Pain Management During Neonatal Blood Sampling: An Overview of Systematic Reviews

This overview of systematic reviews aimed to identify effective pain management strategies for neonatal blood sampling. Searches were conducted in four databases from 2014 to April 2026. Eligible studies were systematic reviews including randomized or quasi-randomized controlled trials assessing pain management in neonates during blood sampling. Reviews were required to have searched at least two databases within the past 10 years, reported their search strategy, and conducted a risk-of-bias assessment. The search identified 2463 records; 22 reviews (13 Cochrane and two non-Cochrane pairwise reviews, and seven network meta-analyses) met inclusion criteria. Interventions evaluated included opioids, paracetamol, topical anesthetics, breastfeeding or breastmilk, sucrose, music medicine, acupuncture, and other non-pharmacological methods. Sucrose with or without non-nutritive sucking was effective in reducing pain scores during heel pricks in preterm and term neonates (mean difference -1.74, 95% confidence interval [-2.11, -1.37], moderate-certainty). Skin-to-skin contact also reduced pain scores compared with control (mean difference -3.47 [-5.55, -1.38], moderate-certainty). Recent network meta-analyses generally supported parent-led interventions and oral sweet solutions as the most effective strategies. Breastfeeding, supplemental breastmilk, acupuncture, and light reduction were promising but require further evidence. For other interventions, evidence was insufficient to draw conclusions. Evidence from systematic reviews and network meta-analyses indicates that sucrose and skin-to-skin contact effectively reduce procedural pain in neonates. Parent-led and other non-pharmacological interventions, including breastfeeding, also appear beneficial and should increasingly be considered part of family-centred neonatal pain care where feasible.