Efficacy of breast milk olfactory and gustatory interventions on preterm neonates behaviour responses to pain during heel prick procedures: a hospital-based study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20251092Keywords:
Breast milk, Olfactory and gustatory interventions, Preterm neonates, Pain, Behavioral response, Heel prickAbstract
Background: Premature infants are particularly vulnerable to stress and pain due to the multiple procedures they undergo in the NICU during a critical phase of brain development. Their heightened sensitivity to tactile stimuli increases the risk of negative effects from frequent medical interventions. Acute pain can have both immediate and long-term neurodevelopmental consequences. This study aimed to assess the impact of breast milk feeding on pain levels during the heel stick procedure in late preterm neonates in selected hospitals of Greater Noida.
Methods: A randomized clinical trial compared pain levels in late preterm neonates undergoing a heel stick, with one group receiving breast milk feeding prior to the procedure (n=64) and the other group not (n=64). Pain was assessed using the premature infant pain profile (PIPP) at baseline, 5 minutes and 15 minutes after the procedure.
Results: Among 64 late preterm neonates who did not receive breast milk, 79.7% experienced no to minimal pain and 20.3% had minimal to moderate pain, with none experiencing severe pain. In the breast milk feeding group, all 64 neonates reported no to minimal pain during the procedure. 15 minutes post-procedure, the control group reported higher pain (2) than the experimental group (2), with a significant difference (p<0.001).
Conclusions: Breast milk feeding is effective in reducing pain during the heel stick procedure in late preterm neonates. This method is a cost-effective and non-pharmacological approach that can be readily adopted to alleviate procedural pain in this vulnerable population.
Metrics
References
Merskey H, Bugduk N. Classification of chronic pain, descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. 1994.
Krishnan L. Pain relief in neonates. J neonatal surg. 2013;2:19-20. DOI: https://doi.org/10.47338/jns.v2.31
Yamada J, Stinson J, Lamba J, Dickson A, McGrath P, Stevens B. A review of systematic reviews on pain interventions in hospitalized infants. Pain Res Manag. 2008;13:413-20. DOI: https://doi.org/10.1155/2008/232316
Kothari SY, Dogara AR, Nimbalkar SM, Phatak AG, Nimbalkar AS. Missed Opportunities for sedation and pain management at a Level III Neonatal Intensive Care Unit. Front Pediatr. 2016;4:7-8 DOI: https://doi.org/10.3389/fped.2016.00007
Grunau re. Neonatal pain in very preterm infants: long term effects of brain, neuro development and pain reactivity. Rambam Maimonides. 2013;4:25. DOI: https://doi.org/10.5041/RMMJ.10132
Grunau RE, Holsti L, Peters JW. Long term consequences of pain in human neonates. Semin Fetal Neonatal Med. 2006;11:268-75. DOI: https://doi.org/10.1016/j.siny.2006.02.007
Donia ASE, Tolba OA. Effect of early procedural pain experience on subsequent response among premature infants. Egyptian Pediatric Association Gazette. 2016;64:74-8. DOI: https://doi.org/10.1016/j.epag.2016.03.002
Carbaial R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in Intensive Care Units. JAMA. 2008;300:60-70. DOI: https://doi.org/10.1001/jama.300.1.60
Gardner SL, Carter SB, Hines IM, Hernandez AJ. Handbook of neonatal intensive care. 7th ed. USA: Mosby. 2011.
Appleyard L. Breastfeeding reduces procedural pain in infants: A review of literature. NZJ Med Sci. 2014;68:88-9.
Holsti L, Grunau R E, Shany E. Assessing pain in preterm infans in the neonatal intensive care unit: moving to a brain oriented approach. Pain Manag. 2011;1:171-9. DOI: https://doi.org/10.2217/pmt.10.19
Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev. 2012;12:4950. DOI: https://doi.org/10.1002/14651858.CD004950.pub3
Hockenberry MJ, Wilson D. Wong’s nursing care of infants and children. 8th edition. Missouri: Elsevier publication. 2009.
George JB. Nursing theories: The base for professional practice. 5th Ed. New Jersey: Prentice Hall. 2002.
Valeri BO, Holsti L, Linhares BM. Neonatal pain and developmetal outcoms in children born preterm; a systematic review. The Clin J of Pain. 2015;31:355-62. DOI: https://doi.org/10.1097/AJP.0000000000000114
Brummelte S, Gurunau RE, Chau V, Poskitt KJ, Brant R , Vinall J, et al. Procedural pain and brain development in premature newborns. Ann Neurol. 2012;71:385-96. DOI: https://doi.org/10.1002/ana.22267
Nair MKC, Jain. The High Risk Newborn. 1sted. New Delhi: Jaypee Publications. 2008. DOI: https://doi.org/10.5005/jp/books/10973
Field T. Preterm newborn pain research review. Infant Behav Dev. 2017;49:141-50. DOI: https://doi.org/10.1016/j.infbeh.2017.09.002
Slater R, Cornelisen L, Fabrizi L, Patten D, Yoxen J, Worley A, et al. Oral sucrose as an analgesic drug for procedural pain in newborn infants: Arandomised controlled trial. The Lancet. 2010;376:1225-32. DOI: https://doi.org/10.1016/S0140-6736(10)61303-7
Castral TC, Warnock F, Leite AM, Haas VJ, Scochi CGS. The effects of skin-to- skin contact during acute pain in preterm newborns. European J of Pain. 2008;12:464-71. DOI: https://doi.org/10.1016/j.ejpain.2007.07.012
Kahalaf O, Clark L, Sivaranjan E. Use of facilitated tucking for nonpharmacological pain management in preterm infants: a systematic review. J Perinatal and Neonatal Nurs. 2009;23:372-7. DOI: https://doi.org/10.1097/JPN.0b013e3181bdcf77
Stevens B, Yamada J, Beyene J, Gibbins S, Petryshen P, Stinson J, et al. Consistent management of repeated procedural pain with sucrose in preterm neonates: Is it effective and safe for repeated use over time. Clin J Pain. 2005;21:543-8. DOI: https://doi.org/10.1097/01.ajp.0000149802.46864.e2
Sahebihag MH, Hosseinzadeh M, Mohammadpourasl A, Kosha A. the effect of breast-feeding infant’s pain relief during vaccination. Iran I Nurs Midwifery Res. 2011;16:1-7.
Modarres M, Jazayeri A, Rahnama P, Montazeri A. Breastfeeding and pain relief in full-term neonates during immunization injections: a clinical randomized trial. BMC Anesthesiol. 2013;13:22. DOI: https://doi.org/10.1186/1471-2253-13-22
Lin CH, Liaw JJ, Chen YT, Yin T, Yang L, Lan HY. Efficacy of breast milk olfactory and gustatory interventions on neonates' biobehavioral responses to pain during heel prick procedures. Int J Environ Res Public Health. 2022;22;19(3):1240. DOI: https://doi.org/10.3390/ijerph19031240
Leite AM, Linhares MB, Lander J, Castral TC, Santos CB, Silvan Scochi CG. Effects of breastfeeding on pain relief in full term newborns. Clinical J of Pain. 2009;25:827-32. DOI: https://doi.org/10.1097/AJP.0b013e3181b51191
Codipietro L, Ceccarelli M, Ponzone A. Breastfeeding or oral sucrose solution in term neonates receiving heel lance: a randomized, controlled trial. Pediatrics. 2008;3:716. DOI: https://doi.org/10.1542/peds.2008-0221
Bulut O, Topaloglu SC, Bulut, N. Impact of breast milk on cortical pain response in newborns during the heel prick procedure: a randomized controlled trial. J Perinatol. 2024;44:1675-81. DOI: https://doi.org/10.1038/s41372-024-02081-4