Related Experiment Video
Updated: Jun 24, 2025
A Preterm Rat Model for Pain Studies
Published on: February 9, 2024
Effectiveness of non-pharmacological interventions in reducing pain in preterm infants: A systematic review and
Tainá Costa Pereira Lopes1, Alexia Gabriela da Silva Vieira2, Sarah Almeida Cordeiro1
1Program in Health Sciences (PPGCIS), Faculty of Medicine, Federal University of Amazonas, UFAM, Brazil.
Insights
Non-pharmacological interventions effectively manage pain in preterm infants within the Neonatal Intensive Care Unit (NICU). This systematic review identifies sensory saturation, sugars, and skin-to-skin contact as top choices for pain control.
Area of Science:
- Neonatal care
- Pain management
- Evidence-based practice
Background:
- Preterm infants in the Neonatal Intensive Care Unit (NICU) experience significant pain.
- Effective pain management is crucial for infant well-being and development.
- Non-pharmacological measures offer a promising alternative or adjunct to pharmacological interventions.
Purpose of the Study:
- To systematically review and compare the effectiveness of various non-pharmacological interventions for pain control in preterm infants.
- To identify the most effective non-pharmacological measures for clinical decision-making in the NICU.
Main Methods:
- A systematic review and network meta-analysis of randomized clinical trials (RCTs) published between April 2020 and December 2023.
- Searched multiple databases including MedLine, LILACS, EMBASE, and Cochrane.
- Assessed risk of bias, certainty of evidence, and heterogeneity using established methodologies (Rob 2, GRADE, I² test).
Main Results:
- Twelve studies involving 961 preterm infants were analyzed, with ten studies included in the network meta-analysis (716 infants).
- Several non-pharmacological measures demonstrated significant pain reduction compared to control groups.
- Sensory saturation, sugars, non-nutritive sucking, maternal heart sound, lullaby, breast milk odor/taste, magnetic acupuncture, skin-to-skin contact, and facilitated tucking were effective.
Conclusions:
- Non-pharmacological measures are strongly recommended for managing pain in preterm infants in the NICU.
- This review provides a comparative analysis to guide the selection of the most effective non-pharmacological pain management strategies.
- Findings support the integration of these interventions into clinical practice and policy for improved infant care.
Objective:
To identify the most effective non-pharmacological measures for pain control in preterm infants in the Neonatal Intensive Care Unit (NICU).
Methods:
A Systematic review and network meta-analysis of randomized clinical trials published in English, Portuguese, and Spanish from April 2020 to December 2023. The data sources used were MedLine via PubMed, LILACS, EMBASE, The Cochrane Central Register of Controlled Trials, and Pedro. We performed the risk of bias analysis with Rob 2 and the certainty of the evidence and strength of the recommendation using the Grading of Recommendations Assessment, Development, and Evaluation system. We assessed heterogeneity using the Higgins and Thompson I2 test, the classification of interventions using the P-score, and inconsistencies using the Direct Evidence Plot.
Results:
From 210 publications identified, we utilized 12 studies in analysis with 961 preterm infants, and we combined ten studies in network meta-analysis with 716 preterm infants, and 12 combinations of non-pharmacological measures. With moderate confidence, sensory saturation, sugars, non-nutritive sucking, maternal heart sound, lullaby, breast milk odor/taste, magnetic acupuncture, skin-to-skin contact, and facilitated tucking have been shown to reduce pain in preterm infants when compared to no intervention, placebo, proparacaine or standard NICU routine: sensory saturation [SMD 5,25 IC 95%: -8,98; -1,53], sugars [SMD 2,32 IC 95%: -3,86; -0,79], pacifier [SMD 3,74 IC 95%: -7,30; 0,19], and sugars and pacifier SMD [3,88 IC 95% -7,72; -0,04].
Conclusion:
Non-pharmacological measures are strongly recommended for pain management in preterm infants in the NICU.
Implications For Clinical Practice:
The findings of this study have important implications for policy and practice. This is the only systematic review that compared the effectiveness of non-pharmacological measures, thus making it possible to identify which measure presents the best results and could be the first choice in clinical decision making.
