonatal infant pain scale (NIPS), the amount of milk, and mood changes were evaluated as a criterion to measure the pain level. Results: NIPS score in the intervention group was significantly lower than the control group. Children in the intervention group consume significantly more milk than the control group. Furthermore, 76% of children in the intervention group were classified as "calm," 24% as "relatively restless," and no child was classified as "severely restless." While in the control group, 54% of children were classified as "severely restless," and the remaining 46% as "relatively restless." Conclusion: Our result showed that using general anesthesia to perform achillotomy in the treatment of clubfoot in children could be associated with less pain in these patients and without significant complications.

Arnica D30 – an alternative for managing procedural pain in full-term neonates

Background: Despite scientific advances, the management of procedural pain in neonates remains suboptimal. Applying adequate therapy to control pain during the neonatal period is a moral and ethical act. In recent decades, ample evidence has accumulated regarding the risks, associated with both untreated pain and the use of more aggressive analgesic therapy. Thus, the emphasis in neonatal clinical practice is on non-aggressive pain management techniques, including non-pharmacological methods, such as glucose and homeopathic agents. The efficacy and safety of homeopathic agents for reducing procedural pain in neonates is the subject of the present study. Materials and methods: Healthy full-term newborn babies with an average age of 72–84 hours were included. They were divided into three study groups: group (A) – without analgesia, (n = 67), group (B) – analgesic with Arnica D30 (n = 57) and group (C) – analgesic with Sol.Glucose 25% (n = 40). The severity of the pain was assessed using the multimodal - Neonatal Infant Pain Scale (NIPS) and the unimodal - Neonatal Facial Coding System (NFCS) scale. Assessments were done 30s before, 30 seconds after, and 5 minutes after the painful stimulus caused by the heel prick. Heart rate, transcutaneous oxygen saturation, respiratory rate and blood pressure were examined at the same intervals. The results obtained were processed statistically by descriptive analysis and ANOVA at a significance level of p &amp;lt; 0.05. Results: Five minutes after heel prick both scales showed a score near 3, i.e. no significant pain, and statistically significant lower score in those given Arnica D30, compared to those who received Sol.Glucose 25% (p &amp;lt; 0.05). When monitoring the physiological indicators, we found a significant increase in the heart rate 30 seconds after the procedure between group B and C. Five minutes after the heel prick we recorded significantly values of respiratory rate and systolic blood pressure in all three groups compared to accounted for pre-procedural values. Conclusion: Arnica D30 has better analgesic effects compared to Sol.Glucose 25% for newborn babies after heel prick tests.

A comparison of the effect of procedural pain on cerebral oxygen saturation between late preterm and term infants

ObjectivesWe prospectively compared cerebral oxygen saturation (CrSO2) and pain score changes during procedures in late preterm (LPT) versus term infants.MethodsNear-infrared spectroscopy, pulse oximetry, Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile-Revised (PIPP-R) scores were assessed and CrSO2 data analyzed.ResultsThirty infants in each group were evaluated. LPT infants displayed a milder significant drop in Minimum post-procedural CrSO2 and smaller Maximum-Minimum post-procedural CrSO2 disparity. CrSO2 minute changes between the groups were non-significant. Moderate correlations were observed in both groups between NIPS and Minimum post-procedural CrSO2, and a moderate correlation was found in the Maximum-Minimum post-procedural CrSO2 difference in LPT infants. No correlation between PIPP-R and CrSO2 values was noted.ConclusionLPT and term infants demonstrated decreased CrSO2 in response to painful procedures. Correlations between CrSO2 and PIPP-R or NIPS scores were poor to moderate, reflecting the complex nature of these associations relative to gestational age.

Nurses' Assessment of Pain in Saudi Neonatal Intensive Care Units

BackgroundResearch reveals that neonatal pain management in Neonatal Intensive Care Units (NICUs) is suboptimal. There is limited research that assessed NICU nurses’ pain assessment practices in Saudi Arabia. AimTo assess the nurses’ pain assessment practices in the NICU in Saudi Arabia. DesignThis study used a descriptive cross-sectional design. SettingsResearch was conducted using an online survey. Participants/SubjectsThis study was carried out on 65 NICU nurses. The participants were recruited from one governmental and one private hospital in Saudi Arabia. MethodsData on pain assessment practices were collected, including the frequency of pain assessment, pain assessment scales used for preterm and term neonates, and pain assessment documentation. Data were analyzed using frequencies and percentages. ResultsThe majority of the participants (94%) routinely assessed pain and documented pain assessment (97%). One-third of the participants assessed pain regularly every hour (32%). The most used pain assessment scales for term neonates were the neonatal infant pain scale (40%) and the cry, required oxygen, increased vital signs, expression, and sleeplessness scale (23%). The most used pain assessment scales for preterm neonates were the neonatal infant pain scale (31%), the cry, required oxygen, increased vital signs, expression, sleeplessness scale (19%), and the premature infant pain profile (17%). ConclusionsNICU nurses in Saudi Arabia consistently assessed for and documented pain; however, the tools chosen were sometimes suboptimal. A substantial number of NICU nurses used invalid tools to assess pain in term and preterm neonates. An interventional program is needed to enhance the use of evidence-based practice recommendations regarding neonatal pain assessment by nurses in the Neonatal Intensive Care Units in Saudi Arabia.

Urinary markers of pain in children in neonatal intensive care units: a cross-section study

Introduction: Repetitive exposition to pain negatively affects newborns development. Procedural pain in newborn in Neonatal Intensive Care Unit (NICU) triggers a series of physiological, behavioral and hormonal disorders that may set off the impairment of the neurological development in preterm infants, who undergo long periods of hospitalization at a moment of physiological immaturity and fast brain development. Objective: This study aimed not only to observe the pain score in newborns and infants when undergoing painful procedures in neonatal intensive care units but also to analyse urinary IL-8 and cortisol levels at such stressful moments. Methods: Patients were submitted to venipuncture and to other methods of blood collection. Cortisol and IL-8 levels were measured by immunometric assay and chemiluminescence detection. For the collection of data regarding observation of neonatal pain, the Neonatal Infant Pain Scale was used with immediate results. To describe the qualitative variables, absolute and relative frequencies were used. For the quantitative variables with normal distribution, mean, standard deviation, minimum and maximum were used. Results: A total of 81 patients were included: 47 were submitted to venipuncture and 36 to other methods of blood collection. Significance for cortisol can be seen (p=0.04); however, IL-8 levels, when associated with the pain scale, were not sensitive enough (p=0.11). Conclusion: The results showed that cortisol is a better marker for pain than IL-8, and its accumulation in urine may help the detection and interpretation of pain. Conclusion: Based on this information, nurses can step in to reduce the discomfort brought by painful procedures, and thus highlight humanistic practices in nursing assistance.

Effect of pacifier and pacifier with dextrose in reducing pain during orogastric tube insertion in newborns: a randomized controlled trial*

ObjectiveThis study aimed to assess the efficacy of pacifier use, with and without 25% dextrose, in reducing pain during orogastric tube insertion in newborns.Study designIn a randomized controlled trial involving 60 newborns at a public hospital from April to December 2019, participants were divided into three groups: pacifier (n = 20), pacifier with 25% dextrose (n = 20), and control (n = 20). A pacifier, with and without dextrose, was used for the experimental groups, while the control group performed a routine procedure. Neonatal infant pain scale, crying duration, heart rate (HR), and oxygen saturation (SpO2) were evaluated.ResultsResults indicated that the control group experienced significantly higher pain levels, elevated HRs, decreased SpO2, and prolonged crying. Conversely, the pacifier with 25% dextrose group showed a notable reduction in crying duration.ConclusionA pacifier, with and without 25% dextrose, effectively reduces pain and improves physiological and behavioral parameters during orogastric tube insertion.Clinical trial numberNCT05462964Clinical trial registrationThe protocol for this randomized controlled experimental trial is registered on ClinicalTrials.gov. The clinical trial registration number is https://clinicaltrials.gov; NCT05462964.

Effects of the use of a cocoon on the autonomic, motor, and regulatory systems in preterm newborns: Randomized clinical trial

IntroductionThe wrapping of the newborn in an orthopedic tubular mesh, simulating a cocoon, can allow the infant to regain the feeling of security and stability experienced in the uterus given that the movement of one of the parts of the body exerts tactile and pressure variation in others. ObjectiveWe aimed to evaluate the influence of an orthopedic tubular mesh, simulating a cocoon, in therapeutic positioning, on the variables of the autonomous, motor, and regulatory systems of preterm newborns. MethodsA controlled and randomized clinical trial was conducted with preterm newborns positioned in dorsal decubitus and divided into two groups: (a) cocoon – newborns covered with an orthopedic tubular mesh, and (b) control – newborns positioned according to the sector's routine and without the use of an orthopedic mesh. During the follow-up, each newborn was placed in the position for 30 min and was recorded for a total of 2 min, once at the beginning and again at the end of the observation period. Variables related to the autonomous system (heart rate, respiratory rate, and peripheral oxygen saturation), motor system (general movements), and regulatory system (Neonatal Infant Pain Scale) were evaluated before and after the intervention. The videos were evaluated by a researcher blind to the purpose of the study, and the resulting data were analyzed using SPSS. ResultsOf the 40 preterm newborns evaluated (32.5 ± 1.83 weeks), 21 were female, and 20 were allocated to the cocoon group. The variables related to the autonomous, motor, and regulatory systems remained unchanged following the positioning in the cocoon, as compared to the typical positioning employed in the neonatal unit. ConclusionThe simulation of a cocoon, utilizing an orthopedic tubular mesh, when applied to preterm newborns admitted to a neonatal intensive care unit can contribute to maintaining low levels of stress, without altering variables of the autonomous, motor, and regulatory systems.

Comparing the effect of aromatherapy with breast milk, Lavandula stoechas, and Rosa damascena on venipuncture pain in preterm infants.

Since preterm infants frequently undergo painful diagnostic and therapeutic procedures, pain management, especially through non-pharmacological methods, will be extremely beneficial. Accordingly, the present study aimed to compare the effects of aromatherapy with breast milk, Lavandula stoechas, and Rosa damascena on venipuncture pain in preterm infants. In this interventional study, preterm infants were randomly divided into four groups of aromatherapy with breast milk (25 infants), Lavandula stoechas (25 infants), Rosa damascena (25 infants), and sham (25 infants). One minute before, during, and two minutes after venipuncture, the Neonatal Infant Pain Scale (NIPS) as well as heart rate and SPO2 were measured. The results indicated that pain intensity was significantly lower during and after venipuncture in all the aromatherapy methods compared with the sham group (P<0.001). Breast milk odor decreased the pain more than the other two odors during and after venipuncture (P<0.001); however, there was no significant difference between Lavandula stoechas and Rosa damascena (P=0.94). SPO2 was significantly higher in infants in the Lavandula stoechas (P<0.001) and Rosa damascena (P=0.03) groups compared with the sham infants. All three aromatherapy methods were effective in decreasing preterm infants' venipuncture pain. Since no study on the effect of aromatherapy with Rosa damascena was found in this regard, the effectiveness of aromatherapy with Rosa damascena is of great importance, and future studies are recommended to analyze this topic in greater depth.

The effect of bubble nasal continuous positive airway pressure application on saliva cortisol levels in full-term neonates

Background Neonates with respiratory distress are commonly treated with bubble nasal continuous positive airway pressure (nCPAP) and undergo many procedures that cause stress-induced pain. Salivary cortisol is a biomarker of alteration in the hypothalamic-pituitary-adrenal axis caused by repeated and long-term exposure to stress.&#x0D; Objective To analyze the effect of bubble nCPAP use on salivary cortisol levels in full-term infants.&#x0D; Methods This study used a one-group pre-test­–post-test design to compare salivary cortisol levels before and 30 minutes after bubble nCPAP application. Salivary cortisol was measured using an ELISA method. Pain was also assessed at the same time points using the Neonatal Infant Pain Scale (NIPS) score. We included infants of 37 0/7 to 42 6/7 weeks’ gestational age with respiratory distress necessitating bubble nCPAP application. Infants with birth weight of &lt;2,500 grams, major congenital anomalies, an APGAR score of &lt;5 at 5 minutes, shock, and infants who had undergone surgery were excluded.&#x0D; Results A total of 38 subjects participated in this study. Prior to bubble nCPAP application, median cortisol levels were significantly lower (1.65 ng/mL) than after bubble nCPAP application (6.8 ng/mL) (p value?). There were no significant differences in cortisol increase based on gender, type of birth, or salivary cortisol sampling time. There were significant differences in pain level after the 30-minute nCPAP application.&#x0D; Conclusion An increase in cortisol levels and pain scale scores during administration of bubble nCPAP indicates a pain response in full-term neonates; therefore, this procedure should be accompanied by pain or stress management.

The effect of the simulated intrauterine sound on behavioral and physiological indices of pain during capillary blood sampling for screening preterm infants: a randomized clinical trial study

IntroductionDue to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants.MethodsA double‑blind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO2) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants’ faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t‑test in SPSS software version 20.0.ResultsEighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30–3.80(, and (1.15 ± 0.84, 95%: 0.95–1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30–5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p < 0.001) and five min after heel lancing (p < 0.001). Mean scores of heart rate in the three phases of before, during, and five min after the intervention were respectively in the intervention group (127.57 ± 4.45, 95% CI:126.27-128.99), (131.07 ± 6.54, 95% CI:129.20-133.22), (128.45 ± 5.15, 95% CI:127.02-130.07) and in the control group (128.67 ± 4.57, 95% CI:127.32-130.07), (136.07 ± 7.24, 95% CI:133.90-138.37), and (132.42 ± 6.47, 95% CI:130.37-134.49). There were significant differences in heart rate between the intervention and the control group during (p = 0.002) and five min after the heel lance (p = 0.003). Mean scores of SPO2 in the three phases of baseline, during, and five min after the intervention were respectively in the intervention group (96.72 ± 0.93, 95% CI:96.42-97.00), (91.47 ± 1.46, 95% CI:91.05–91.92), (94.17 ± 1.03, 95% CI:93.22-94.00) and in the control group (96.6 ± 0.84, 95% CI:96.35–96.85), (91.5 ± 1.24, 95% CI:91.12–91.87), and (93.60 ± 1.27, 95% CI:93.85–94.50).ConclusionThis study showed that the simulated intrauterine sound reduces the behavioral pain and heart rate in the intervention group during and after heel lance. These results suggest using the method during the painful heel lancing to reduce pain parameters in preterm infants.

Comparison of breastfeeding, music therapy, and oral sucrose's impact on pain relief among infants during pentavalent vaccination.

Vaccination is a quick, safe, and effective way to avoid contracting hazardous diseases, but it often causes pain and discomfort. Various pharmacological and non-pharmacological pain management techniques are used to treat pain. This study aimed to compare the effectiveness of breastfeeding, musical therapy, and oral sucrose in infant's pain relief during pentavalent vaccination. A quasi-experimental posttest-only research design was used. A total of 150 infants were enrolled using the purposive sampling technique (50 in the breastfeeding, 50 in the musical therapy, and 50 in the oral sucrose groups) coming for the first, second, and third doses of pentavalent vaccination. The data were collected using observation and the Neonatal Infant Pain Scale (NIPS). The results were calculated by descriptive and inferential statistics. The study revealed that half of the infants in the breastfeeding group felt severe pain, whereas the majority of infants in the musical therapy and oral sucrose groups felt severe pain during pentavalent vaccination. The median pain score in breastfeeding, musical therapy, and oral sucrose was 4.50, 6, and 7, respectively. Breastfeeding was significantly different from both musical therapy and oral sucrose in terms of pain scores. However, no significant difference was observed between musical therapy and oral sucrose. Overall, the results indicate that breastfeeding had a distinct impact on pain relief during pentavalent vaccination compared with the other interventions, while musical therapy and oral sucrose did not differ significantly in their effectiveness. The study concluded that breastfeeding is a safe, reliable, cost-effective, and easily accessible method to relieve an infant's pain during pentavalent vaccination. It is a simple method to alleviate pain among infants during vaccination.

EFEKTIFITAS METODE KANGGURU MENGURANGI RASA NYERI PENYUNTIKAN INTRAMUSCULAR PADA BAYI BARU LAHIR DI PMB SITI FATIMAH, AMD. KEB TAHUN 2023

Prevention of pain in newborns is by nonpharmacological mens effective to reduce pain in intramuscular injection of newborn. The use of kangarro method is a nonpharmacological method that can reduce intramuscular injection pain physiologically. Based on the above, researchers are interested in conducting a study entitled “Effectiveness of Kangoroo Methods to Reduce Pain in Intramuscular Injection in Newborns in PMB Siti Fatimah”.Knowing the effectiveness of kangaroo methods reduces pain in intramuscular injections in newborns in PMB Siti Fatimah, Kel Kuta Jaya Kec Pasar Kemis, Kab Tangerang.The design of this study uses quasi-experimental. With the posttest only, control group approach. Population of newborns with inclusion criteria Normal newborns weighing 2500 – 4000 grams, in stable condition not in a state of asphyxia, apnea or shock, babies without physical disabilities, born at PMB Siti Fatimah. Sampling was taken by purposive sampling with a sample of 60 respondents, 30 control groups and 30 intervention groups. This research was conducted at PMB Siti Fatimah in May-June 2023. Measurements used observation with the NIPS (Neonatal Infant Pain Scale) measurement tool. Data analysis using univariate analysis, namely the mean, median, minimum, maximum and standard deviation and bivariate analysis using the independent T-test program SPSS 25. The average intramuscular injection pain scale in the control group was 4.97, the median was 5, the minimum value was 3 and the maximum was 7 with a standard deviation of 1.65, while the average intramuscular injection pain scale in the intervention group with the kangaroo method was 2.70, the median was 3, the value minimum 2 and highest 4 with a standard deviation of 0.70. Statistical test results There is an effect of the kangaroo method on reducing pain in intramuscular injections in newborns at PMB Siti Fatimah, Amd.Keb. with a p-value of 0.000 &lt; ɑ (0.05). There is a significant effect of the kangaroo method on reducing intramuscular injection pain in newborns. It is hoped that this method can be implemented in the care of newborns, especially to reduce the pain of injecting Hb0 and Vit K given intramuscularly.