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Non-nutritive sucking and facilitated tucking relieve preterm infant pain during heel-stick procedures: a
Jen-Jiuan Liaw1, Luke Yang, Kai-Wei Katherine Wang
1School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC. jiuan@mail.ndmctsgh.edu.tw
Insights
Non-pharmacological pain relief, including non-nutritive sucking and facilitated tucking, significantly reduces pain in preterm infants during heel-stick procedures. Facilitated tucking offers broader benefits for physiological and behavioral stability.
Area of Science:
- Neonatal care and pain management.
- Developmental pediatrics.
- Evidence-based nursing interventions.
Background:
- Repeated painful procedures in preterm infants can negatively impact neurodevelopmental outcomes.
- Effective pain management is crucial for improving the long-term health of preterm infants.
- Non-pharmacological strategies are increasingly explored for pain relief in neonates.
Purpose of the Study:
- To compare the efficacy of non-nutritive sucking and facilitated tucking against routine care for pain management in preterm infants.
- To assess the impact of these interventions on infant pain, behavioral, and physiological responses during heel-stick procedures.
Main Methods:
- A prospective, randomized controlled crossover trial was conducted in a Level III Neonatal Intensive Care Unit.
- Thirty-four preterm infants (29-37 weeks gestational age) underwent three heel-stick procedures, each with a different treatment: routine care, non-nutritive sucking, or facilitated tucking.
- Pain was assessed using the Premature Infant Pain Profile (PIPP), alongside behavioral coding and electrocardiogram monitoring for physiological responses.
Main Results:
- Both non-nutritive sucking and facilitated tucking resulted in significantly lower pain scores during heel-stick procedures compared to routine care.
- Non-nutritive sucking and facilitated tucking showed significantly lower odds of pain (PIPP score ≥6) and moderate-to-severe pain (PIPP score ≥12) than routine care.
- Facilitated tucking demonstrated a lower frequency of stress-related behaviors, abnormal heart rates, and decreased oxygen saturation compared to routine care.
Conclusions:
- Non-nutritive sucking and facilitated tucking are effective non-pharmacological methods for reducing procedural pain in preterm infants.
- Non-nutritive sucking was more effective in reducing PIPP pain scores than facilitated tucking.
- Facilitated tucking provided additional benefits by enhancing infants' physiological and behavioral stability during painful procedures.
Background:
Preterm infants' repeated exposure to painful procedures may contribute to negative consequences. Thus, improving preterm infants' neurodevelopmental outcomes requires prioritising their pain management.
Objectives:
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.
Design:
Prospective, randomised controlled crossover trial.
Setting:
Level III Neonatal Intensive Care Unit in Taipei.
Method:
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.
