Comparison the Effectiveness of Breastfeeding, Oral 25% Dextrose, Kangaroo-Mother Care Method, and EMLA Cream on Pain Score Level Following Heal Pick Sampling in Newborns
Arandomized clinical trial
Keywords:
Kangaroo-Mother Care Methods, Breastfeeding, Dextrose, EMLA, Infant, Pain, Pain Management, Neonatal Infant Pain ScaleAbstract
Background: Today, it is considered that infants can feel pain, and it can have several adverse effects on their development. Although different interventions, such as skin-to-skin contact (kangaroo mother care method), glucose solutions, breastfeeding, and local anesthetic agents, have been evaluated to reduce infants’ pain, there is no clinical trial available to identify the best method. Objective: The aim of this study was to compare the efficacy of four methods of relieving infants’ pain, i.e., breastfeeding, oral 25% dextrose, kangaroo mother care method (KMCM), and EMLA cream based on a pain score level following heal-prick sampling in term newborns. Methods: In this double-blind, controlled, randomized clinical trial, full term, and healthy infants in Shahid Motahhari Hospital, Marvdasht, Shiraz Province, Iran were studied. Infants were randomly allocated to four groups of interventions, i.e., A: breast milk feeding (n=42), B: oral 25% dextrose (n=40), C: KMCM (n=38), and D: KMCM ointment (n=40). All interventions were applied 15 minutes before heel-prick sampling. To evaluate the pain level in infants, the Neonatal Infant Pain Scale (NIPS) questionnaire was used. The data were analyzed with SPSS version 16 by ANOVA and the chi-squared tests. Results: One hundred and sixty-one infants (93 males, 68 females) with an age range of 3 to 5 days were studied. There was no significant difference between the groups in terms of gender (p=0.113), weight (p=0.059), and baseline pain score level (p=0.904). The breastfeeding method showed the lowest pain score in comparison to the other interventions (A=5.52±2.22, B=6.45±1.88, C=6.84±1.96, D=7.37±1.95; p=0.001) after the heel-prick sampling. Conclusion: It seems that, among the four methods of interventions in this study, the most effective method of lowering perceived pain in infants undergoing painful procedures was proven to be breastfeeding. Trial Registration: This study is registered in the Iranian Registry of Clinical Trials with the registration number of IRCT20151201253256N1. Funding: This research was supported financially by the Research Council of the International Campus of Shiraz University of Medical Sciences.References
Bonica J. The need of a taxonomy. Pain. 1979; 6(3): 247. doi: 10.1016/0304-3959(79)90046-0.
Dilen B, Elseviers M. Oral glucose solution as pain relief in newborns: results of a clinical trial. Birth.
; 37(2): 98-105. doi: 10.1111/j.1523-536X.2010.00389.x, PMID: 20557532.
Whitfield MF, Grunau RE. Behavior, pain perception, and the extremely low-birth weight survivor. Clin
Perinatol. 2000; 27(2): 363-79. doi: 10.1016/S0095-5108(05)70026-9, PMID: 10863655.
Stevens B, Gibbins S, Franck LS. Treatment of pain in the neonatal intensive care unit. Pediatr Clin North
Am . 2000; 47(3): 633-50. doi: 10.1016/S0031-3955(05)70230-3, PMID: 10835995.
Fulbrook P, Latour J, Albarran J, De Graaf W, Lynch F, Devictor D, et al. The presence of family members
during cardiopulmonary resuscitation. Eur J Cardiovasc Nurs. 2007; 6(4):255-8. doi:
1016/j.ejcnurse.2007.07.003, PMID: 17919981.
Pasero C. Circumcision Requires Anesthesia and Analgesia: Need proof? Am J Nurs. 2001; 101(9): 22-3.
doi: 10.1097/00000446-200109000-00014.
Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess
neonatal pain. Neonatal Netw. 1993; 12(6): 59-66. PMID: 8413140.
Gale G, VandenBerg K. Kangaroo care. Neonatal Netw. 1998; 17(5): 69-71. PMID: 9791453
Roller CG, Meyer K, Anderson GC. Birth kangaroo (skin-to-skin) care and breastfeeding: an eclamptic
woman's story. MCN Am J Matern Child Nurs . 1999; 24(6): 294-5. doi: 10.1097/00005721-199911000- 00006, PMID: 10565143.
Bauer J, Sontheimer D, Fischer C, Linderkamp O. Metabolic rate and energy balance in very low birth
weight infants during kangaroo holding by their mothers and fathers. J Pediatr. 1996; 129(4): 608-11. doi:
1016/S0022-3476(96)70129-4, PMID: 8859271.
Gómez PA, Baiges NM, Batiste FM, Marca GM, Nieto JA, Closa MR. [Kangaroo method in delivery room
for full-term babies]. An Esp Pediatr. 1998; 48(6): 631-3. PMID: 9662849.
Gray L, Watt L, Blass EM. Skin-to-skin contact is analgesic in healthy newborns. Pediatrics. 2000;
(1):e14-e. PMID: 10617751.
Grazel R. Neonatal pain management with oral sucrose. Worldviews on Evidence‐based Nursing presents
the archives of Online Journal of Knowledge Synthesis for Nursing. 2002; 9(1): 142-8. doi:
1111/j.1524-475x.2002.00142.x.
Taddio A, Shah V, Hancock R, Smith RW, Stephens D, Atenafu E, et al. Effectiveness of sucrose analgesia
in newborns undergoing painful medical procedures. CMAJ. 2008; 179(1): 37-43. doi:
1503/cmaj.071734, PMID: 18591525, PMCID: PMC2464480.
Tarhani F, Momennasab M, Tarhani S. A Survey: Glucose Sedative Effect in Neonates during Venus
Blood Sampling. Yafte journal of medical scienes. 2004; 6(2): 47-51.
McCullough S, Halton T, Mowbray D, Macfarlane PI. Lingual sucrose reduces the pain response to
nasogastric tube insertion: a randomised clinical trial. Arch Dis Child Fetal Neonatal Ed. 2008; 93(2):
F100-3. doi: 10.1136/adc.2006.110338, PMID: 17634178.
Cordoni A, Cordoni LE. Eutectic mixture of local anesthetics reduces pain during intravenous catheter
insertion in the pediatric patient. Clin J Pain. 2001; 17(2): 115-8. doi: 10.1097/00002508-200106000- 00003, PMID: 11444712.
Tansky C, Lindberg CE. Breastfeeding as a pain intervention when immunizing infants. J Nurse Pract.
; 6(4): 287-95. doi: 10.1016/j.nurpra.2009.09.014.
Shahali S, Taavoni S, Haghani H, Neysani SE. Comparison of the Effect of Breast Sucking with Being in
the Mother's Hug on Pain Relieving during Immunization Injection. Journal Of Babol University Of
Medical Sciences. 2010; 11(5): 32-7.
Shah PS, Aliwalas L, Shah V. Breastfeeding or breastmilk to alleviate procedural pain in neonates: a
systematic review. Breastfeed Med. 2007; 2(2): 74-82. doi: 10.1089/bfm.2006.0031, PMID: 17661578.
Malekan Rad E, Momtazmanesh N, Barkatin R. The effects of glucose, breast milk and lidocaine cream on
acute pain of arteriopuncture in term neonates. KAUMS Journal (FEYZ). 2004; 8(2): 15-9.
Bilgen H, Özek E, Cebeci D, Örs R. Comparison of sucrose, expressed breast milk, and breast-feeding on
the neonatal response to heel prick. J Pain. 2001; 2(5): 301-5. doi: 10.1054/jpai.2001.23140, PMID:
Rogers TL, Ostrow CL. The use of EMLA cream to decrease venipuncture pain in children. J Pediatr Nurs .
; 19(1): 33-9. doi: 10.1016/j.pedn.2003.09.005, PMID: 14963868.
Buckley MM, Benfield P. Eutectic lidocaine/prilocaine cream A review of the topical anaesthetic/analgesic
efficacy of a eutectic mixture of local anaesthetics (EMLA). Drugs. 1993; 46(1): 126-51. doi:
2165/00003495-199346010-00008, PMID: 7691503.
Taddio A, Shennan AT, Stevens B, Leeder JS, Koren G. Safety of lidocaine-prilocaine cream in the
treatment of preterm neonates. J Pediatr. 1995; 127(6): 1002-5. doi: 10.1016/S0022-3476(95)70050-1,
PMID: 8523173.
Gourrier E, Karoubi P, El Hanache A, Merbouche S, Mouchnino G, Leraillez J. Use of EMLA cream in a
department of neonatology. Pain. 1996; 68(2): 431-4. doi: 10.1016/S0304-3959(96)03208-3, PMID:
Larsson B, Tannfeldt G, Lagercrantz H, Olsson G. Alleviation of the pain of venepuncture in neonates.
Acta Paediatr. 1998; 87(7): 774-9. doi: 10.1111/j.1651-2227.1998.tb01746.x, PMID: 9722252.
Suraseranivongse S, Kaosaard R, Intakong P, Pornsiriprasert S, Karnchana Y, Kaopinpruck J, et al. A
comparison of postoperative pain scales in neonates. Br J Anaesth. 2006; 97(4): 540-4. doi:
1093/bja/ael184, PMID: 16885171.
Sarhangi F, Mollahadi M, Ebadi A, Matinzadeh ZK, Tadrisi SD. Validity and reliability of Neonatal Infant
Pain Scale in Neonatal Intensive Care Units in Iran (2010). Pakistan Journal of Medical Sciences. 2011;
(5).
Johnston CC, Collinge JM, Henderson SJ, Anand K. A cross-sectional survey of pain and pharmacological
analgesia in Canadian neonatal intensive care units. Clin J Pain. 1997; 13(4): 308-12. doi:
1097/00002508-199712000-00008, PMID: 9430811.
Kapellou O. Blood sampling in infants (reducing pain and morbidity). Clinical evidence. 2011; 2011.
Shah PS, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. The
Cochrane Library. 2006. doi: 10.1002/14651858.cd004950.pub2.
Blass EM, Shide DJ, Zaw-Mon C, Sorrentino J. Mother as shield: Differential effects of contact and
nursing on pain responsivity in infant rats: Evidence for nonopioid mediation. Behav Neurosci. 1995;
(2): 342. doi: 10.1037/0735-7044.109.2.342, PMID: 7619324.
Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics.
; 109(4): 590-3. doi: 10.1542/peds.109.4.590, PMID: 11927701.
Blass EM, Blom J. β-Casomorphin causes hypoalgesia in 10-day-old rats: evidence for central mediation. Pediatr Res. 1996; 39(2): 199-203. doi: 10.1203/00006450-199602000-00002, PMID: 8825787.
Ren K, Blass E, Dubner R. Suckling and sucrose ingestion suppress persistent hyperalgesia and spinal Fos
expression after forepaw inflammation in infant rats. Proc Natl Acad Sci. 1997; 94(4): 1471-5. doi:
1073/pnas.94.4.1471, PMCID: PMC19815.
Weller A, Blass EM. Behavioral evidence for cholecystokinin-opiate interactions in neonatal rats. Am J
Physiol. 1988; 255(6): R901-7. PMID: 3202224.
Johnston CC, Stevens B, Pinelli J, Gibbins S, Filion F, Jack A, et al. Kangaroo care is effective in
diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med. 2003; 157(11): 1084-8. doi:
1001/archpedi.157.11.1084, PMID: 14609899.
Johnson AN. Kangaroo holding beyond the NICU. Pediatr nurs. 2005; 31(1): 53. PMID: 15794326.
Blass EM, Smith BA. Differential effects of sucrose, fructose, glucose, and lactose on crying in 1-to 3-day- old human infants: Qualitative and quantitative considerations. Developmental Psychology. 1992; 28(5):
doi: 10.1037/0012-1649.28.5.804.
Efe E, Savaser S. The effect of two different methods used duringperipheral venous blood collection on
pain reduction in neonates. Agri. 2007; 19(2): 49-56. PMID: 17760245.
Eghbalian F, Shalchi Z. Comparing The Efficacy Of Oral Glucose 50%, Acetaminophen And Breast- Feeding On Reducing Neonatal Pain. Urmia Medical Journal. 2014; 25(7): 578-85.
Eriksson M, Gradin M, Schollin J. Oral glucose and venepuncture reduce blood sampling pain in newborns.
Early Hum Dev. 1999; 55(3): 211-8. doi: 10.1016/S0378-3782(99)00018-3, PMID: 10463785.
Campos RG. Rocking and pacifiers: two comforting interventions for heelstick pain. Res Nurs Health.
; 17(5): 321-31. doi: 10.1002/nur.4770170503, PMID: 8090943.
Gradin M, Eriksson M, Holmqvist G, Holstein Å, Schollin J. Pain reduction at venipuncture in newborns:
oral glucose compared with local anesthetic cream. Pediatrics. 2002; 110(6): 1053-7. doi:
1542/peds.110.6.1053, PMID: 12456899.
Abad F, Diaz‐Gomez N, Domenech E, Gonzalez D, Robayna M, Feria M. Oral sucrose compares
favourably with lidocaine‐prilocaine cream for pain relief during venepuncture in neonates. Acta Paediatr.
; 90(2): 160-5. doi: 10.1111/j.1651-2227.2001.tb00278.x, PMID: 11236045.
Mucignat V, Ducrocq S, Lebas F, Mochel F, Baudon J, Gold F. [Analgesic effects of Emla cream and
saccharose solution for subcutaneous injections in preterm newborns: a prospective study of 265
injections]. Arch Pediatr. 2004; 11(8): 921-5. doi: 10.1016/j.arcped.2004.03.028, PMID: 15288082.
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