Comparing the Effect of Breast-Milk and Leg Massage on Neonate’s Pain ‎Intensity during Heel-Blood Sampling in Neonatal Care Unit

Abstract

Introduction: Prevention and management of pain is one of the major challenges in the neonate intensive care units. The aim of this study was to evaluate the effect of breast-milk and leg massage on the intensity pain from painful procedures such as heel stick.
 Methods: This study was a randomized clinical trial aimed to compare the effect of breast-milk and leg massage on neonate’s pain intensity during heel-blood sampling in neonatal care unit of Tehran Fayazbakhsh Hospital, Iran in 2016. Neonates were divided into two groups of 15, based on randomly number schedule. In the first group, first massage, then heel stick was performed, after 12 hours of wash out period, breast feeding intervention was performed and then blood sampling was done from the other heel. In the second group, the intervention group, the action had done opposite. The neonates were laid in the supine or lateral position, at the same time as bleeding was started, filming of the faces and organs of the infant was carried out by a researcher's colleague and it continued only two minutes after the bleeding was completed.Videos were viewed by two senior specialist babies and the pain intensity was determined based on the NIPS scale. The data were fed into the SPSS 20 software and descriptive and analytic statistics were applied for data analysis.
 Results: The mean of the statistical Wilcoxon signed Ranks Test showed that there was a significant difference for pain score during (p<0/001), and after the intervention of each of the two groups (p<0/0001).
 Conclusion: Based on the result of study, nurses can use leg massage to decrease the pain during painful procedures relevant to newborns instead of breast-milk.

Massage for pain relief in newborns submitted to puncture: systematic review

“…From the 12 records included in this review, 11 are randomized clinical trials (24)(25)(27)(28)(29)(30)(31)(32)(33)(34)(35) , and one is characterized as a non-randomized clinical trial (26) , with a total of 981 participants and the age ranged between 24 hours of life and 42 weeks of Gestational age (GA). The characteristics of the study are summarized in Chart 2 (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) .…”

“…As for the intervention technique, four (33.3%) studies reported the application of light to moderate pressure massage (26)(27)(28)30) and eight (66.6%) did not specify the pressure used during the massage (24)(25)29,(31)(32)(33)(34)(35) . Regarding the application time, six (50%) studies performed the massage for 2 minutes; three (25%) for 3 minutes; one (8.3%) for 1 minute; one (8.3%) for 10 minutes; and one (8.3%) for 30 minutes.…”

“…Furthermore, other studies have also compared the effectiveness of massage application in relation to other techniques used to relieve neonatal pain, such as massage with non-nutritive suction and control (30) ; acupressure with the control group (31) ; massage, non-nutritive suction, swinging, 20% sucrose, distilled water and breast milk (29) ; massage with breast milk (34) ; massage, maternal hug and control group (33) ; massage, breastfeeding and control group (35) . The authors of this study identified the effectiveness of massage over other techniques (or control group) in 83.3% of the studies.…”

“…Therefore, three instruments were used by the researchers to assess the response to pain felt by newborns. Among them, the most dominant scale in the studies was the Neonatal Infant Pain Scale (NIPS), present in seven (58.3%) articles (24,28,(31)(32)(33)(34)(35) . The Premature Infant Pain Profile (PIPP) scale was used in four (33.3%) studies (25)(26)(27)30) , and the Douleur Aiguë du Nouveau-né (DAN) scale was used in one (8.3%) study (29) .…”

“…In addition, an experimental study also reinforces that massage ensures benefits in the physiological scope, ensuring less hospitalization time and the number of mortalities (39) . Therefore, it was observed a prevalence of positive results of massage regarding pain relief and reduction of crying time in newborns compared to certain non-pharmacological procedures applied when submitted to puncture, having significant results for the normality of vital signs and SpO2, enabling consistency for clinical practice, promoting quality of life for patients (24)(25)(26)(27)(28)(30)(31)(32)(34)(35) .…”