Am Fam Physician. 2010 Feb 15;81(4):550.
Background: Although newborns experience pain, they are unable to express where and how they are hurting. Studies have shown that newborns have the basic neuronal circuitry capable of detecting nociceptive stimuli. Further, research has shown that painful stimuli in infants can alter pain sensitivity, brain development, and even behavior. Guidelines suggest that some measure of pain control should be used when performing invasive diagnostic and therapeutic procedures, but these are not implemented regularly. Weissman and colleagues studied the effectiveness of common pain management techniques in newborns during heel-lancing procedures.
The Study: Newborns who were 37 weeks of gestation or older were prospectively studied after being divided into six groups: heel lancing without any pain control; heel lancing with pacifier; heel lancing when being held by the mother; glucose solution given two minutes before heel lancing; formula feeding during heel lancing while the infant is in a crib; and breastfeeding during heel lancing. Each mother decided which pain relief option she preferred, and her child was subsequently monitored with electrocardiography, video recording of facial expression by Neonatal Facial Coding System (NFCS) standards, heart rate variability, and duration of cry.
Results: All of the intervention groups had better pain response inhibition than the control group. Babies who were breastfed or given formula displayed the lowest increase in heart rate, lowest manifestation of pain during NFCS testing, shortest crying duration, and the lowest sympathovagal heart rate response. The authors note that correlations were found among all the methods of testing, including physiologic and behavioral markers.
Conclusion: The authors conclude that using any method of pain control is better than doing nothing at all, with breastfeeding and formula feeding being the most effective.
Weissman A, et al. Heel-lancing in newborns: behavioral and spectral analysis assessment of pain control methods. Pediatrics. November 2009;124(5):e921–e926.
Copyright © 2010 by the American Academy of Family Physicians.
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