Background & Aims

During the first few days after birth, newborns may undergo several painful procedures, such as heel blood samplings, to monitor their health status. Repeated painful procedures have negative short-term and long-term impact on newborns neurological and behavioral development. Nurses have a legal and moral responsibility to alleviate newborns’ pain, but available interventions are used in suboptimal ways. The American Academy of Pediatrics recommends the use of non-pharmacological interventions to optimize pain relief in newborns. Sucrose, breastfeeding and skin-to-skin contact are non-pharmacological interventions known to relieve procedural pain in infants. Use of white noises, which recreate the sound a fetus hears in the intrauterine environment, is less studied. The aim of this study is to evaluate the preliminary effects of white noise combined with breastfeeding on pain during heel blood sampling in term neonates.

Methods

This pilot pragmatic randomized study recruited 50 mother/infant dyads using a convenience sampling strategy. Participants were randomized to experimental group (breastfeeding and white noise) or control group (breastfeeding only). White noises were accessed from a YouTube app on a cellphone. Neonates’ pain due to heel blood sampling for systematic screening of metabolic diseases was assessed using the Neonatal Infant Pain Scale (NIPS) at four time points: T0 – one minute after installation for skin-to-skin contact and breastfeeding; T1 – at heel puncture; T2 – after 10 heel compressions; and T3- one minute following the procedures completion. Total sampling time was also measured. Analysis was carried out using Student’s t-test and Fisher’s exact test to compare mean sampling time and group composition. Mann–Whitney U tests were used to compare NIPS scores at different time points.

Results

The vast majority of families who were approached (98%) agreed to take part in this study. A total of 26 and 24 newborns were recruited in the experimental and control groups, respectively. No significant difference was observed between both groups for the four pain measurement times (NIPS), despite the longer sampling time in the experimental group (x=241.35, SD=115.573, p=0.030) compared to the control group (x=184.08, SD=55.671, p=0.030). Indeed, newborns showed a zero-pain score at T0, 1 minute after installation in skin-to-skin contact. Similarly, no statistically significant difference was observed during needle insertion (p value = 0.063), after ten heel compressions (p value = 0.153) and one minute after the end of the procedure (p value = 0.239).

Conclusions

The use of white noise combined with breastfeeding did not significantly improve the management of pain during a painful procedure in term newborns. However, this study shows the feasibility of the design with this population. The prolonged duration of the heel blood sampling procedure in the experimental group suggests the need for a study with a larger sample size to determine if the difference in duration of the painful procedure can explain the absence of a significant result.

References

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Presenting Author

Sylvie Le May

Poster Authors

Sylvie Le May

PhD

Université de Montréal, CA

Lead Author

E-mail

Yekaterina SKAKUN

RN. BScN

Research Centre, CHU Sainte-Justine, Montreal, QC, Canada

Lead Author

E-mail

Nicoleta PAVEL CATANA

RN. BScN.

CHU Sainte-Justine, Montreal, QC, Canada

Lead Author

E-mail

Stéphany CARA-SLAVICH

B.A.A.

CHU Sainte-Justine, Montreal, QC & University of Montreal, Montreal, QC, Canada

Lead Author

E-mail

Pascale OUIMET

RN . BScN

Research Centre, CHU Sainte-Justine, Montreal, QC, Canada

Lead Author

E-mail

Gwenaelle DE CLIFFORD-FAUGERE

RN

Faculty of Nursing, Université du Québec en Abitibi-Témiscamingue (UQAT)

Lead Author

E-mail

Johanne DÉRY

RN. PhD

Faculty of Nursing, University of Montreal, Montreal, QC, Canada

Lead Author

E-mail

Anne GAGNÉ

CHU Sainte-Justine, Montreal, QC, Canada & University of Montreal, Montreal, QC, Canada

Lead Author

E-mail

Topics

  • Pain in Special Populations: Infants/Children