Effect of gentle manual pressure on neonatal pain during heel prick: a randomised crossover trial

Heel prick tests are one of the most common needle-related painful procedures performed on neonates in hospitals (Carbajal, 2008). Various studies have suggested that acute episodic pain can cause early neurological injury in neonates. Repeated and prolonged exposure to pain may even alter subsequent psychokinetic development, as well as affect long-term neurodevelopmental, behavioural and social-emotional outcomes. Examples include increased sensitivity to pain, prolonged hyperalgesia after acute painful stimuli and decreased visual perceptual ability later in life (American Academy of Paediatrics et al, 2007; Bouza, 2009; Walker et al, 2009a; Doesburg et al, 2013). The American Academy of Paediatrics and other paediatrics organisations have jointly stated that health workers are encouraged to use nonpharmacological methods to reduce pain in minor, routine procedures such as heel prick tests (American Academy of Paediatrics et al, 2007). Many studies have been conducted aiming to reduce pain during heel prick tests by nonpharmacological means. For example, Ramenghi et al (1996) have found that sucrose solutions significantly reduce neonate crying time after heel prick. Elserafy et al (2009) noticed that a sucrose solution with a pacifier decreased pain score in neonates during simple painful procedures including heel pricks. In Liaw et al's study (2012), non-nutritive sucking was as effective as sucrose solution to reduce discomfort in painful minor procedures. Goubet et al (2007) found exposure to a familiar odour reduced crying and grimacing in neonates having heel pricks. In a study conducted by Jain et al (2006), 2 minutes of massage over the ipsilateral leg before heel prick significantly reduce pain score in neonates. Gray et al's study (2002) suggested a mother's cuddle with breastfeeding is a potent analgaesic for neonates having heel prick. Morrow et al (2010) and Castral et al's (2007) studies also suggested that swaddling and skin to skin contact can significantly reduce neonatal pain during heel pricks. Alternatively, Ozdogan et al's (2010) study suggested that expressed breast milk without cuddling was ineffective in reducing pain during heel pricks.