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Decreased Pain in Blood Collection in Neonates
Am Fam Physician. 1998 Mar 15;57(6):1392-1393.
Suckling is known to reduce neonatal reaction to unpleasant stimuli. Blass studied the effectiveness of milk, milk components, formula or water in the reduction of crying in neonates who had blood drawn for routine testing by heelstick.
Seventy-two infants between the ages of 22 and 40 hours were randomly assigned to one of nine groups. Body weights were similar among the groups, as were distributions of gender and race. Infants in each group were given 2 mL of milk (Similac), Ross Special Formula, dilute fat, concentrated fat, a fat/lactose solution, protein, lactose, sucrose or water for two minutes before undergoing the heel-stick procedure. Each infant's heel was also warmed before the procedure. Two minutes after the solution was finished, the infant's heel was stuck for blood collection purposes. Each procedure was videotaped and an observer who did not know which solution was given to which infant rated the amount of crying in each instance.
The greatest reduction in crying occurred in the infants who tasted sucrose, both during the procedure and immediately after the procedure. The fat, protein and Ross Special Formula solutions seemed to be effective during the recovery period but not during the procedure itself. Water and lactose were not effective at reducing crying. The infants who received water cried almost throughout the entire experiment. The sucrose group, however, cried less than one half (47 percent) of the time. Three of the eight infants in the sucrose group did not cry at all. Similac also reduced the amount of crying during treatment but not during the period following the heelstick.
The author concluded that some milk components and sucrose, as well as sucking itself, may help provide relief for mild or moderate pain in neonates.
Blass EM. Milk-induced hypoalgesia in human newborns. Pediatrics. 1997;99:825–9.
editor's note: The benefits of allowing newborns to suckle before and during even moderately painful procedures seem to outweigh the risks (e.g., aspiration). As with any non-verbal patient, it is often too easy to overlook or minimize the pain an infant may be experiencing. This small study helps remind us to consider the whole patient.—g.b.h.
Copyright © 1998 by the American Academy of Family Physicians.
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