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Neonatal pain response and adverse effects and maternal anxiety were assessed in 27 infants who were randomly allocated to venepuncture or heel stick. Pain was assessed by nurses using the Neonatal Infant Pain Scale (NIPS) and a three point scale for the mothers. NIPS scores were higher in the heel stick group compared with the venepuncture group. Maternal anxiety was higher before the procedure while perception of an infant's pain was lower in the venepuncture group compared with the heel stick group. Venepuncture is less painful than heel stick in newborn infants undergoing routine blood sampling. (Arch Dis Child 1997;77:F143-F144) Keywords: pain response; heel stick; venepuncture; blood sampling Heel stick is the conventional method of blood sampling in neonates. Previous research has shown that infants undergoing heel stick show signs of distress and pain.1 2 There are currently no published data comparing pain response with an alternative method of blood sampling such as venepuncture.Venepuncture is a common procedure performed in older infants and children.3 Its advantages include increased sample volume, reduced risk of a haemolysed or clotted sample, and perhaps less pain. The benefit of heel stick is that it is very easy to perform, and therefore paramedics can also do the task.The primary objective of the study was to compare the pain response to diVerent methods of blood sampling in full term infants. The secondary objectives were to compare the incidence of adverse eVects. MethodsThe study was approved by the research ethics committee and informed parental consent was obtained. Healthy neonates of >37 weeks gestational age having blood taken for measurement of serum bilirubin or glucose were eligible. The babies were randomly assigned to the heel stick or venepuncture sampling technique. Randomisation was computer generated. One investigator (VS) performed all procedures. Heel stick and venepuncture were performed in a standardised manner while the infant was held in the mother's or nurse's arms. For the heel stick group, the heel was wiped with alcohol, pricked with a lancet and squeezed to collect the required volume of blood (0.25 ml). A cotton wool ball was applied to prevent bleeding. For venepuncture, the investigator identified the site (most common site used was the dorsum of the hand), cleaned it with alcohol, punctured the vein using a 21 gauge needle and collected 0.25 ml of blood. A cotton wool ball was applied to prevent bleeding after the needle was removed. The mother and the nurse responsible for care of the baby were present during the procedure. The nurse rated the infant's pain using the Neonatal Infant Pain Scale(NIPS). 4 The total score ranges from 0 to 7. Pain assessments were made at baseline (before the procedure), during (when maximal response was observed), and after the procedure (when cotton wool was applied). Nurses were blinded to the purpose of the study.At the end of the procedure, each mother completed a questionnaire rating her anxiety level before the pr...

There are few data to inform a decision to resuscitate babies who are unexpectedly stillborn. The outcome for 42 successfully resuscitated stillborn children, of whom 62% survived to be discharged home, is reported. Of the survivors, a poor outcome with severe disability was found in 23% (including one postneonatal death), equivocal outcome was found in 15% (two mild hypertonia; two with mild hemiplegia and no associated other disability) and 62% were free of any impairment at follow up 20 months to 8 years later. In 39 (93%) fetal problems had been identified and the resuscitation team was present at delivery. Poor outcome was associated with late return of heart beat, delayed respirations, neonatal acidaemia and early onset of seizures. Of the unexpected apparent stillbirths successfully resuscitated, 52% died or survived severely disabled, 10% had an equivocal outcome, but 36% survived apparently intact. Therefore, vigorous resuscitation is clearly indicated in these circumstances. (Arch Dis Child Fetal Neonatal Ed 1998;78:F112-F115)