Skip to main content
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1994 May;70(3):F177–F181. doi: 10.1136/fn.70.3.f177

Alleviation of the pain of heel prick in preterm infants.

N McIntosh 1, L van Veen 1, H Brameyer 1
PMCID: PMC1061036  PMID: 8198410

Abstract

The hypothesis that the variability of physiological parameters may indicate pain or stress in the neonate was examined. Four parameters (heart rate, respiratory rate, transcutaneous oxygen tension, and carbon dioxide tension) were examined over a 2 minute epoch in response to a heel prick in an attempt to measure stress/pain in 35 preterm newborn infants (26-34 weeks' gestation) half of whom were receiving intensive care. The change in absolute values of these parameters did not discriminate a dummy procedure without prick from the actual procedure containing the prick (paired t test), but the variability of the parameters during an epoch showed significant discrimination. Three procedures were evaluated to reduce this distress using unpaired t test. The use of local anaesthetic cream was not successful. The components of the mixture cause vasoconstriction that would reduce blood flow to the heel and lead to more squeezing which is likely to be painful in the presence of tissue damage. A nurse comforting the infant with tactile and vocal stimulation was slightly helpful but the use of a spring loaded lance was most successful in reducing the distress. The use of spring loaded lances may be more humane for heel pricks.

Full text

PDF
F177

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Als H., Lawhon G., Brown E., Gibes R., Duffy F. H., McAnulty G., Blickman J. G. Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: neonatal intensive care unit and developmental outcome. Pediatrics. 1986 Dec;78(6):1123–1132. [PubMed] [Google Scholar]
  2. Anand K. J., Carr D. B. The neuroanatomy, neurophysiology, and neurochemistry of pain, stress, and analgesia in newborns and children. Pediatr Clin North Am. 1989 Aug;36(4):795–822. doi: 10.1016/s0031-3955(16)36722-0. [DOI] [PubMed] [Google Scholar]
  3. Anand K. J., Hickey P. R. Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. N Engl J Med. 1992 Jan 2;326(1):1–9. doi: 10.1056/NEJM199201023260101. [DOI] [PubMed] [Google Scholar]
  4. Anand K. J., Hickey P. R. Pain and its effects in the human neonate and fetus. N Engl J Med. 1987 Nov 19;317(21):1321–1329. doi: 10.1056/NEJM198711193172105. [DOI] [PubMed] [Google Scholar]
  5. Berg K. M., Berg W. K., Graham F. K. Infant heart rate response as a function of stimulus and state. Psychophysiology. 1971 Jan;8(1):30–44. doi: 10.1111/j.1469-8986.1971.tb00434.x. [DOI] [PubMed] [Google Scholar]
  6. Brown L. Physiologic responses to cutaneous pain in neonates. Neonatal Netw. 1987 Dec;6(3):18–22. [PubMed] [Google Scholar]
  7. Erkinjuntti M., Kero P. Heart rate response related to body movements in healthy and neurologically damaged infants during sleep. Early Hum Dev. 1985 Oct;12(1):31–37. doi: 10.1016/0378-3782(85)90134-3. [DOI] [PubMed] [Google Scholar]
  8. Field T. Alleviating stress in intensive-care unit neonates. J Am Osteopath Assoc. 1987 Sep;87(9):646–650. [PubMed] [Google Scholar]
  9. Fitzgerald M., Millard C., McIntosh N. Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia. Pain. 1989 Oct;39(1):31–36. doi: 10.1016/0304-3959(89)90172-3. [DOI] [PubMed] [Google Scholar]
  10. Fitzgerald M., Shaw A., MacIntosh N. Postnatal development of the cutaneous flexor reflex: comparative study of preterm infants and newborn rat pups. Dev Med Child Neurol. 1988 Aug;30(4):520–526. doi: 10.1111/j.1469-8749.1988.tb04779.x. [DOI] [PubMed] [Google Scholar]
  11. Fitzgerald M. The post-natal development of cutaneous afferent fibre input and receptive field organization in the rat dorsal horn. J Physiol. 1985 Jul;364:1–18. doi: 10.1113/jphysiol.1985.sp015725. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Franck L. S. A new method to quantitatively describe pain behavior in infants. Nurs Res. 1986 Jan-Feb;35(1):28–31. [PubMed] [Google Scholar]
  13. Gray M. L., Crowell D. H. Heart rate changes to sudden peripheral stimuli in the human during early infancy. J Pediatr. 1968 Jun;72(6):807–814. doi: 10.1016/s0022-3476(68)80433-0. [DOI] [PubMed] [Google Scholar]
  14. Grunau R. V., Craig K. D. Pain expression in neonates: facial action and cry. Pain. 1987 Mar;28(3):395–410. doi: 10.1016/0304-3959(87)90073-X. [DOI] [PubMed] [Google Scholar]
  15. Harpin V. A., Rutter N. Making heel pricks less painful. Arch Dis Child. 1983 Mar;58(3):226–228. doi: 10.1136/adc.58.3.226. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Johnston C. C., Stevens B., Craig K. D., Grunau R. V. Developmental changes in pain expression in premature, full-term, two- and four-month-old infants. Pain. 1993 Feb;52(2):201–208. doi: 10.1016/0304-3959(93)90132-9. [DOI] [PubMed] [Google Scholar]
  17. Johnston C. C., Stevens B. Pain assessment in newborns. J Perinat Neonatal Nurs. 1990 Jul;4(1):41–52. doi: 10.1097/00005237-199007000-00006. [DOI] [PubMed] [Google Scholar]
  18. McGrath P. J., Craig K. D. Developmental and psychological factors in children's pain. Pediatr Clin North Am. 1989 Aug;36(4):823–836. doi: 10.1016/s0031-3955(16)36723-2. [DOI] [PubMed] [Google Scholar]
  19. McIntosh N. Massage in preterm infants. Arch Dis Child Fetal Neonatal Ed. 1994 Jan;70(1):F80–F80. doi: 10.1136/fn.70.1.f80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. McIntosh N., Van Veen L., Brameyer H. The pain of heel prick and its measurement in preterm infants. Pain. 1993 Jan;52(1):71–74. doi: 10.1016/0304-3959(93)90116-7. [DOI] [PubMed] [Google Scholar]
  21. Owens M. E. Pain in infancy: conceptual and methodological issues. Pain. 1984 Nov;20(3):213–230. doi: 10.1016/0304-3959(84)90012-5. [DOI] [PubMed] [Google Scholar]
  22. Owens M. E., Todt E. H. Pain in infancy: neonatal reaction to a heel lance. Pain. 1984 Sep;20(1):77–86. doi: 10.1016/0304-3959(84)90813-3. [DOI] [PubMed] [Google Scholar]
  23. Porter F. L., Porges S. W., Marshall R. E. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev. 1988 Apr;59(2):495–505. [PubMed] [Google Scholar]
  24. Thompson C. R., Brown J. S., Gee H., Taylor E. W. Heart rate variability in healthy term newborns: the contribution of respiratory sinus arrhythmia. Early Hum Dev. 1993 Jan;31(3):217–228. doi: 10.1016/0378-3782(93)90197-3. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood Fetal and Neonatal edition are provided here courtesy of BMJ Publishing Group

RESOURCES