Effects of combined use of non-nutritive sucking, oral sucrose, and facilitated tucking on infant behavioural states across heel-stick procedures: a prospective, randomised controlled trial.
BACKGROUND
Pain and stress agitate preterm infants, interrupting their sleep. Frequent high arousal states may affect infants' brain development and illness recovery. Preserving infants' sleep and relieving their pain during painful procedures are both important for their health.


OBJECTIVE
To compare the effectiveness of different combinations of non-nutritive sucking (sucking), oral sucrose, and facilitated tucking (tucking) with routine care on infants' sleep-wake states before, during, and after heel-stick procedures.


METHODS
Prospective, randomised controlled trial.


METHODS
Level III Neonatal Intensive Care Unit in Taipei.


METHODS
A convenience sample of 110 infants (gestational age 26.4-37 weeks) needing heel sticks were randomly assigned to five combinations of non-pharmacological treatments: sucking-oral sucrose-tucking; sucking-oral sucrose; oral sucrose-tucking; sucking-tucking; and routine care. Infant states, measured by a state-coding scheme, included quiet sleep, active sleep, transition, quiet awake, active awake, and fussing or crying. All states were recorded at 1-min intervals during four phases: baseline, intervention, heel-stick procedures, and recovery.


RESULTS
Infants receiving sucking-oral sucrose-tucking or sucking-oral sucrose experienced 52.8% (p=0.023) and 42.6% (p=0.063) more quiet-sleep occurrences than those receiving routine care after adjusting for phase, baseline states, non-treatment sucking during baseline and recovery, positioning, and infants' characteristics. Infants receiving oral sucrose-tucking, sucking-oral sucrose, sucking-oral sucrose-tucking, and sucking-tucking experienced 77.3% (p<0.001), 72.1% (p=0.008), 51.5% (p=0.017), and 33.0% (p=0.105) fewer occurrences of fussing or crying, respectively, than those receiving routine care after adjusting for related factors.


CONCLUSIONS
The four treatment combinations differentially reduced infants' high arousal across heel-stick procedures. The combined use of oral sucrose-tucking, sucking-oral sucrose, and sucking-oral sucrose-tucking more effectively reduced occurrences of infant fussing or crying than routine care. Treatment combinations of sucking-oral sucrose-tucking and sucking-oral sucrose also better facilitated infants' sleep than routine care. To preserve infants' sleep, clinicians should use combinations of non-nutritive sucking, oral sucrose, and facilitated tucking to reduce agitation during painful procedures.
School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC. jiuan@mail.ndmctsgh.edu.tw
Jen-Jiuan
JJ
Liaw
Luke
L
Yang
Chuen-Ming
CM
Lee
Hueng-Chuen
HC
Fan
Yue-Cune
YC
Chang
Li-Ping
LP
Cheng
D001800:Blood Specimen Collection / Q000009:adverse effects / Q000379:methods*; D006365:Heel; D006801:Humans; D018730:Infant Behavior; D007231:Infant, Newborn; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods; D011446:Prospective Studies; D012890:Sleep; D013391:Sucking Behavior; D013395:Sucrose / Q000008:administration & dosage*; D013624:Taiwan; D014851:Wakefulness
D013395:Sucrose