Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: A randomized clinical trial

Background Non‐pharmacological interventions are effective neonatal pain reduction strategies. We aimed to study the effects of non‐nutritive sucking (NNS) and swaddling on infants' behavioural and physiological parameters during shallow or deep heel stick procedures. Method In this prospective...

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Bibliographic Details
Published in:European journal of pain 2016-07, Vol.20 (6), p.989-997
Main Authors: Leng, H.-Y., Zheng, X.-L., Zhang, X.-H., He, H.-Y., Tu, G.-F., Fu, Q., Shi, S.-N., Yan, L.
Format: Article
Language:English
Subjects:
Blood Specimen Collection - adverse effects
Female
Heart Rate
Humans
Infant Behavior
Infant Care
Infant, Newborn
Male
Pain Management - methods
Pain Measurement
Pain, Procedural - diagnosis
Pain, Procedural - etiology
Pain, Procedural - therapy
Prospective Studies
Sucking Behavior
Sucrose - therapeutic use
Sweetening Agents - therapeutic use
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Summary:Background Non‐pharmacological interventions are effective neonatal pain reduction strategies. We aimed to study the effects of non‐nutritive sucking (NNS) and swaddling on infants' behavioural and physiological parameters during shallow or deep heel stick procedures. Method In this prospective, multi‐centred, randomized controlled clinical trial, we enrolled 671 newborns. The infants undergoing shallow or deep heel stick procedures were randomized into four groups: oral sucrose (routine care, group S), oral sucrose combined with NNS (group NS), oral sucrose combined with swaddling (group SS) and oral sucrose combined with NNS and swaddling (group NSS). The behavioural responses were evaluated by the Revised Neonatal Facial Coding System and the physiological signals were monitored by electrocardiogram monitors. Results A significant synergistic analgesic effect was observed between the NS and SS groups in both the shallow (F = 5.952, p = 0.015) and deep heel stick (F = 7.452, p = 0.007) procedure. NSS group exhibited the lowest pain score. For the deep heel stick procedure, the NS group had a significantly lower increase in heart rate (HR)% and decrease in SPO2% than the S group (F = 17.540, p = 0.000, F = 10.472, p = 0.001), while this difference was not observed in the shallow heel stick procedure. No difference was found between the S and SS groups, in terms of different physiological parameters. Conclusion Non‐nutritive sucking and swaddling had synergistic effects on pain relief when used with oral sucrose. For the deep heel stick procedure, oral sucrose combined with NNS and swaddling provided the best pain relief effect. For the shallow heel stick procedure, addition of NNS and swaddling did not improve the effects.
ISSN:1090-3801
1532-2149
DOI:10.1002/ejp.824