Effectiveness of various nonpharmacological analgesic methods in newborns

Abstract

Background: Pain during the developmental period may ad versely affect developing neuronal pathways and result in adverse neurodevelopmental, cognitive, and behavioral effects in later life. Immunizations, e.g., hepatitis B vaccine (HBV), administered at birth are painful experiences to which neonates are universally subjected. Purpose: Here we aimed to study and compare the effective ness of various nonpharmacological pain management methods in newborns to enable the development of safe and effective analgesic methods for newborns. Methods: This prospective study was conducted at a tertiary care hospital in the Himalayan region. Three hundred term healthy neonates were divided into 6 groups of 50 each. Groups 1-5 were intervention groups, patients of which received a nonpharmacological intervention (breastfeeding, nonnutritive sucking, rocking, 25% sucrose, or distilled water) before the intramuscular HBV, while patients in group 6 received no inter vention. The pain response in each group after the HBV injec tion was assessed and compared using cry duration and Douleur Aigue Nveaune (DAN) score, a behavioral acute pain rating scale for newborns. Results: Cry duration was decreased in all intervention groups, significantly so in the sucrose (19.90 seconds), breastfeeding (31.57 seconds), and nonnutritive sucking (36.93 seconds) groups compared with controls (52.86 seconds). DAN scores decreased significantly (P<0.05) at one or more points i.e. 30, 60, or 120 seconds in the breastfeeding and 25% sucrose intervention groups compared with controls. Conclusion: Oral sucrose and nonnutritive sucking are simple yet underutilized nonpharmacological interventions that effec tively reduce pain in newborns.

State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review

“…Parents' role in the pain experience of older children has received considerable attention (11), but previous research has shown little interest in NICU parents' expectations about their infant's pain (8). Parents have consistently stated in studies that they wish to remain with their infant during painful procedures, but they feel unsupported in taking an active role (e.g., 8,16,54,58). Being present when staff provides pain management and being actively involved in delivering the pain relief are two separate things with distinct outcomes in efficacy (Tables 1, 7, 8).…”

Predicting Who Receives Nonpharmacologic Pain Interventions in the Pediatric Intensive Care Unit

“…Bohr, E. Ely, K.S. ( Cruz et al, 2016 ;Hatfield et al, 2019 ;Kumar et al, 2020 ), accounted for less than 15% of interventions documented. Yet in this sample, patients received a median of 7 (interquartile range, 2-15) painful procedures during the 24hour timeframe of the study .…”

“…In the present study, more than half of the patients were less than 2 years of age. Therefore, we would anticipate greater use of evidence-based nonpharmacologic pain interventions for children in this age group such as oral sucrose, nonnutritive sucking, swaddling, and comforting touch ( Cruz et al, 2016 ;Hatfield et al, 2019;Kumar et al, 2020 ). For older children, techniques such as preprocedural preparation, massage, and distraction, including use of virtual reality, have demonstrated efficacy in reducing child distress during procedures ( McCarthy et al, 2010 ;McCarthy et al, 2014 ;Staveski et al, 2018 ;Won et al, 2017 ).…”

Prevention and management of pain in the neonatal intensive care unit

“…Kumar et al 6) investigated and compared the effectiveness of various nonpharmacological methods of analgesia in newborns in a prospective study conducted at a tertiary care hospital. Three hundred healthy term neonates were divided into 6 groups of 50 newborns each.…”

“…All patients subsequently received an intramuscular hepatitis B vaccine injection. Interestingly, in contrast to most other studies, Kumar et al 6) considered sucrose a nonpharmacological method of intervention, reporting that when breastfeeding is unavailable, other methods such as 25% sucrose or nonnutritive sucking can be employed in the pain management of newborns.…”