Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Armand Trousseau, Department of Perinatology, F75012, Paris, France.
Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien (HUEP), Clinical Research Unit of East of Paris (URC-Est), F75012, Paris, France.
Int J Nurs Stud. 2018 Oct;86:29-35. doi: 10.1016/j.ijnurstu.2018.06.007. Epub 2018 Jun 15.
Reducing acute pain in premature infants during neonatal care improves their neurophysiological development. The use of pharmacological and non-pharmacological analgesia, such as sucrose, is limited per day, particularly for very preterm infants. Thus, the usual practice of non-nutritive sucking is often used alone. Facilitated tucking could be an additional strategy to non-nutritive sucking for reducing pain. To the best of our knowledge, no randomized trial has compared the combination of facilitated tucking and non-nutritive sucking to non-nutritive sucking alone.
To compare the efficacy of facilitated tucking in combination with non-nutritive sucking (intervention group) to non-nutritive sucking alone (control group) in reducing pain during the heel-stick procedure in very preterm infants.
Prospective, randomized controlled trial.
Level III and II neonatal care units, including the neurosensory care management program.
Very preterm infants (gestational age between 28 and 32 weeks) were randomly assigned by a computer programme to the intervention or control group during a heel-stick procedure within the first 48 h of life. In both groups, infants were placed in an asymmetric position on a cushion; noise and light were limited following routine care. A heel-stick was performed first in the care sequence. In the intervention group, facilitated tucking was performed by a nurse or nursing assistant. The procedure was video recorded from 15 s (T-15 s) before the procedure until three minutes (T + 3 min) after the end of the procedure. Pain was blindly assessed by two independent specialist nurses. The primary outcome was the pain score evaluated 15 s before the procedure and 30 s immediately after by the premature infant pain profile (PIPP) scale. The secondary outcome was the pain score evaluated between T-15 s and T + 3 min by the DAN scale (a French acronym for the acute pain of a newborn).
Sixty infants were included (30 in each group). The PIPP pain scores did not differ between the intervention group (median: 8.0; interquartile range (IQR): 6.0-12.0) and the control group (median: 9.5; IQR: 7.0-13.0, p = 0.32). Pain assessed by the DAN scale at T + 3 min was lower in the intervention group than in the control group (median: 0.3; IQR: 0.0-1.0 and 2.0; IQR: 0.5-3.0, respectively, p = 0.001).
The combined use of facilitated tucking and non-nutritive sucking did not significantly alleviate pain during the heel-stick procedure. However, the addition of facilitated tucking facilitated faster pain recovery following the heel-stick procedure.
在新生儿护理中减轻早产儿的急性疼痛可改善其神经生理发育。每天使用药物和非药物镇痛（如蔗糖）的次数有限，尤其是对于极早产儿。因此，通常单独使用非营养性吸吮。促进襁褓包裹可能是减少疼痛的另一种非营养性吸吮策略。据我们所知，尚无随机试验比较促进襁褓包裹与单独使用非营养性吸吮的效果。
比较促进襁褓包裹联合非营养性吸吮（干预组）与单独使用非营养性吸吮（对照组）在减轻极早产儿足跟采血过程中疼痛的效果。
前瞻性随机对照试验。
包括神经感觉护理管理方案的三级和二级新生儿护理单位。
在生命的头 48 小时内，通过计算机程序将极早产儿（胎龄 28 至 32 周）随机分配到干预组或对照组进行足跟采血。在两组中，婴儿均在软垫上处于不对称位置；按照常规护理限制噪音和光线。足跟采血首先在护理顺序中进行。在干预组中，由护士或护理助理进行促进襁褓包裹。从程序开始前 15 秒（T-15 秒）到程序结束后 3 分钟（T+3 分钟），对该过程进行视频记录。由两名独立的专科护士盲法评估疼痛。主要结局是在程序前 15 秒和程序后 30 秒用早产儿疼痛评分量表（PIPP）评估的疼痛评分。次要结局是在 T-15 秒和 T+3 分钟之间用 DAN 量表（新生急性疼痛的法语缩写）评估的疼痛评分。
共纳入 60 名婴儿（每组 30 名）。干预组（中位数：8.0；四分位距（IQR）：6.0-12.0）和对照组（中位数：9.5；IQR：7.0-13.0，p=0.32）的 PIPP 疼痛评分无差异。干预组在 T+3 分钟时用 DAN 量表评估的疼痛评分低于对照组（中位数：0.3；IQR：0.0-1.0 和 2.0；IQR：0.5-3.0，p=0.001）。
促进襁褓包裹联合非营养性吸吮的使用并未显著减轻足跟采血过程中的疼痛。然而，促进襁褓包裹的添加促进了足跟采血后更快的疼痛恢复。
