The Implementation Of Environmental And Behavioral Pain-management Strategies In Nicu Context

Objective:To determine the efficacy of 25% oral glucose and familiar odor in the reduction of pain during a heel lance procedure in hospitalized newborns.Methodology:Part One: This was a self controlled study comprising 25 newborns. They were assigned to give 1 ml glucose solution either at the first or second puncture time. Pain assessment comprised NFCS (Neonatal Facial Coding System), DAN (Douleur Aiguēdu Nouveau-né), duration of crying and heart rate.Part Two: This was a self controlled study comprising 25 newborns. They were assigned to familiarize with a vanilla smell 2 hours before the procedure. Pain assessment comprised of NFCS, DAN, duration of crying, heart rate and seconds in heart rate return to baseline.Results:Part One:NFCS scores immediately upon heel lance and squeeze were reduced in the treatment group compared to the control group (P<0.01). The three dimension-DAN scores including facial expressions, limb movements, vocal expressions and the total sum of these criteria witnessed significant difference in the two groups (P<0.01). In the recovery period following completion of the blood collection, duration of crying is significantly less in the treatment group of newborns (P<0.05). Physical response of heart rate was significantly higher in the treatment group, at the time point of 0s, 5s, 10s, 15s, 40s, 85s, than in the control group (P<0.05).Part Two: Results show that infants who smelled a familiar odor cried and grimaced significantly less during the lance, squeeze and recovery phase. Moreover, infants who smelled the familiar odor exhibited significantly less motor agitation during the heel lance procedure and lower heart rate.Conclusion:Oral glucose was effective in reducing behavioral responses to pain, in attenuating duration of crying in recovery period. Oral glucose does cause an increase in heart rate in the treatment group. Combination of both behavioral and physical assessment tools in determining pain stimuli in neonates experience would be a more rationale approach.Smelling a familiar odor reduces agitation during the heel lance and diminishes distress after the procedure.