Comparison of pain during heel prick in preterm neonates receiving only expressed breast milk and expressed breast milk with kangaroo mother care


  • Gurudutt Joshi Department of Pediatrics, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
  • Manila Singhvi Department of Pediatrics, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India



Heel prick, Newborn, Pain, Premature


Background: Newborns' heels are sampled for blood, which is crucial in the identification of genetic and metabolic illnesses. Repeated painful stimulation impairs the future development of their normal motor and cognitive functions. Hence it is necessary to find out suitable remedy to alleviate the pain. The aim of this study was to observe the premature newborns' response to pain (Heel prick) by giving either single (EBM) or combined (EBM and KMC).

Methods: The analytical cross-sectional study was conducted in NICU of SMIMER. hospital, Surat from March 2022 to February 2023. The study included 56 premature newborns, divided into three groups. Group A received only EBM, Group B received EBM and KMC (15 minutes), and Group C received EBM and KMC (30 minutes) before the heal prick. The pain was assessed by PIPP score in all three groups at the end of 30,60 and 120 seconds after the procedure. Data were analyzed using SPSS 24 and a one-way ANOVA test was applied.

Results: The PIPP score after 60 seconds between Group A with B and A with C was statistically significant (p<0.05) whereas Group B with C was insignificant (p>0.05). The score after 60 seconds between Group A with B and A with C was statistically significant (p<0.05) whereas Group B with C was insignificant (p>0.05).

Conclusions: EBM with KMC (15 minutes) duration had an effective impact on pain relief as compared to EBM with KMC (30 minutes) duration at the interval of 60 seconds.


Lee S, Ralston H, Drey E. Fetal pain: a systematic multidisciplinary review of the evidence. JAMA. 2005;294(8):947-54.

Owens M. A crying need. Am J Nurs. 1986;86(1):73-4.

Sok P, Lupo P, Richard M, et al. Utilization of archivedneonatal dried blood spots for genome-wide genotyping. PLoS One. 2020;15:e0229352.

Vander BS, Oerlemans A. Fostering caring relationships: Suggestions to rethink liberal perspectives on the ethics of newborn screening. Bioethics. 2018;32:171-83.

Murphy M, Chakraborty P, Pervin J. Incidentalscreen positive findings in a prospective cohort study inMatlab, Bangladesh: insights into expanded newbornscreening for low-resource settings. Orphanet J Rare Dis. 2019;14:25.

Nazeri P, Shariat M, Mehrabi Y. Is there anassociation between thyrotropin levels within the normalrange and birth growth parameters in full-term newborns. J Pediatr Endocrinol Metab. 2018;31:1001-7.

Rodrigues L, Tanaka S, Haas V. Heel pricktest: maternalfetal conditions that may have an effect onthe test results in newborns admitted to the intensive careunit. Rev Bras Ter Intensiva. 2019;31:186-92.

Goel N, Shrestha S, Smith R. Screening for earlyonset neonatal sepsis: NICE guidance-based practiceversus projected application of the Kaiser Permanentsepsis risk calculator in the UK population. Arch Dis ChildvFetal Neonat Ed. 2020;105:118-22.

Johnston C, Byron J, Filion F, Campbell-Yeo M, Gibbins S, Ng E. Alternative female kangaroo care for procedural pain in pretermneonates: a pilot study. Acta Paediatr 2012;101(11):1147-50.

Charpak N, Ruiz J, Zupan J, Cattaneo A, Figueroa Z, TessierR, et al. Kangaroo Mother Care: 25 years after. Acta Paediatr. 2005;94(5):514-22.

Warnock F, Castral T, Brant R, Sekilian M, Leite A, Owenssde L, et al. Brief report: Maternal kangaroo care for neonatalpain relief: a systematic narrative review. J Pediatr Psychol. 2010;35(9):975-84.

Dimenna L. Considerations for implementation of a neonatal kangaroo care protocol. Neonatal Netw. 2006;25(6):405-12.

Stevens B, Johnston C, Petryshen P, Taddio A. Premature infant pain profile: development and initial validation. Clin J Pain. 1996;12(1):13-22.

Anand K, Barton B, McIntosh N, et al. Analgesia and sedation in preterm neonates who require ventilator support: results from NOPAIN trial. Neonatal outcome and prolonged analgesia in neonates. Arch Pediatr Adolesc Med. 1999;153(4):331-8.

Anand K, Hall R, Desai N. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the neopain randomised trial. Lancet. 2004;363(9422):1673-82.

Bellu R, DeWaal K, Zanini R. Opioids for neonates receiving mechanical ventilation. Cochrane Database Syst Rev. 2008;(1):CD004212.

Ng E, Taddio A, Ohlsson A. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database Syst Rev. 2012;6:CD002052.

Pillai Riddell R, Racine N, Turcotte K. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev. 2013;10:CD001069.

Chidambaram A, Manjula S, Adhisivam B, Vishnu Bhat B. Effect of Kangaroo mother care in reducing pain due to heel prick among preterm neonates: a crossover trial. J Mater Fetal Neonatal Med. 2014; 27(5):488-90.

Mosayebi Z, Javidpour M, Rahmati M, Hagani H, Movahedian A. The effect of kangaroo mother care on pain from heel lance in preterm newborns admitted to neonatal intensive care unit: a crossover randomized clinical trial. J Compr Pediatr. 2014;5(4):1-6.

Castral T, Warnock F, Leite A, Haas V, Scochi C. The effects of skin-to-skin contact during acute pain in preterm newborns. Eur J Pain. 2008;12(4):464-71.

Johnston CC, Stevens B, Pinelli J. Kangaroo care is effective in diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med. 2003;157(11): 1084-88.

Ou‐Yang MC, Chen IL, Chen CC, Chung MY, Chen FS, Huang HC. Expressed breast milk for procedural pain in preterm neonates: a randomized, double‐blind, placebo‐controlled trial. Acta Paediatr. 2013;102(1): 15-21.

Shah P, Aliwalas L, Shah V. Breastfeeding or Breast milk to Alleviate Procedural Pain in Neonates: A Systematic Review. Breastfeeding Med. 2007;(2):74-82.

Shendurnikar N Analgesic Effects of Breastfeeding on Heel Lancing. Indian Pediatr. 2005;42:730-2.

Bilgen H. Ozek E, Cebeci D, Ors R. Comparison of sucrose, expressed breastmilk and breastfeeding on the neonatal responses to heel prick. J Pain. 2001;2:301-5.

Craig KD, Korol CT, Pillai RR, Challenge ofjudging pain in vulnerable infants. Clin Perinatol. 2002;29: 445-57.

Gray L. Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy Newborn. Pediatrics. 2002;109:590-3.

Shukla V. Pain control interventions in preterm neonates: A randomized control Trial. Indian Pediatr. 2018;55:292-6.






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