title: Effect of foremilk and hindmilk on simple procedural pain in newborns.
abstract: BACKGROUND
  Infants are exposed to painful stimuli during routine medical care in the first few days of life. The aim of the present study was to compare the effect of foremilk; hindmilk, which has been known to have more fat content than foremilk; and sterile water in reducing pain in newborns undergoing minor painful procedures.
  
  
  METHODS
  Sixty-two healthy term infants requiring a heel prick blood sample for screening tests were randomly allocated to receive 2 mL of foremilk, hindmilk or sterile water. Median crying time, duration of the first cry, percent change in heart rate, maximum heart rate and neonatal facial coding system scores were recorded to assess the infants' response to pain.
  
  
  RESULTS
  Statistically significant differences between the three groups were not found in terms of crying time, duration of the first cry, percent change in heart rate or maximum heart rate (P = 0.19, P = 0.08, P = 0.22 and P = 0.91, respectively). When the mean pain scores of the groups were compared at 0, 1, 2 and 3 min, there was no statistically significant difference between the three groups (P = 0.58, P = 0.55, P = 0.58 and P = 0.84 for 0, 1, 2 and 3 min, respectively).
  
  
  CONCLUSIONS
  Although hindmilk has a minor superiority in terms of crying time, duration of the first cry and percent change in heart rate, it does not reach statistical significance. It is concluded that neither foremilk nor hindmilk is superior in relieving pain when compared to placebo.
authors.affiliation: Department of Pediatrics, Marmara University Hospital, Istanbul, Turkey.
authors.forename: Zeynep Seda
authors.initials: ZS
authors.lastname: Uyan
authors.forename: Eren
authors.initials: E
authors.lastname: Ozek
authors.forename: Hülya
authors.initials: H
authors.lastname: Bilgen
authors.forename: Dilsat
authors.initials: D
authors.lastname: Cebeci
authors.forename: Ipek
authors.initials: I
authors.lastname: Akman
mesh_terms: D001800:Blood Specimen Collection; D003448:Crying; D005260:Female; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn / Q000502:physiology*; D008055:Lipids / Q000032:analysis; D008297:Male; D008895:Milk, Human / Q000737:chemistry*; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors; D014867:Water / Q000008:administration & dosage
chemical_list: D008055:Lipids; D014867:Water