Das Rupam, Deshmukh Vikrant, Sohane Arpit, Suryawanshi Pradeep, Deshmukh Rupeshkumar, Malshe Nandini
Department of Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
Front Pediatr. 2025 Sep 5;13:1622357. doi: 10.3389/fped.2025.1622357. eCollection 2025.
Heel-stick procedures for glucose monitoring are common in neonatal intensive care units (NICUs) and can have adverse physiological and developmental effects on preterm neonates. The National Neonatology Forum of India and the American Academy of Pediatrics recommend the routine use of non-pharmacological measures during such procedures. Our study aimed to evaluate the efficacy of expressed breast milk (EBM), facilitated tucking (FT), and their combination in reducing heel stick pain in preterm neonates, as assessed using the Premature Infant Pain Profile (PIPP) score at 1 and 4 min post-procedure.
In this randomized controlled trial, preterm neonates born between 27 and 36 weeks of gestation, who met the eligibility criterion, were randomly allocated into three categories: EBM ( = 56), FT ( = 56), and EBM + FT ( = 56), following approval from the Institutional Ethics Committee and parenteral consent at a tertiary-level NICU in Pune. Neonates were videotaped by a senior resident/clinical fellow for 2 min before and up to 4 min after the heel-stick procedure. Infants' pain was determined using the PIPP score at the time of heel-sticking and at 1 and 4 min post-procedure.
Repeated-measures ANOVA revealed significant reductions in pain scores from baseline (EBM: 8.55 ± 3.19, FT: 8.63 ± 2.83, and EBM + FT: 9.46 ± 2.82; < 0.001) to both 1 min (EBM: 5.68 ± 2.77, FT: 6.39 ± 3.17, and EBM + FT: 6.45 ± 2.87; < 0.001) and 4 min (EBM: 4.05 ± 1.85, FT: 4.66 ± 2.59, and EBM + FT: 4.82 ± 2.39; < 0.001) post-procedure. Bonferroni analyses confirmed significant within-group reductions in pain across all time points.
EBM and FT, whether alone or in combination, are effective in reducing pain in preterm neonates during heel-stick procedures.
https://ctri.nic.in/Clinicaltrials/login.php, identifier [CTRI/2023/09/057787 (Registered on: 18/09/2023)].
足跟采血进行血糖监测在新生儿重症监护病房（NICU）很常见，可能会对早产儿产生不良的生理和发育影响。印度国家新生儿论坛和美国儿科学会建议在此类操作过程中常规使用非药物措施。我们的研究旨在评估挤出的母乳（EBM）、辅助包裹（FT）及其组合在减轻早产儿足跟采血疼痛方面的效果，通过操作后1分钟和4分钟时使用早产儿疼痛量表（PIPP）评分进行评估。
在这项随机对照试验中，符合纳入标准的孕27至36周出生的早产儿，经机构伦理委员会批准并获得浦那一家三级NICU患儿家长同意后，被随机分为三组：EBM组（n = 56）、FT组（n = 56）和EBM + FT组（n = 56）。由一名高级住院医师/临床研究员在足跟采血操作前2分钟至操作后4分钟对新生儿进行录像。在足跟采血时以及操作后1分钟和4分钟使用PIPP评分确定婴儿的疼痛程度。
重复测量方差分析显示，疼痛评分从基线（EBM组：8.55±3.19，FT组：8.63±2.83，EBM + FT组：9.46±2.82；P < 0.001）到操作后1分钟（EBM组：5.68±2.77，FT组：6.39±3.17，EBM + FT组：6.45±2.87；P < 0.001）和4分钟（EBM组：4.05±1.85，FT组：4.66±2.59，EBM + FT组：4.82±2.39；P < 0.001）均有显著降低。Bonferroni分析证实所有时间点各小组内疼痛均显著减轻。
EBM和FT，单独使用或联合使用，在足跟采血操作期间减轻早产儿疼痛方面均有效。
https://ctri.nic.in/Clinicaltrials/login.php，标识符[CTRI/2023/09/057787（注册于：2023年9月18日）]
