Management of Pain From Heel Stick in Neonates

Abstract

The heel stick procedure is the most common painful procedure performed in preterm and full-term neonates. Various nonpharmacologic interventions have been used for pain relief. However, the magnitude of the effect of different interventions has received little attention. In this study, 4 eligible studies conducted in Thailand, focusing on the effects of interventions on pain responses to heel stick procedure in neonates, were obtained for analysis. Swaddling in full-term newborns was found to have the largest mean effect size (dmn = 0.79). However, the moderate-to-large effect sizes (dmn = 0.5-0.75) of positioning in preterm newborns tended to exist throughout the poststick period while the effect sizes of other interventions decreased over time. The effect sizes of these interventions for physiological responses varied.

Effects of breastfeeding and heel warming on pain levels during heel stick in neonates

“…Heel stick, which is used for diagnosis in newborn screening tests, is one of the most frequently performed interventions with newborns (da Motta & da Cunha, 2015; Morrow, Hidinger, & Faulk, 2010;Okan, Ozdil, Bulbul, Yapici, & Nuhoglu, 2010;Prasopkittikun & Tilokskulchai, 2003). At present, it is recommended to use pharmacologic and nonpharmacologic methods with invasive medical procedures in newborns.…”

“…Nonpharmacologic methods that are commonly used to reduce the effects of invasive procedures in newborns include breastfeeding (Obeidat & Shuriquie, 2015;Pillai Ridell, et al, 2015;Harrison et al, 2016;Okan et al, 2010;Yilmaz & Arikan, 2011;Shah, Herbozo, Aliwalas, & Shah, 2012;Uga et al, 2008;Marín Gabriel et al, 2013;Aguilar Cordero, Mur Villar, García García, Rodríguez López, & Rizo Baeza, 2014), pacifiers (da Motta & da Cunha, 2015Yilmaz & Arikan, 2011), and sucrose and sweet solutions (Kassab, Anabrees, Harrison, Khriesat, & Chen, 2017;Kassab, Foster, Foureur, & Fowler, 2012;Pillai Riddell et al, 2015;Yilmaz & Arikan, 2011). Other alternatives include music therapy (Marofi, Nikobakht, Badiee, & Golchin, 2015); massage, touching, and positioning (Hartley, Miller, & Gephart, 2015); and nesting, kangaroo care, foetal positioning, and wrapping (Morrow et al, 2010;Prasopkittikun & Tilokskulchai, 2003;Okan et al, 2010;Obeidat & Shuriquie, 2015;Ali, McGrath, & Drendel, 2016;Cong, 2015;Shu et al, 2014). Breastfeeding is reported as effective in reducing pain during minor painful procedures (Chromá & Sikorová, 2012;da Motta & da Cunha, 2015;Obeidat & Shuriquie, 2015;Shah et al, 2012), and it is suggested that it should be used to reduce pain during interventional procedures in newborns (Ali et al, 2016;Reece-Stremtan & Gray, 2016;Shah et al, 2012).…”

Comparative Survey of Holding Positions for Reducing Vaccination Pain in Young Infants

“…Contact such as holding can reduce response to painful procedures [ 29 – 31 ]. Holding by the caregiver is recommended by the WHO for infants and young children receiving vaccine injection [ 15 ].…”

What About Parental Involvement in Infants' Pain Management? A Commentary on Erkut, Mutlu, and Çakıcı (2021)

“…Furthermore, references cited in this article to justify the need for this clinical trial do not support the potential analgesic mechanism of upright or supine holding alone. 9,10 The authors did not mention an extensively cited Cochrane systematic review conducted by Riddell et al 11 on the effectiveness of rocking/ holding and other nonpharmacological analgesic strategies, which found low-quality evidence to suggest that holding alone is effective in reducing pain (ie, reactivity or regulation) in neonates. As highlighted by McNair et al, 12 holding should be considered only as an adjuvant intervention to other effective analgesic strategies such as offering small amounts of sweet solutions.…”