title: Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: A randomized clinical trial.
abstract: Non-pharmacological interventions are effective neonatal pain reduction strategies. We aimed to study the effects of non-nutritive sucking (NNS) and swaddling on infants' behavioural and physiological parameters during shallow or deep heel stick procedures.
  
  
  
  In this prospective, multi-centred, randomized controlled clinical trial, we enrolled 671 newborns. The infants undergoing shallow or deep heel stick procedures were randomized into four groups: oral sucrose (routine care, group S), oral sucrose combined with NNS (group NS), oral sucrose combined with swaddling (group SS) and oral sucrose combined with NNS and swaddling (group NSS). The behavioural responses were evaluated by the Revised Neonatal Facial Coding System and the physiological signals were monitored by electrocardiogram monitors.
  
  
  
  A significant synergistic analgesic effect was observed between the NS and SS groups in both the shallow (F = 5.952, p = 0.015) and deep heel stick (F = 7.452, p = 0.007) procedure. NSS group exhibited the lowest pain score. For the deep heel stick procedure, the NS group had a significantly lower increase in heart rate (HR)% and decrease in SPO2 % than the S group (F = 17.540, p = 0.000, F = 10.472, p = 0.001), while this difference was not observed in the shallow heel stick procedure. No difference was found between the S and SS groups, in terms of different physiological parameters.
  
  
  
  Non-nutritive sucking and swaddling had synergistic effects on pain relief when used with oral sucrose. For the deep heel stick procedure, oral sucrose combined with NNS and swaddling provided the best pain relief effect. For the shallow heel stick procedure, addition of NNS and swaddling did not improve the effects.
authors.affiliation: Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Leng
authors.affiliation: Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China.
authors.forename: X-L
authors.initials: XL
authors.lastname: Zheng
authors.affiliation: Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China.
authors.forename: X-H
authors.initials: XH
authors.lastname: Zhang
authors.affiliation: Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China.
authors.forename: H-Y
authors.initials: HY
authors.lastname: He
authors.affiliation: Department of Nursing, Chengdu Women's & Children's Central Hospital, Chengdu City, China.
authors.forename: G-F
authors.initials: GF
authors.lastname: Tu
authors.affiliation: Department of Nursing, Shenzhen Children's Hosptial, Shenzhen City, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Fu
authors.affiliation: Department of Nursing, Hunan Children's Hosptial, Changsha City, China.
authors.forename: S-N
authors.initials: SN
authors.lastname: Shi
authors.affiliation: Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China.
authors.forename: L
authors.initials: L
authors.lastname: Yan
mesh_terms: D001800:Blood Specimen Collection / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate; D006801:Humans; D018730:Infant Behavior; D007224:Infant Care; D007231:Infant, Newborn; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D000073818:Procedural Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D013391:Sucking Behavior; D013395:Sucrose / Q000627:therapeutic use; D013549:Sweetening Agents / Q000627:therapeutic use
chemical_list: D013549:Sweetening Agents; D013395:Sucrose