García-Valdivieso Inmaculada, Sánchez-Infante Jorge, Pando Cerra Pablo, Yáñez-Araque Benito, Hernández-Iglesias Sonsoles, Peña Cambón Fernando, Álvarez-Bueno Celia, Checa Peñalver Abel, Pérez-Pozuelo Juan Manuel, Gómez-Cantarino Sagrario
Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, 45071, Spain.
Faculty of Health Sciences, Francisco de Vitoria University, Madrid, 28223, Spain.
BMC Pediatr. 2025 Mar 28;25(1):243. doi: 10.1186/s12887-025-05577-w.
In the history of Neonatology, decades ago pain has been little studied because it was believed that newborns didn't have the capacity to experience pain. Nowadays, there is enough evidence for the existence of neonatal pain but its adequate treatment is an aspect that is continuously evolving. The objective of this study was to evaluate the effectiveness of non-pharmacological analgesia therapies used to alleviate pain in newborns by analysing neonatal cortisol levels as biological markers of pain.
A systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the Cochrane Collaboration Handbook. Searches were performed in databases such as PubMed, Web of Science, Scopus, CINAHL, Cochrane Library and Science Direct until the end of May 2024. The search identified 1075 articles, of which 10 studies met the inclusion criteria and had the necessary data to develop the meta-analysis. Furthermore, in each meta-analysis, subgroups were performed: non-pharmacological analgesia vs. placebo, and pre-post intervention by gestational age.
The meta-analysis found that breastfeeding exhibited a moderate effect size (SMD = -0.63; 95% CI = -1.07 to -0.19), sucrose showed a small effect (SMD = -0.15; 95% CI = -0.55 to 0.26), and skin to skin contact exhibited a large effect (SMD = -1.34; 95% CI = -2.21 to -0.46). Patients under 28 weeks have less post-intervention pain and showed a large effect (SMD = 1.44; 95% CI = 0.47 to 2.40), between 28 and 32 weeks they have more post-intervention pain and presented a small effect (SMD = -0.43; 95% CI = -0.86 to -0.0), and over 32 weeks they have an increased post-intervention pain and exhibited a large effect (SMD = -1.08; 95% CI = -1.65 to -0.51).
Non-pharmacological therapies showed efficacy in pain reduction based on neonatal cortisol levels. Skin to skin contact is the most effective method to reduce pain from invasive procedures, such as heel pricks in preterm infants under 28 weeks. Breastfeeding also demonstrated to be an effective and safe alternative to use for pain relief and to reduce cortisol levels. However, the cortisol results indicate that sucrose was not effective in reducing neonatal pain.
PROSPERO: CRD42023463831.
在新生儿学的历史中，几十年前疼痛很少被研究，因为人们认为新生儿没有体验疼痛的能力。如今，有足够的证据证明新生儿疼痛的存在，但其适当的治疗是一个不断发展的方面。本研究的目的是通过分析新生儿皮质醇水平作为疼痛的生物学标志物，评估用于减轻新生儿疼痛的非药物镇痛疗法的有效性。
按照系统评价和Meta分析的首选报告项目（PRISMA）以及Cochrane协作手册进行系统评价和Meta分析。在PubMed、科学网、Scopus、护理学与健康领域数据库、Cochrane图书馆和科学Direct等数据库中进行检索，直至2024年5月底。检索共识别出1075篇文章，其中10项研究符合纳入标准并拥有进行Meta分析所需的数据。此外，在每项Meta分析中，还进行了亚组分析：非药物镇痛与安慰剂对比，以及按胎龄进行干预前后对比。
Meta分析发现，母乳喂养显示出中等效应量（标准化均数差[SMD]= -0.63；95%置信区间[CI]= -1.07至-0.19），蔗糖显示出小效应（SMD= -0.15；95% CI= -0.55至0.26），皮肤接触显示出大效应（SMD= -1.34；95% CI= -2.21至-0.46）。28周以下的患者干预后疼痛较轻，显示出大效应（SMD= 1.44；95% CI= 0.47至2.40），28至32周之间的患者干预后疼痛较重，显示出小效应（SMD= -0.43；95% CI= -0.86至-0.0），32周以上的患者干预后疼痛增加，显示出大效应（SMD= -1.08；95% CI= -1.65至-0.51）。
基于新生儿皮质醇水平，非药物疗法在减轻疼痛方面显示出疗效。皮肤接触是减轻侵入性操作（如28周以下早产儿足跟采血）疼痛的最有效方法。母乳喂养也被证明是一种有效且安全的减轻疼痛和降低皮质醇水平的替代方法。然而，皮质醇结果表明蔗糖在减轻新生儿疼痛方面无效。
国际前瞻性系统评价注册库（PROSPERO）：CRD42023463831。
