Non-pharmacological Methods in Pain Managment During Heel Stick in Preterm Infants
Condition: Pain, Acute; Neonatal Intensive Care Unit
MeSH terms: Acute Pain
Study type: Interventional

Summary: 
      Aims and objectives: This study was performed to examine the effects of Non-nutritive
      sucking, breast milk odor, and Facilitated tucking on preterm infant pain before, during, and
      after heel-stick procedures.

      Design: A randomized clinical trial in a single center.

      Methods:

      The study was conducted on 144 premature infants with a gestational age of 31 to 36 weeks and
      6 days hospitalized in the neonatal intensive care unit of Shahid Sayad Shirazi Hospital in
      Iran. Neonates were randomly assigned to four groups: 36 babies were included in the
      Non-nutritive sucking(1st Group), 36 in breast milk odor (2nd Group), 36 in Facilitated
      tucking (3rd Group), and 36 in the control group (4th Group). Pain score, heart rate, oxygen
      saturation, and respiratory rate of the babies in all groups before, during, and after the
      procedure were evaluated by two nurses independently.
    

Detailed description: 
      Aim: Due to the necessity of various painful procedures and their side effects on infants,
      pharmacological and non-pharmacological methods are adopted to reduce the pain. Since
      pharmacological methods can be associated with several side effects, it is better to use
      non-pharmacological methods for pain control in newborns. Therefore, the purposes of this
      study were to compare the effects of three different methods (including Non-nutritive
      sucking, breast milk odor, and Facilitated tucking) on preterm infant pain before, during,
      and after heel-stick procedures.

      Method: The study was conducted on 144 premature infants with a gestational age of 31 to 36
      weeks and 6 days hospitalized in the neonatal intensive care unit of Shahid Sayad Shirazi
      Hospital, Iran. Initially, neonates are divided into two groups according to gestational age
      (including neonates between 31-33 weeks and 34-36 weeks) to moderate the confounding effect
      of the age, and then the allocation of neonates to four groups was performed.

      Using the stratification block randomization method, 36 babies were included in the
      Non-nutritive sucking(1st Group), 36 in breast milk odor (2nd Group), 36 in Facilitated
      tucking (3rd Group), and 36 in the control group (4th Group). Two researchers viewed the
      recorded videos independently and evaluate the heart rate, oxygen saturation, respiratory
      rate, and neonatal pain at 1st,2nd,3rd minute before the procedure, during, and at
      1st,2nd,3rd minutes after the procedure according to the Premature Infant Pain Profile
      (PIPP).
    

Intervention name(s): Breast milk odor group; Facilitated tucking group; Non-nutritive sucking group; Control group
Intervention type(s): Procedure; Procedure; Procedure; Procedure
Intervention description(s): The researcher applied the breast milk that dripped on the pad for 3 minutes before the heel stick for 36 premature newborns in the breast milk odor group. About three cc breast milk dripped onto a sterile pad and placed at a distance of 10 cm from the nose of the newborn. It continued until 3 minutes after the invasive procedure. Heart rate, arterial oxygen saturation, and respiration rate were recorded in this group before the study. Then, to evaluate the pain in the infants, a video camera was placed on the incubator. The infants in each group were filmed from three minutes before the procedure to three minutes after. Neonatal pain was measured at 1, 2, and 3 minutes before, during, and at 1, 2, and 3 minutes after the procedure by two researchers independently using the new version Premature Infant Pain Profile (PIPP).; The Facilitated tucking position was given to 36 premature newborns in the Facilitated tucking group, from 3 minutes before to 3 minutes after the heel stick procedure. Premature newborns were kept in the facilitated tucking position by the investigator using the incubator windows without opening the incubator cover to prevent heat loss of the newborn. Heart rate, arterial oxygen saturation, and respiration rate were recorded in this group before the study. Then, to evaluate the pain in the infants, a video camera was placed on the incubator. The infants in each group were filmed from three minutes before the procedure to three minutes after. Neonatal pain was measured at 1, 2, and 3 minutes before, during, and at 1, 2, and 3 minutes after the procedure by two researchers independently using the new version Premature Infant Pain Profile (PIPP).; 36 premature newborns who were in the non-nutritive sucking group were given a silicone pacifier suitable for the week of the baby's mouth from 3 minutes before to 3 minutes after the heel stick. Heart rate, arterial oxygen saturation, and respiration rate were recorded in this group before the study. Then, to evaluate the pain in the infants, a video camera was placed on the incubator. The infants in each group were filmed from three minutes before the procedure to three minutes after. Neonatal pain was measured at 1, 2, and 3 minutes before, during, and at 1, 2, and 3 minutes after the procedure by two researchers independently using the new version Premature Infant Pain Profile (PIPP).; The control group will consist of 36 premature newborns who are routinely applied in the clinic. In the clinic where the research was conducted, no attempt is made to reduce pain during heel stick. Heart rate, arterial oxygen saturation, and respiration rate were recorded in this group before the study.
Then, to evaluate the pain in the infants, a video camera was placed on the incubator. The infants in each group were filmed from three minutes before the procedure to three minutes after. Neonatal pain was measured at 1, 2, and 3 minutes before, during, and at 1, 2, and 3 minutes after the procedure by two researchers independently using the new version Premature Infant Pain Profile (PIPP).
Other intervention name(s): Breast milk odor; pacifire
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention