Breastfeeding or oral sucrose solution in term neonates receiving heel lance: a randomized, controlled trial. Analgesic effect of breast feeding in term neonates: randomised controlled trial. Comparison of two doses of breast milk and sucrose during neonatal heel prick. Breastfeeding is analgesic in healthy newborns. Comparison of sucrose and human milk on pain response in newborns. The effect of two different methods used during peripheral venous blood collection on pain reduction in neonates. Feeding and oral glucose--additive effects on pain reduction in newborns. The effects of various interventions to newborns on pain and duration of crying. Artificial sweetener reduces nociceptive reaction in term newborn infants. Analgesic effects of breastfeeding on heel lancing. Analgesia in newborns given oral glucose. A comparative study of nonpharmacological methods to reduce pain in neonates. Effects of breastfeeding on pain relief in full-term newborns. Analgesic effects of skin-to-skin contact and breastfeeding in procedural pain in healthy term neonates. Heel-lancing in newborns: behavioral and spectral analysis assessment of pain control methods. Effects of colostrum in newborn humans: dissociation between analgesic and cardiac effects. Effect of foremilk and hindmilk on simple procedural pain in newborns. Analgesic effect of expressed breast milk in procedural pain in term neonates: a randomized, placebo-controlled, double-blind trial.
The purpose of this work was to compare the efficacy of breastfeeding versus orally administered sucrose solution in reducing pain response during blood sampling through heel lance. METHODS; We conducted an open-label, randomized, controlled trial at a neonatal unit of a public hospital in northern Italy on 101 term neonates undergoing heel lance with an automated piercing device for routine neonatal screening for congenital disorders. Newborn infants were randomly assigned to breastfeeding during blood sampling or to the oral administration of 1 mL of 25% sucrose solution. We validated the multidimensional acute pain rating scale of the Premature Infant Pain Profile, heart rate increase, oxygen saturation decrease, crying behavior (duration of first cry, cry percentage in 2 minutes, and during blood sampling), duration of sampling, and the number of performed heel lances.
                Median Premature Infant Pain Profile scores were lower in the breastfeeding group (3.0) than in the sucrose-solution group (8.5), and the median group difference was -5.0. The median heart rate increase, oxygen saturation decrease, and duration of first cry for the breastfeeding group were, respectively, 13.0, -1, and 3 and for sucrose group were 22, -3, and 21. Medians were significantly different between the groups. There were no significant differences in the sampling duration and numbers of heel lances.
                This study suggests that breastfeeding provides superior analgesia for heel lance compared with oral sucrose in term neonates. To investigate whether breast feeding is effective for pain relief during venepuncture in term neonates and compare any effect with that of oral glucose combined with a pacifier.
                Randomised controlled trial.
                180 term newborn infants undergoing venepuncture; 45 in each group.
                During venepuncture infants were either breast fed (group 1), held in their mother's arms without breast feeding (group 2), given 1 ml of sterile water as placebo (group 3), or given 1 ml of 30% glucose followed by pacifier (group 4). Video recordings of the procedure were assessed by two observers blinded to the purpose of the study.
                Pain related behaviours evaluated with two acute pain rating scales: the Douleur Aiguë Nouveau-né scale (range 0 to 10) and the premature infant pain profile scale (range 0 to 18).
                Median pain scores (interquartile range) for breast feeding, held in mother's arms, placebo, and 30% glucose plus pacifier groups were 1 (0-3), 10 (8.5-10), 10 (7.5-10), and 3 (0-5) with the Douleur Aiguë Nouveau-né scale and 4.5 (2.25-8), 13 (10.5-15), 12 (9-13), and 4 (1-6) with the premature infant pain profile scale. Analysis of variance showed significantly different median pain scores (P<0.0001) among the groups. There were significant reductions in both scores for the breast feeding and glucose plus pacifier groups compared with the other two groups (P<0.0001, two tailed Mann-Whitney U tests between groups). The difference in Douleur Aiguë Nouveau-né scores between breast feeding and glucose plus pacifier groups was not significant (P=0.16).
                Breast feeding effectively reduces response to pain during minor invasive procedure in term neonates. The aim of the present study was to test analgesic effects of double- versus single-dose breast milk and compare this effect with efficacy of double- versus single-dose sucrose in a group of healthy term newborns during heel prick blood sampling.
                Healthy newborns (n= 142) were consecutively allocated to one of the six groups: group 1, single-dose breast milk; group 2, single-dose sterile water; group 3, single-dose 12.5% sucrose; group 4, two doses breast milk; group 5, two doses sterile water; and group 6, two doses 12.5% sucrose before the heel prick. The medians for crying time and the pain scores according to the neonatal facial coding system were recorded.
                Crying times were 117 s, 126 s, 82 s, 128 s, 117 s, and 95 s in groups 1-6, respectively (P= 0.053). The mean pain scores were 4.60, 5.82, 3.91, 4.94, 5, and 4.05 in groups 1-6, respectively (P= 0.068). There was a significant difference between the groups for mean pain scores at 1 min and 3 min. There was a significant difference between the single-dose sucrose group and single-dose sterile water group at 1 min (P= 0.002). The babies in the sucrose group were active awake, whereas the ones in the breast milk group were asleep before heel prick.
                Two doses of sucrose solution were not superior to single-dose sucrose. Neither single nor double doses of breast milk were effective in relieving pain in neonates. Two milliliters breast milk does not reduce response to pain during minor painful procedures in term neonates even when two doses have been given. Further studies are needed. This study identifies a behavioral and nonpharmacologic means of preventing newborn pain.
                To determine whether breastfeeding is analgesic in newborn infants undergoing heel lance-a routine, painful, hospital procedure.
                A prospective, randomized, controlled trial.
                Hospital maternity services at Boston Medical Center, Boston, Massachusetts, and Beverly Hospital, Beverly, Massachusetts.
                A random sample of 30 full-term, breastfed infants.
                Infants in the intervention group were held and breastfed by their mothers during heel lance and blood collection procedures for the Newborn Screening Program Blood Test. Infants in the control group experienced the same blood test while receiving the standard hospital care of being swaddled in their bassinets.
                Crying, grimacing, and heart rate differences were analyzed between the breastfeeding and the control infants before, during, and after blood collection.
                Crying and grimacing were reduced by 91% and 84%, respectively, from control infant levels during the blood collection. Heart rate was also substantially reduced by breastfeeding.
                Breastfeeding is a potent analgesic intervention in newborns during a standard blood collection. The aim of this study was to compare the analgesic effect of 2 ml 25% sucrose and human milk in a group of healthy term newborns. Healthy infants (n = 102) were randomly allocated to receive one of three solutions (sucrose, human milk, sterile water) 2 min prior to taking a heel prick blood sample. The median values of crying time, recovery time and percentage change in heart rate at 1, 2 and 3 min were recorded in response to the heel prick. Median crying times were 36, 52, and 62 s in the sucrose, placebo and human milk groups, respectively (P = 0.0009). In the sucrose group, there was a significant reduction in crying time compared to human milk and placebo groups. Similarly, the median recovery time in the sucrose group (72 s) was shorter than that in the human milk (112 s) and placebo groups (124 s) (P = 0.004). The percentage change in heart rate at 1, 2 and 3 min was also significantly lower in the sucrose group (P = 0.008, P = 0.01, P = 0.002 at 1, 2, and 3 min respectively).
                The orosensorial antinociceptive effect of human milk is not as effective as an analgesic as a 25% sucrose solution. The purpose of the present study was to examine and compare the analgesic effects of breast feeding and sucrose solutions in reducing pain due to venipuncture in term neonates. 102 term infants requiring a venous blood sample for routine screening of phenylketonuria (n=26) and hyperbilirubinemia (n= 76) were included in the study. The participants were allocated into one of the sucrose, breast feeding, and control groups. Allocation of the infants into groups was performed due to mothers' wishes whereas the control group included the infants on whom routine procedures of the hospital were performed. In order to assess the pain response of the neonates before, during and after venipuncture, Neonatal Infant Pain Scale (NIPS) was used and their heart rates, oxygen saturation levels and length of crying were noted. The crying time (seconds) was shorter both sucrose (9.56+/-12.96) and breast feeding (28.62+/-33.71) than the control group (103.50+/-63.69). No difference was found in the analgesic effect of breast feeding compared with sucrose, when assessed with the NIPS. The mean heart rate did not significantly differ among three groups before, during and after procedure. During procedure, the mean oxygen saturation levels of sucrose group were found significantly higher than the control group, but no difference was observed between sucrose and breast feeding groups. This study has confirmed some well known information that breast feeding and oral sucrose solution have pain reducing effects in infants undergoing venipuncture. The aims of this study were to compare the pain reducing effect of oral glucose with that of being breast-fed shortly before venipuncture in newborns, and also the pain score and crying time with parents' assessment.
                Randomised, controlled trial.
                120 full term newborns undergoing venipuncture randomly assigned to on of four groups: I, Breast-fed and 1-ml placebo; II, Breast-fed and 1-ml 30% glucose; III, Fasting and 1-ml placebo; and IV, Fasting and 1-ml 30% glucose.
                Pain during venipuncture was measured with the Premature Infant Pain Profile (PIPP). Crying time was recorded. The parents assessed their babies' pain on a Visual Analogue Scale (VAS).
                The PIPP score was significantly lower in the infants receiving glucose, than in those not given glucose (p=0.004). There was no significant difference in PIPP score between the infants who were fed and the fasting infants. The PIPP score was lower in group II (median 7) than in group I (md 10). There was a similar difference between group IV (md 9) and group III (md 11). The median crying times during the first 3 min in groups I, II, III, and IV were 63, 18, 142 and 93 s, respectively. There was low agreement between the parents' assessment of pain and the PIPP score and crying time.
                Breast-feeding shortly before venipuncture has no major impact on the pain score but on crying time. The combination of oral glucose and breast-feeding shows the lowest pain score and significantly shorter duration of crying. This study aimed to compare the effects of mother's milk, sucrose and pacifier use to overcome pain during painful interventions to the newborns on the crying time and pain.
                Various non-pharmacological methods are used to overcome the pain associated with painful interventions with newborns.
                A prospective, randomised, controlled study involved 120 newborns in Turkey.
                The population consisted of healthy newborns hospitalised in the gynaecology clinics of Trabzon Delivery and Children's Diseases hospital between February 2007-January 2008. The newborns who had blood sampling by heel stick were divided into four groups: mother's milk, sucrose, pacifier and control groups with 30 newborns in each. Data collection was performed using an information form on the newborn characteristics, which was developed by the researchers in the light of literature, clinical IR ear thermometer ET1 for temperature measurement, OXIMAX N-65 Pulse oxymeter for oxygen saturation and heart rate and neonatal infant pain scale for the measurement of the behavioural responses of newborns. Results.  No differences were determined between the groups for heart rate and oxygen saturation in the newborns during painful interventions (p > 0·05). Sucrose followed by pacifier was the most effective method of reducing the crying time in the newborns.
                The results indicate that all three practices reduce the behavioural responses to pain at a higher rate than in the control group.
                Health care personnel should perform painful interventions to the newborns while the babies are held by their mothers and during the procedure use of sucrose should be the primary choice.
                © 2010 Blackwell Publishing Ltd. Sucrose has been shown to have an analgesic effect in preterm and term neonates. Sucrose, however, has a high osmolarity and may have deleterious effects in infants with fructose intolerance. Furthermore, it may favour caries. We therefore investigated the effects of a commercially available artificial sweetener (10 parts cyclamate and 1 part saccharin), glycine (sweet amino acid) or breast milk in reducing reaction to pain as compared with a placebo.
                Eighty healthy term infants, four days old, with normal birth weight.
                The infants were randomly assigned to one of four groups: 2 ml sweetener, glycine, expressed breast milk or water were given 2 min before a heel prick for the Guthrie test. The procedure was filmed with a video camera and analysed by two observers who did not know which medication the infant had received.
                Using a multivariate regression analysis, the following variables had significant correlation with relative crying time and recovery time: behavioural state before the intervention, the pricking nurse, and the type of medication. Relative crying time and recovery time were significantly less in the sweetener group but not in the glycine and the breast milk group.
                The artificial sweetener used in our study reduces pain reaction to a heel prick in term neonates, and thus provides an alternative to sucrose. In contrast, glycine tends to increase pain reaction whereas breast milk has no effect. nan There is evidence that newborn babies feel pain even at the lowest gestational ages when they can survive. Because sweet solutions such as sucrose, given orally, may relieve pain in neonates, we decided to compare the effects of two concentrations of glucose (normally used for intravenous infusions) and of breast milk in a randomized controlled trial in 120 babies requiring heel-prick tests. Glucose solutions and breast milk are readily available in the neonatal department. No other treatment was given. Our results strongly suggest that 1 ml of a 30% glucose solution given orally alleviates mild pain significantly and can be used for this purpose in newborns. Breast milk and 10% glucose did not have a similar effect. A randomized study was done to compare non pharmacological methods to reduce the pain of heel pricks in 104 stable term neonates. Non-nutritive sucking (NNS), rocking, massage, sucrose (20 percent), distilled water (DW) and expressed breast milk (EBM) were used as pain reducing agents. Duration of cry and Douleur Aiguë du Nouveau né (DAN) score were used to assess pain. Physiological parameters were also recorded before and after the stimulus. At 30 seconds after the stimulus, the pain scores were lowest in the sucrose group but this was not sustained at 1, 2 and 4 minutes. At 2 and 4 minutes pain scores were lowest in the NNS and rocking groups as compared to sucrose, distilled water, expressed breast milk and massage. The total duration of crying was also lowest in the NNS and rocking groups. Physiological parameters were comparable in all groups. Babies who were in Prechtl State 1 and 2 (sleeping) at the time of stimulus showed significantly lesser response to pain compared to babies who were awake. This was seen in all the intervention groups. In conclusion, our study suggests that rocking or giving a baby a pacifier are more effective non-pharmacological analgesics than EBM, DW, sucrose or massage for the pain of heel pricks in neonates. A calm or sleeping state before a painful procedure also appears to decrease crying and pain scores. Breastfeeding may be useful for relieving procedural pain experienced by neonates. Researchers have compared breastfeeding against other pain relieving approaches in several studies, presenting marked methodologic heterogeneity.
                To investigate the effectiveness of breastfeeding in reducing pain in newborns undergoing blood collection for newborn screening.
                The sample of this randomized clinical trial study consisted of 60 full-term newborns: 31 in the experimental group and 29 in the control group. The experimental group was breastfed 5 minutes before, during, and for 5 minutes after the blood collection procedure. Neonates in the control group were held in mothers' arms but not fed or given a soother. The duration of breastfeeding was prolonged in comparison to previous studies.
                The primary outcomes were Neonatal Facial Actions (Neonatal Facial Activity Coding System-upper face), sleep-wake state. Heart rate was considered as an index of arousal. Sucking frequency was only evaluated in the experimental group. Compared with the control group, the experimental group had significantly lower, Neonatal Facial Activity Coding System and sleep-wake state scores and heart rates changes. In the experimental group sucking frequency was highest during the first 5 minutes of breastfeeding before the procedure.
                This study innovates from earlier studies in 4 respects: the different phases of the procedure were evaluated separately; the breastfeeding intervention covered the period from 5 minutes before the blood collection until the end of recovery; sleep-wake state was fully assessed (not merely crying) and the sucking frequency in the experimental group was assessed during the procedure. The conclusion was that breastfeeding was effective in reducing pain caused by blood collection for newborn screening. The effectiveness of skin-to-skin contact to decrease pain from heel-lancing in healthy term neonates and whether breastfeeding in addition to skin-to-skin contact provided a more effective analgesia than skin-to-skin contact alone were investigated.
                A randomised, controlled trial was conducted in 107 neonates undergoing heel-lance. Infants were randomly assigned to three groups: (i) being breastfed with skin-to-skin contact (group 1, n=35), (ii) being held in their mother's arms with skin-to-skin contact but no breastfeeding (group 2, n=36), or (iii) lying on the table before, during and after painful stimulus (group 3, n=36). Physiological responses to pain were measured by heart rate and oxygen saturation changes and behavioural responses were measured by duration of crying and grimacing.
                Infants had a mean (SD) birthweight of 3355 (270) g and gestational age of 39.5 (0.6) weeks; at the time of the procedure, mean (SD) postnatal age was 33.1 (5) hours. There was no significant difference between the groups in clinical characteristics and time spent squeezing the heel. Heart rate, oxygen saturation changes and length of crying were significantly reduced in groups 1 and 2 compared with group 3 (p<0.001). No difference was found between group 1 and group 2. Grimacing was less in group 2 than in group 3 (p<0.001).
                In healthy term neonates, skin-to-skin contact with the mother and breastfeeding with skin-to-skin contact reduce both physiological and behavioural pain response. Breastfeeding in the 1st 2 postnatal days with skin-to-skin contact did not increase the analgesic effect of skin-to-skin contact alone. Pain experience can alter clinical outcome, brain development, and subsequent behavior in newborns, primarily in preterm infants. The aims of this study were (1) to evaluate several simple, commonly used methods for pain control in newborns and (2) to evaluate the concordance between behavioral and autonomic cardiac reactivity to pain in term neonates during heel-lancing.
                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.
                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; P < .01), lowest neonatal facial score (2.3 and 2.9, respectively, vs 7.1; P < .001), lowest cry duration (5 and 13 seconds, respectively, vs 49; P < .001), and lowest decrease in parasympathetic tone (-2 and -2.4, respectively, vs 1.2; P < .02) compared with the other groups.
                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. This study evaluates the effects of colostrum, delivered via syringe or on a pacifier, on the pain and heart rate reactions of newborns undergoing routine heel-lance. This was achieved by following a quasi-randomized, controlled trial in which 60 newborn infants at Boston Medical Center, Boston, MA, were randomly assigned to receive colostrum, sucrose, or water, by syringe or on a pacifier, for a total of 6 groups (n = 10 per group). The effectiveness of an intervention was determined by comparing crying, grimacing, and heart rate differences among groups during and following blood collection. We report that colostrum, delivered by syringe or on a pacifier, did not reduce crying or grimacing relative to control infants who received water. As has been previously reported, sucrose markedly reduced both crying and grimacing, and attenuated the rise in heart rate that normally accompanies blood collection (p < .002). Water, via syringe or on a pacifier, did not prevent the increase in heart rate, nor did colostrum via syringe. In contrast, colostrum delivered on a pacifier prevented the increase in heart rate despite pain reactivity and extreme crying. The implications of this dissociation are discussed. Infants are exposed to painful stimuli during routine medical care in the first few days of life. The aim of the present study was to compare the effect of foremilk; hindmilk, which has been known to have more fat content than foremilk; and sterile water in reducing pain in newborns undergoing minor painful procedures.
                Sixty-two healthy term infants requiring a heel prick blood sample for screening tests were randomly allocated to receive 2 mL of foremilk, hindmilk or sterile water. Median crying time, duration of the first cry, percent change in heart rate, maximum heart rate and neonatal facial coding system scores were recorded to assess the infants' response to pain.
                Statistically significant differences between the three groups were not found in terms of crying time, duration of the first cry, percent change in heart rate or maximum heart rate (P = 0.19, P = 0.08, P = 0.22 and P = 0.91, respectively). When the mean pain scores of the groups were compared at 0, 1, 2 and 3 min, there was no statistically significant difference between the three groups (P = 0.58, P = 0.55, P = 0.58 and P = 0.84 for 0, 1, 2 and 3 min, respectively).
                Although hindmilk has a minor superiority in terms of crying time, duration of the first cry and percent change in heart rate, it does not reach statistical significance. It is concluded that neither foremilk nor hindmilk is superior in relieving pain when compared to placebo. To assess the effectiveness of expressed breast milk (EBM) in reducing pain due to venepuncture, in term neonates, as measured by behavioural and physiological observations.
                This randomized, placebo-controlled, double-blind trial involved 81 full-term neonates, up to 4 wk of postnatal age, who needed venepuncture for blood investigations. Two minutes before the venepuncture, in the intervention arm, 40 babies received 5 ml of EBM, while 41 babies in control group received 5 ml of distilled water (DW) as placebo. Two observers who were blinded to the intervention recorded the physiological (heart rate and oxygen saturation) and behavioural parameters [duration of crying and modified Neonatal Facial Coding Scores (NFCS)] after the venepuncture.
                There was no difference in the baseline characteristics of the neonates in the two groups. The duration of crying was significantly shorter in babies fed EBM [median 38.5 s, interquartile range (IQR) 9.5-57.5 s] than in those fed DW (median 90 s, IQR 28-210 s). The mean duration of crying in EBM group was shorter by 70.7 (95% confidence interval 36.6-104.9) s. The modified NFCS at 0, 1 and 3 min was significantly lower (p < 0.01) in the EBM than in the DW group. The change in heart rate and oxygen saturation was significantly lower in the EBM group and returned to baseline values sooner than in the DW group.
                Feeding 5 ml of EBM before venepuncture is effective in reducing symptoms due to pain in term neonates.