title: Non-nutritive sucking and facilitated tucking relieve preterm infant pain during heel-stick procedures: a prospective, randomised controlled crossover trial.
abstract: BACKGROUND
  Preterm infants' repeated exposure to painful procedures may contribute to negative consequences. Thus, improving preterm infants' neurodevelopmental outcomes requires prioritising their pain management.
  
  
  OBJECTIVE
  To compare the effectiveness of two non-pharmacological pain-relief strategies (non-nutritive sucking and facilitated tucking) with routine care on preterm infants' pain, behavioural, and physiological responses before, during, and after heel-stick procedures.
  
  
  METHODS
  Prospective, randomised controlled crossover trial.
  
  
  METHODS
  Level III Neonatal Intensive Care Unit in Taipei.
  
  
  METHODS
  Thirty-four preterm infants (gestational age 29-37 weeks) needing three procedural heel sticks were recruited by convenience sampling and randomly assigned to a sequence of three treatments (two pain-relief interventions and the control condition): (1) routine care, non-nutritive sucking, facilitated tucking, (2) non-nutritive sucking, facilitated tucking, routine care, and (3) facilitated tucking, routine care, non-nutritive sucking. Each treatment condition was performed on a different day to avoid any carry-over effect. Pain was measured by the Premature Infant Pain Profile (PIPP), infant behaviour by a behavioural coding scheme, and physiological signals by electrocardiogram monitors. All data were collected 3 min without stimuli (baseline), during heel-stick procedures, and recovery.
  
  
  RESULTS
  Infants receiving non-nutritive sucking and facilitated tucking had significantly lower mean (standard deviation) pain scores during heel-stick procedures (6.39 [3.35] and 7.15 [3.88], respectively) than those receiving routine care (9.52 [4.95]). Infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.39, p=0.011 and 0.34, p=0.005, respectively) for pain (PIPP score≥6) than infants receiving routine care after adjusting for time, baseline pain scores, and infants' characteristics. Similarly, infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.23, p<0.001 and 0.28, p=0.03, respectively) for moderate-to-severe pain (PIPP score≥12) than infants receiving routine care. Infants receiving facilitated tucking had lower frequency ratios for stress-related behaviours, abnormal heart rates, and decreased oxygen saturation than infants receiving routine care.
  
  
  CONCLUSIONS
  Both non-nutritive sucking and facilitated tucking effectively reduced pain scores more than routine care during heel-stick procedures. Non-nutritive sucking reduced PIPP pain scores more effectively than facilitated tucking. However, facilitated tucking showed broader effects not only on relieving pain, but also on enhancing infants' physiological and behavioural stability during heel-stick procedures.
authors: School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC. jiuan@mail.ndmctsgh.edu.tw
authors: Jen-Jiuan
authors: JJ
authors: Liaw
authors: Luke
authors: L
authors: Yang
authors: Kai-Wei
authors: KW
authors: Katherine Wang
authors: Chin-Mi
authors: CM
authors: Chen
authors: Yue-Cune
authors: YC
authors: Chang
authors: Ti
authors: T
authors: Yin
mesh_terms: D018592:Cross-Over Studies; D006365:Heel; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D059408:Pain Management; D018962:Phlebotomy / Q000009:adverse effects*; D011446:Prospective Studies; D013391:Sucking Behavior