Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: A randomized clinical trial

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Abstract

Non-pharmacological interventions are effective neonatal pain reduction strategies. We aimed to study the effects of non-nutritive sucking (NNS) and swaddling on infants' behavioural and physiological parameters during shallow or deep heel stick procedures.

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Most cited references 31

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Pain expression in neonates: facial action and cry.

R Grunau, Adrian Craig (1987)

Pain expression in neonates instigated by heel-lance for blood sampling purposes was systematically described using measures of facial expression and cry and compared across sleep/waking states and sex. From gate-control theory it was hypothesized that pain behavior would vary with the ongoing functional state of the infant, rather than solely reflecting tissue insult. Awake-alert but inactive infants responded with the most facial activity, consistent with current views that infants in this state are most receptive to environmental stimulation. Infants in quiet sleep showed the least facial reaction and the longest latency to cry. Fundamental frequency of cry was not related to sleep/waking state. This suggested that findings from the cry literature on qualities of pain cry as a reflection of nervous system 'stress', in unwell newborns, do not generalize directly to healthy infants as a function of state. Sex differences were apparent in speed of response, with boys showing shorter time to cry and to display facial action following heel-lance. The findings of facial action variation across sleep/waking state were interpreted as indicating that the biological and behavioral context of pain events affects behavioral expression, even at the earliest time developmentally, before the opportunity for learned response patterns occurs. Issues raised by the study include the importance of using measurement techniques which are independent of preconceived categories of affective response.

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Pain management in newborns.

Kanwaljeet J S Anand, Richard W Hall (2014)

As a standard of care for preterm/term newborns effective pain management may improve their clinical and neurodevelopmental outcomes. Neonatal pain is assessed using context-specific, validated, and objective pain methods, despite the limitations of currently available tools. Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Nonpharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain or adjunctive therapy. Local/topical anesthetics, opioids, NSAIDs/acetaminophen and other sedative/anesthetic agents can be incorporated into NICU protocols for managing moderate/severe pain or distress in all newborns.

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Sucrose for procedural pain management in infants.

Denise Harrison, Simon Beggs, Bonnie Stevens (2012)

The use of oral sucrose has been the most extensively studied pain intervention in newborn care to date. More than 150 published studies relating to sweet-taste-induced calming and analgesia in human infants have been identified, of which 100 (65%) include sucrose. With only a few exceptions, sucrose, glucose, or other sweet solutions reduced pain responses during commonly performed painful procedures in diverse populations of infants up to 12 months of age. Sucrose has been widely recommended for routine use during painful procedures in newborn and young infants, yet these recommendations have not been translated into consistent use in clinical practice. One reason may be related to important knowledge and research gaps concerning analgesic effects of sucrose. Notably, the mechanism of sweet-taste-induced analgesia is still not precisely understood, which has implications for using research evidence in practice. The aim of this article is to review what is known about the mechanisms of sucrose-induced analgesia; highlight existing evidence, knowledge gaps, and current controversies; and provide directions for future research and practice.

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Author and article information

Journal

Title: European Journal of Pain

Abbreviated Title: Eur J Pain

Publisher: Wiley

ISSN: 10903801

Publication date Created: July 2016

Publication date (Print): July 2016

Publication date (Electronic): December 18 2015

Volume: 20

Issue: 6

Pages: 989-997

Affiliations

[1 ]Department of PICU; Children's Hospital of Chongqing Medical University; Chongqing City China

[2 ]Department of Nursing; Chengdu Women's & Children's Central Hospital; Chengdu City China

[3 ]Department of Nursing; Shenzhen Children's Hosptial; Shenzhen City China

[4 ]Department of Nursing; Hunan Children's Hosptial; Changsha City China

Article

DOI: 10.1002/ejp.824

PubMed ID: 26685099

SO-VID: b7f3bece-7d7f-48a1-a179-7c9b2760fa3c

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http://doi.wiley.com/10.1002/tdm_license_1.1

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Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: A randomized clinical trial

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 31

Pain expression in neonates: facial action and cry.

Pain management in newborns.

Sucrose for procedural pain management in infants.

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