Authors (including presenting author) :
Fong SYVL, Sung WH, Tsang MC, Chan WH, Chan LK
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine
Introduction :
Heel-pricking is inevitable in Neonatal Intensive Care Unit (NICU). The World Health Organization encourages using breastmilk as natural analgesic for procedural pain in infants. Yet, the relationship between breastmilk oral care (BOC) and the control of procedural pain has never been investigated.
Objectives :
A quality improvement project to explore the feasibility of BOC in alleviating procedural pain of heel-pricking in preterm neonates.
Methodology :
78 neonates with corrected gestational age (CGA) less than 37 weeks requiring heel-pricking (HP) in NICU were enrolled between 1st November, 2019 and 24th March, 2020. Number of cases is similar between the control (n= 38) and intervention (n= 40) groups. Only data on the first attempt of a single HP episode with blood sample less than 1ml were collected. Neonates with unstable clinical conditions, oral defects, drug withdrawal syndrome, conditions contraindicated to breastmilk administration and those who cried just before BOC were excluded. In the intervention group, BOC was performed by coating the entire oral mucosa of neonates with applicator soaked with 0.2-0.3ml breastmilk. HP was proceeded immediately after BOC. No intervention was performed in the control group before HP. All nursing staff complied with department protocol for BOC and HP. Assessors of three monitored nursing interventions during data collection . Per-protocol analysis was adopted. Pain level was evaluated by utilizing validated Neonatal Infant Pain Scale (NIPS). Secondary outcomes (duration of crying, duration of blood-taking, vitals change) and demographic data were collected. Stratification was conducted during data analysis.
Result & Outcome :
As compared with the control group, NIPS score was significantly lowered among neonates with body weight (BW) below 1.4 kg [Mean 0.2 ± 0.65] and with CGA between 28 and 31.6 weeks [Mean 0.43 ± 0.79] in BOC group by 1.43 [95% CI -2.29, -0.56; P value 0.002] and 1.44 [95% CI -2.55, -0.33; P value 0.01] respectively. There was no statistical significance in vitals change, duration of blood-taking and duration of crying between two groups. Inter-rater reliability was 1.0. Conclusion BOC just before HP significantly reduced NIPS score by 1.43 and 1.44 in preterm neonates with BW below 1.4 kg and with CGA between 28 and 31.6 weeks respectively in comparison with the control group. Limitation Intervention bias existed. The effect of BOC duration on pain control was not analysed. Additionally, the pressure exerted on the heels during HP was subjective and could not be measured. Implication Large-scale study of higher evidential hierarchy is recommended in the future on the related topic.
