title: The use of non-nutritive sucking to decrease the physiologic pain response during neonatal circumcision: a randomized controlled trial.
abstract: OBJECTIVE
  The purpose of this research was to study the effects on the physiologic pain response of the neonate during circumcision with the use of a gloved human finger.
  
  
  METHODS
  This was a randomized controlled trial analyzing the effect of non-nutritive sucking (NNS) on pain response during circumcision. Term neonates were randomized to 2 groups. All infants received oral Tylenol and a dorsal penile nerve block (DPNB) before the circumcision. The study group was offered the addition of NNS before the DPNB and throughout the procedure. The primary outcome measured was heart rate during the circumcision. Other variables studied included crying time and salivary cortisol levels. Each circumcision was filmed to calculate pain profile scores using the Premature Infant Pain Profile. Variables were compared using Student t test, chi-square, and Wilcoxon test. A P value of < .05 was considered significant.
  
  
  RESULTS
  Forty-four infants met inclusion criteria. Twenty-two infants were randomized to each arm. No difference in mean heart rate during the procedure was apparent. A significant decrease in crying time, 90-minute post-procedure salivary cortisol level, and post-penile clamping pain score was noted in the study group (all P values < .01).
  
  
  CONCLUSIONS
  NNS significantly decreases some elements of measurable physiologic pain response of the neonate during circumcision. This method is a useful and inexpensive addition to DPNB and oral analgesics.
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, NC 27514, USA. msouth@unch.unc.edu
authors.forename: Mary M T
authors.initials: MM
authors.lastname: South
authors.forename: Robert A
authors.initials: RA
authors.lastname: Strauss
authors.forename: Andrew P
authors.initials: AP
authors.lastname: South
authors.forename: John F
authors.initials: JF
authors.lastname: Boggess
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
mesh_terms: D002944:Circumcision, Male; D003448:Crying; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007231:Infant, Newborn; D008297:Male; D010146:Pain / Q000517:prevention & control*; D012463:Saliva / Q000737:chemistry; D013391:Sucking Behavior
chemical_list: D006854:Hydrocortisone