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Comparative Efficacy of Interventions for Analgesia During Heel Prick in Newborn Infants - A Systematic Review and Network Meta-Analysis.

Indian pediatrics
January 1, 1970
Thangaraj Abiramalatha et al. (16 authors)
Journal ArticleMeta-AnalysisSystematic ReviewHuman Study
Study Details

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

Extracted Claims (26)
InterventionDirectionEndpointPopulationDosageImpactClaim #
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
Abstract

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.

Medical Subject Headings (MeSH)
HumansInfant, NewbornAnalgesiaHeelNetwork Meta-AnalysisPainPain ManagementPunctures
Study Links
PubMed ID39193923
Quality Scores
SafetyNot Assessed
Efficacy70/10
Quality85/10
Research Impact Scores
APT Score0.05
Weight Score1.39
Normalized Score0.65
Related Supplements
Comparative Efficacy of Interventions for Analgesia During H... | Panacea Index