NP Medical News about Infant, Newborn Pain Behavior Control

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Heel-Lancing in Newborns: Behavioral and Spectral Analysis Assessment of Pain Control Methods
Pediatrics, 11/02/09

Weissman A et al. – Any method of pain control is better than none. Feeding and breastfeeding during heel–lancing were found to be the most effective methods of pain relief.

Methods

A prospective study was conducted of 180 term newborn infants who were undergoing heel–lancing for routine neonatal screening of phenylketonuria and hypothyroidism.
Newborns were assigned to 6 groups: (1) control (no pain relief intervention); (2) nonnutritive sucking; (3) holding by mother; (4) oral glucose solution; (5) oral formula feeding; or (6) breastfeeding.
Outcome measures included the Neonatal Facial Coding System score; cry duration; and autonomic variables obtained from spectral analysis of heart rate variability before, during, and after heel–lancing.

Results

Infants with no pain control showed the highest pain manifestation compared with newborns to whom pain control was provided.
Infants who breastfed or received an oral formula showed the lowest increase in heart rate (21 and 23 beats per minute, respectively, vs 36), lowest neonatal facial score (2.3 and 2.9, respectively, vs 7.1), lowest cry duration (5 and 13 seconds, respectively, vs 49), and lowest decrease in parasympathetic tone (–2 and –2.4, respectively, vs 1.2) compared with the other groups.

Exclusive Author Commentary
Amir Weissman, 11/03/09

The most important take-home-message should be that neonatal pain prevention is the expectation of the parents and the goal of the medical staff. We can not dismiss these very simple-to-use methods that were proven to efficiently reduce pain in neonates and use them whenever painful procedure is performed.

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