Comparative Efficacy of Interventions for Analgesia During Heel Prick in Newborn Infants - A Systematic Review and Network Meta-Analysis.
Study Goal
The researchers aimed to compare the efficacy of various interventions, including touch massage, for reducing pain during and after heel prick procedures in neonates.
Results Summary
Touch massage was among the interventions with high certainty of evidence for reducing pain scores during heel prick, though it was less effective than non-nutritive suckling plus sucrose or breastfeeding.
Population
Neonates undergoing heel prick procedures.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
non-nutritive suckling (NNS) plus sucrose | decrease | pain during heel prick | neonates | SMD -3.15 (-2.62, -3.69) | had a high certainty of evidence (CoE) to reduce pain scores | #1 |
breastfeeding | decrease | pain during heel prick | neonates | - | had a high certainty of evidence (CoE) to reduce pain scores | #2 |
glucose | decrease | pain during heel prick | neonates | - | had a high certainty of evidence (CoE) to reduce pain scores | #3 |
expressed breast milk (EBM) | decrease | pain during heel prick | neonates | - | had a high certainty of evidence (CoE) to reduce pain scores | #4 |
sucrose | decrease | pain during heel prick | neonates | - | had a high certainty of evidence (CoE) to reduce pain scores | #5 |
non-nutritive suckling (NNS) | decrease | pain during heel prick | neonates | - | had a high certainty of evidence (CoE) to reduce pain scores | #6 |
touch massage | decrease | pain during heel prick | neonates | - | had a high certainty of evidence (CoE) to reduce pain scores | #7 |
facilitated tucking plus NNS plus music | decrease | pain at 30 seconds after heel-prick | neonates | - | moderate CoE was noted | #8 |
glucose | decrease | pain at 30 seconds after heel-prick | neonates | - | moderate CoE was noted | #9 |
NNS plus sucrose | decrease | pain at 30 seconds after heel-prick | neonates | - | moderate CoE was noted | #10 |
sucrose plus swaddling | decrease | pain at 30 seconds after heel-prick | neonates | - | moderate CoE was noted | #11 |
mother holding | decrease | pain at 30 seconds after heel-prick | neonates | - | moderate CoE was noted | #12 |
expressed breast milk (EBM) | decrease | pain at 30 seconds after heel-prick | neonates | - | moderate CoE was noted | #13 |
sucrose | decrease | pain at 30 seconds after heel-prick | neonates | - | moderate CoE was noted | #14 |
non-nutritive suckling (NNS) | decrease | pain at 30 seconds after heel-prick | neonates | - | moderate CoE was noted | #15 |
Oral sucrose 2 minutes before combined with NNS during the procedure | decrease | pain during heel prick | neonates | - | was the best intervention for reducing pain | #16 |
Oral sucrose 2 minutes before combined with NNS during the procedure | decrease | pain 30 seconds after the procedure | neonates | - | effectively reduced pain scores | #17 |
Oral sucrose 2 minutes before combined with NNS during the procedure | decrease | pain 1 minute after the procedure | neonates | - | effectively reduced pain scores | #18 |
oral sucrose | decrease | pain during heel prick | neonates | - | moderate to high CoE for a significant reduction in pain | #19 |
oral sucrose | decrease | pain at 30 seconds after heel prick | neonates | - | moderate to high CoE for a significant reduction in pain | #20 |
oral glucose | decrease | pain during heel prick | neonates | - | moderate to high CoE for a significant reduction in pain | #21 |
oral glucose | decrease | pain at 30 seconds after heel prick | neonates | - | moderate to high CoE for a significant reduction in pain | #22 |
expressed breast milk (EBM) | decrease | pain during heel prick | neonates | - | moderate to high CoE for a significant reduction in pain | #23 |
expressed breast milk (EBM) | decrease | pain at 30 seconds after heel prick | neonates | - | moderate to high CoE for a significant reduction in pain | #24 |
non-nutritive suckling (NNS) | decrease | pain during heel prick | neonates | - | moderate to high CoE for a significant reduction in pain | #25 |
non-nutritive suckling (NNS) | decrease | pain at 30 seconds after heel prick | neonates | - | moderate to high CoE for a significant reduction in pain | #26 |
CONTEXT: Heel prick is one among the common painful procedures in neonates. We performed a systematic review and network meta-analysis (NMA) to compare the efficacy of different interventions for analgesia during heel prick in neonates. EVIDENCE ACQUISITION: Medline, Cochrane, Embase and CINAHL databases were searched from inception until February 2023. Randomized and quasi-randomized trials that evaluated different pharmacological and non-pharmacological interventions for analgesia during heel prick for neonates were included. Data from the included trials were extracted in duplicate. A NMA with a frequentist random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. We adhered to the PRISMA-NMA guidelines. RESULTS: One-hundred-and-three trials comparing 51 different analgesic measures were included. Among the 38 interventions, for pain "during" heel prick, non-nutritive suckling (NNS) plus sucrose [SMD -3.15 (-2.62, -3.69)], followed by breastfeeding, glucose, expressed breast milk (EBM), sucrose, NNS and touch massage, had a high certainty of evidence (CoE) to reduce pain scores when compared to no intervention. Among the 23 interventions for pain at 30 seconds after heel-prick, moderate CoE was noted for facilitated tucking plus NNS plus music, glucose, NNS plus sucrose, sucrose plus swaddling, mother holding, EBM, sucrose and NNS. CONCLUSIONS: Oral sucrose 2 minutes before combined with NNS during the procedure, was the best intervention for reducing pain during heel prick. It also effectively reduced pain scores 30 seconds and 1 minute after the procedure. Other interventions with moderate to high CoE for a significant reduction in pain during and at 30 seconds after heel prick are oral sucrose, oral glucose, EBM and NNS. All these are low-cost and feasible interventions for most of the settings.