Efficacy of Heel Warming on Pain Response to Heel Stick in Neonates

Abstract


 
 
 
 Introduction: Heel prick is one of the commonest procedures carried out in the hospitalised newborns. Pain is a subjective experience for which the neonates, infants and children respond with behavioural reactions. Applying hot pack to the skin surface causes proximal blood vessels to dilate due to the raised temperature which may decrease the pain perception in neonates. We intended to study the effect of heel warming during heel prick in perception of pain in neonates.
 Method: An experimental study was conducted among neonates admitted in paediatric wards of BPKIHS. Total 92 participants undergoing heel prick/stick were selected by consecutive sampling technique and allocated randomly to experimental group and control group. Warmer was applied to the heel of the baby for three to five minutes which provided the baby’s heel with the warmth of 38°C to 40°C prior to heel stick in experimental group only. Newborn’s pain level was assessed in both experimental and control group through The Neonatal Infant Pain Scale (NIPS). Mann Whitney test was used to compare means of pain score between experimental and control groups.
 Results: The mean pain score among experimental group was 1.39 and in control group was 2.20. Experimental group showed significantly lower pain (p < 0.001) compared to the control group. Application of warmth before heel stick caused reduction in pain.
 Conclusions: The findings suggest that heat application prior to heel stick is effective in reducing pain in newborns.
 
 
 

Indications, Measurements, and Complications of Ten Essential Neonatal Procedures

“…However, capillary heel sampling is not recommended for analysis of blood culture, coagulation profile and for tests requiring samples of blood more than 1 ml [188][189][190][191]. The heel stick is described as one of the painful procedures to the newborns [192]. Multiple interventions have been described in the literature to reduce heel stickassociated pain such as breast feeding during the procedure [193], skin-to-skin positioning before and during a heel stick [194], swaddling and heel warming prior to the puncture [192,195], gentle massage of the leg before the heel stick [196], mechanical vibration [197], use of sucrose [198], and facilitated tucking and oral dextrose [199].…”

Effect of Heel Warming with a Thermofor at Two Different Temperatures Before Heel Stick Sampling in Healthy Term Neonates on Total Crying and Procedure Durations: A Randomized Controlled Trial

“…When studies are investigated, it appears there is no consensus between researchers about heel warming. When the literature is further examined, studies reporting advantages of heel warming appear to have been completed with tools providing heel warming with warm (34-37 ºC) or hot (38-40 ºC) temperatures before heel stick sampling (5,14,17,23). In the literature, there is no study comparing the effect of heel warming with a thermofor using warm (34-37 ºC) and hot (38-40 ºC) temperatures on total crying and procedure durations.…”