Different Intervention Effect On Heel Pain Due To Blood Sampling In Term Newborns

Background: It is proved that untreated pain will cause short term and long term impact to newborns. Considering the long-term impact and side-effect of medicine on the newboras, it is not suggested to use medical interventions to decrease pain in new borns. So, it is very important to find out useful non-pharmacological interventions. It has been proved in the foreign countries that breast-feeding and non-nutritive sucking can decrease pain in the newborns caused by heel prick, while there are few in China.Objectives: To explore and compare breast-feeding, non-nutritive sucking and hugging's effect on pain caused by heel prick in term neonates.Methods: A prospective randomized controlled design was employed. A convenient sample of 120 neonates from a hospital in Beijing undergoing heel prick for the Newborn Screening Program Blood Test were enrolled. They were randomized into four groups of breast-feeding, non-nutritive sucking, hugging and control groups. Two minutes before the heel prick, the newborns in breast-feeding group begin to be breast-feed by his mother, while the ones in non-nutritive sucking group begin to suck a vacuate pacifier, the ones in hugging group were hugged by his mother, the ones in control group received no intervention, these last until 8 minutes after the heel prick finished. Heart Rate(HR) and Oxygen Saturation(SaO₂) were monitored by a continuous cardiac and oxygen saturation monitor, then a digital camera videoed these two data persistently, while another digital camera videoed the baby's face to record his grimace and cry.Results: 120 healthy term newborns were included. (1) The time when grimace and cry begin to appear after heel prick were significantly later in breast-feeding group(2 seconds, 5 seconds) than that in hugging group(1 second, 2 seconds) and control group(1 second,2 seconds) (P < 0.05); The lasting time of grimace and cry after heel prick in breast-feeding group(27 seconds, 26 seconds) are much shorter than that in hugging group(88 seconds, 96 seconds) and control group (80 seconds, 62.5 seconds)(P<0.05). The time when grimace begin to appear after heel prick in non-nutritive sucking group(1.5 seconds) is later than that in control group(l second)(P<0.05). The numbers of crying neonates after heel prick in breast-feeding group(19) is less than that in control group(28)(P<0.008). (2)The HR can not reach the statistical significance after the heel prick between four groups(P>0.05). (3)The SaO₂ in breast-feeding group during and 1 to 4 minutes after the procedure of heel prick were significantly higher than that in hugging group and control group(P<0.05); The SaO₂ in non-nutritive sucking group 1 to3 minutes after the procedure of heel prick also reach the statistical significance(P<0.05); The lowest value(92%) of SaO₂ in breast-feeding group after heel prick were higher thanthat in hugging group(85%) and control group(88%)(P < 0.05). The numbers ofnewborns whose SaO₂ can recover to normal value after heel prick in breast-feedinggroup(30) is more than the number in control group(21)(P<0.008); Also the recoverytime of SaO₂ after heel prick in breast-feeding group(0 minute) and non-nutritive suckinggroup (0 minute) were significantly shorter than that in hugging group(l minute) andcontrol group(4 minutes)(P<0.05).Conclusions: Breast-feeding can reduce the commonly accepted indicators of neonatalpain such as crying, facial grimacing and increase oxygen saturation during heel prickand its recovery time. Non-nutritive sucking can delay facial grimace's starting time andincrease the oxygen saturation in recovery time after heel prick; Hugging has no effect onneonatal pain responses. Breast-feeding is much better than non-nutritive sucking andhugging.