Neonatal Intensive Care Unit, Kovai Medical Center and Hospital (KMCH), Coimbatore, Tamil Nadu, India.
Ankura Hospital for Women and Children, Hyderabad, Telangana, India.
Indian Pediatr. 2024 Sep 15;61(9):851-875. Epub 2024 Aug 26.
Heel prick is one among the common painful procedures in neonates. We performed a systematic review and network meta-analysis (NMA) to compare the efficacy of different interventions for analgesia during heel prick in neonates.
Medline, Cochrane, Embase and CINAHL databases were searched from inception until February 2023. Randomized and quasi-randomized trials that evaluated different pharmacological and non-pharmacological interventions for analgesia during heel prick for neonates were included. Data from the included trials were extracted in duplicate. A NMA with a frequentist random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. We adhered to the PRISMA-NMA guidelines.
One-hundred-and-three trials comparing 51 different analgesic measures were included. Among the 38 interventions, for pain "during" heel prick, non-nutritive suckling (NNS) plus sucrose [SMD -3.15 (-2.62, -3.69)], followed by breastfeeding, glucose, expressed breast milk (EBM), sucrose, NNS and touch massage, had a high certainty of evidence (CoE) to reduce pain scores when compared to no intervention. Among the 23 interventions for pain at 30 seconds after heel-prick, moderate CoE was noted for facilitated tucking plus NNS plus music, glucose, NNS plus sucrose, sucrose plus swaddling, mother holding, EBM, sucrose and NNS.
Oral sucrose 2 minutes before combined with NNS during the procedure, was the best intervention for reducing pain during heel prick. It also effectively reduced pain scores 30 seconds and 1 minute after the procedure. Other interventions with moderate to high CoE for a significant reduction in pain during and at 30 seconds after heel prick are oral sucrose, oral glucose, EBM and NNS. All these are low-cost and feasible interventions for most of the settings.
足跟采血是新生儿常见的疼痛操作之一。我们进行了系统评价和网络荟萃分析（NMA），以比较不同干预措施在足跟采血时镇痛的效果。
从建库到 2023 年 2 月，检索了 Medline、Cochrane、Embase 和 CINAHL 数据库。纳入了评估新生儿足跟采血时使用不同药物和非药物干预措施镇痛的随机和半随机试验。对纳入试验的数据进行了重复提取。使用具有固定效应模型的 NMA 进行数据综合。使用 GRADE 评估证据确定性（CoE）。我们遵循 PRISMA-NMA 指南。
共纳入了 103 项比较 51 种不同镇痛措施的试验。在 38 种干预措施中，对于足跟采血时的疼痛，非营养性吸吮（NNS）加蔗糖[SMD-3.15（-2.62，-3.69）]，其次是母乳喂养、葡萄糖、母乳挤出（EBM）、蔗糖、NNS 和触摸按摩，与不干预相比，具有较高的证据确定性（CoE）可以降低疼痛评分。在 23 种足跟采血后 30 秒疼痛的干预措施中，发现辅助襁褓加 NNS 加音乐、葡萄糖、NNS 加蔗糖、蔗糖加襁褓、母亲怀抱、EBM、蔗糖和 NNS 的 CoE 为中等。
在操作过程中，2 分钟前口服蔗糖结合 NNS 是减轻足跟采血时疼痛的最佳干预措施。它还能有效降低操作后 30 秒和 1 分钟的疼痛评分。对于足跟采血时和足跟采血后 30 秒疼痛的显著降低，其他具有中等到高 CoE 的干预措施还有口服蔗糖、口服葡萄糖、EBM 和 NNS。所有这些干预措施都是低成本且可行的，适用于大多数环境。
