Neonatology pp 206-209 | Cite as

Procedural Pain Management with Non-Pharmacological Interventions

  • Celeste Johnston
  • Ananda M. Fernandes
  • Marsha Campbell-Yeo


Neonates who are born preterm spend weeks in the neonatal intensive care unit (NICU) and undergo numerous painful procedures as part of their routine care [1]. In spite of evidence of negative effects and published guidelines on pain control, about one third of procedures remain unmanaged [2].


Preterm Infant Neonatal Intensive Care Unit Preterm Neonate Music Therapy Painful Procedure 
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  1. 1.
    Simons SH, van Dijk M, Anand KS et al (2003) Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med 157:1058–1064PubMedCrossRefGoogle Scholar
  2. 2.
    Carbajal R, Rousset A, Danan C et al (2008) Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 300:60–70PubMedCrossRefGoogle Scholar
  3. 3.
    Stevens B, Johnston C, Taddio A et al (1999) Management of pain from heel lance with lidocaine-prilocaine (EMLA) cream: is it safe and efficacious in preterm infants? J Dev Behav Pediatr 20:216–221PubMedCrossRefGoogle Scholar
  4. 4.
    Zuppa AF, Mondick JT, Davis L, Cohen D (2009) Population pharmacokinetics of ketorolac in neonates and young infants. Am J Ther 16:143–146PubMedCrossRefGoogle Scholar
  5. 5.
    Carbajal R, Lenclen R, Jugie M et al (2005) Morphine does not provide adequate analgesia for acute procedural pain among preterm neonates. Pediatrics 115:1494–500PubMedCrossRefGoogle Scholar
  6. 6.
    Gaspardo CM, Linhares MB, Martinez FE (2005) A eficacia da sacarose no alivio de dor em neonatos: revisao sistematica da literatura. J Pediatr 81:435–442CrossRefGoogle Scholar
  7. 7.
    Tsao JC, Evans S, Meldrum M et al (2008) A Review of CAM for Procedural Pain in Infancy: Part I. Sucrose and Non-nutritive Sucking. Evid Based Complement Alternat Med 5:371–381PubMedCrossRefGoogle Scholar
  8. 8.
    Stevens B, Yamada J, Ohlsson A (2010) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 1:CD001069PubMedGoogle Scholar
  9. 9.
    Blass EM, Shah A (1995) Pain-reducing properties of sucrose in human newborns. Chem Senses 20:29–35PubMedCrossRefGoogle Scholar
  10. 10.
    Abad F, Diaz NM, Domenech E et al (1996) Oral sweet solution reduces pain related behaviour in preterm infants. Acta Paediatr 85:854–858PubMedCrossRefGoogle Scholar
  11. 11.
    Johnston CC, Stremler RL, Horton L, Freidman A (1999) Repeated doses of oral sucrose for decreasing pain from heelstick in preterm neonates. Biol Neonate 75:160–166PubMedCrossRefGoogle Scholar
  12. 12.
    Gibbins S, Stevens B, Hodnett E et al (2002) Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res 51:375–382PubMedCrossRefGoogle Scholar
  13. 13.
    Storm H, Fremming A (2002) Food intake and oral sucrose in preterms prior to heel prick. Acta Paediatr 91:555–560PubMedCrossRefGoogle Scholar
  14. 14.
    Ramenghi LA, Wood CM, Griffith GC, Levene MI (1996) Reduction of pain response in premature infants using intraoral sucrose. Arch Dis Child Fetal Neonatal Ed 74:F126–F128PubMedCrossRefGoogle Scholar
  15. 15.
    Johnston CC, Filion F, Snider L et al (2002) Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks’ postconceptional age. Pediatrics 110:523–528PubMedCrossRefGoogle Scholar
  16. 16.
    Taddio A, Shah V, Hancock R et al (2008) Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures. CMAJ 179:37–43PubMedCrossRefGoogle Scholar
  17. 17.
    Gibbins S, Stevens B (2003) The influence of gestational age on the efficacy and short-term safety of sucrose for procedural pain relief. Adv Neonatal Care 3:241–249PubMedGoogle Scholar
  18. 18.
    Johnston CC, Filion F, Snider L et al (2007) How much sucrose is too much sucrose? Pediatrics 119:226Google Scholar
  19. 19.
    Stevens B, Yamada J, Beyene J et al (2005) Consistent management of repeated procedural pain with sucrose in preterm neonates: Is it effective and safe for repeated use over time? Clin J Pain 21:543–548PubMedCrossRefGoogle Scholar
  20. 20.
    Corbo MG, Mansi G, Stagni A et al (2000) Nonnutritive sucking during heelstick procedures decreases behavioral distress in the newborn infant. Biol Neonate 77:162–167PubMedCrossRefGoogle Scholar
  21. 21.
    Stevens BJ, Johnston C, Franck L et al (1999) The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates. Nurs Res 98:35–43CrossRefGoogle Scholar
  22. 22.
    Shiao SY, Chang YJ, Lannon H, Yarandi H (1997) Meta-analysis of the effects of nonnutritive sucking on heart rate and peripheral oxygenation: research from the past 30 years. Issues Compr Pediatr Nurs 20:11–24PubMedCrossRefGoogle Scholar
  23. 23.
    Shah PS, Aliwalas LL, Shah V (2006) Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 3:CD004950PubMedGoogle Scholar
  24. 24.
    Skogsdal Y, Eriksson M, Schollin J (1997) Analgesia in newborns given oral glucose. Acta Paediatr 86:217–220PubMedCrossRefGoogle Scholar
  25. 25.
    Carbajal R, Veerapen S, Couderc S et al (2003) Analgesic effect of breast feeding in term neonates: randomised controlled trial. BMJ 326:13PubMedCrossRefGoogle Scholar
  26. 26.
    Codipietro L, Ceccarelli M, Ponzone A (2008) Breastfeeding or oral sucrose solution in term neonates receiving heel lance: a randomized, controlled trial. Pediatrics 122:e716–e721PubMedCrossRefGoogle Scholar
  27. 27.
    Gradin M, Finnström O, Schollin J (2004) Feeding and oral glucose-additive effects on pain reduction in newborns. Early Hum Dev 77:57–65PubMedCrossRefGoogle Scholar
  28. 28.
    Gray L, Miller LW, Philipp BL, Blass EM (2002) Breastfeeding is analgesic in healthy newborns. Pediatrics 109:590–593PubMedCrossRefGoogle Scholar
  29. 29.
    Phillips RM, Chantry CJ (2002) Is breastfeeding more analgesic than pacifier? Pediatric Academic Societies’ Annual Meeting, Baltimore, May 2002Google Scholar
  30. 30.
    Phillips RM, Chantry CJ, Gallagher MP (2005) Analgesic effects of breast-feeding or pacifier use with maternal holding in term infants. Ambul Pediatr 5:359–364PubMedCrossRefGoogle Scholar
  31. 31.
    Gray L, Watt L, Blass EM (2000) Skin-to-skin contact is analgesic in healthy newborns. Pediatrics 105:e14PubMedCrossRefGoogle Scholar
  32. 32.
    Kashaninia Z, Sajedi F, Rahgozar M, Noghabi FA (2008) The effect of Kangaroo Care on behavioral responses to pain of an intramuscular injection in neonates. J Spec Pediatr Nurs 13:275–280PubMedCrossRefGoogle Scholar
  33. 33.
    Johnston CC, Stevens B, Pinelli J et al (2003) Kangaroo care is effective in diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med 157:1084–1088PubMedCrossRefGoogle Scholar
  34. 34.
    Johnston CC, Filion F, Campbell-Yeo M et al (2008) Kangaroo mothercare diminishes pain from heel lance in very preterm neonates: a crossover trial. BMC Pediatrics 8:e13CrossRefGoogle Scholar
  35. 35.
    Akcan E, Yigit R, Atici A (2009) The effect of kangaroo care on pain in premature infants during invasive procedures. Turk J Pediatr 51:14–18PubMedGoogle Scholar
  36. 36.
    de Sousa Freire NjB, Santos Garcia JoB, Carvalho Lamy Z (2008) Evaluation of analgesic effect of skin-to-skin contact compared to oral glucose in preterm neonates. Pain 139:28–33CrossRefGoogle Scholar
  37. 37.
    Johnston CC, Filion F, Campbell-Yeo M et al (2009) Enhanced Kangaroo Mother Care for heel lance in Preterm Neonates: A crossover trial. J Perinatol 29:51–56PubMedCrossRefGoogle Scholar
  38. 38.
    Huang CM, Tung WS, Kuo LL, Ying-Ju C (2004) Comparison of pain responses of premature infants to the heelstick between containment and swaddling. J Nurs Res 12:31–40PubMedCrossRefGoogle Scholar
  39. 39.
    Axelin A, Salanterä S, Lehtonen L (2006) ‘Facilitated tucking by parents’ in pain management of preterm infants-a randomized crossover trial. Early Hum Dev 82:241–247Google Scholar
  40. 40.
    Axelin A, Salanterä S, Kirjavainen J, Lehtonen L (2009) Oral glucose and parental holding preferable to opioid in pain management in preterm infants. Clin J Pain 25:138–145PubMedCrossRefGoogle Scholar
  41. 41.
    Aucott S, Donohue PK, Atkins E, Allen MC (2002) Neurodevelopmental care in the NICU. Ment Retard Dev Disabil Res Rev 8:298–308PubMedCrossRefGoogle Scholar
  42. 42.
    Campos RG (1989) Soothing pain elicited distress in infants with swaddling and pacifiers. Child Dev 60:781–792PubMedCrossRefGoogle Scholar
  43. 43.
    Fearon I, Kisilevsky BS, Hains SM et al (1997) Swaddling after heel lance: age specific effects on behavioral recovery in preterm infants. J Dev Behav Pediatr 18:222–232PubMedCrossRefGoogle Scholar
  44. 44.
    Prasopkittikun T, Tilokskulchai F (2003) Management of pain from heel stick in neonates: an analysis of research conducted in Thailand. J Perinat Neonatal Nurs 17:304–312PubMedGoogle Scholar
  45. 45.
    Campos RG (1994) Rocking and pacifiers: two comforting interventions for heelstick pain. Res Nurs Health 17:321–331PubMedCrossRefGoogle Scholar
  46. 46.
    Hepper PG, Shahidullah BS (1994) Development of fetal hearing. Arch Dis Child 71:F81–F87PubMedGoogle Scholar
  47. 47.
    Fifer WP, Moon C, Lecanuet JP et al (1995) The effects of fetal experience with sound Fetal Development. A Psychobiological Perspective. Lawerence Erlbaum Associates, Hillsdale, NJ, pp 351–366Google Scholar
  48. 48.
    Bo LK, Callaghan P (2000) Soothing pain-elicited distress in Chinese neonates. Pediatrics 105:E49PubMedCrossRefGoogle Scholar
  49. 49.
    Butt ML, Kisilevsky BS (2000) Music modulates behaviour of premature infants following heel lance. Can J Nurs Res 31:17–39PubMedGoogle Scholar
  50. 50.
    Johnston CC, Filion F, Nuyt AM (2007) Recorded maternal voice for preterm neonates undergoing heel lance. Adv Neonatal Care 7:258–266PubMedGoogle Scholar
  51. 51.
    Goubet N, Rattaz C, Pierrat V et al (2003) Olfactory experience mediates response to pain in preterm newborns. Dev Psychobiol 42:171–180PubMedCrossRefGoogle Scholar
  52. 52.
    Goubet N, Strasbaugh K, Chesney J (2007) Familiarity breeds content? Soothing effect of a familiar odor on full-term newborns. J Dev Behav Pediatr 28:189–194Google Scholar
  53. 53.
    Rattaz C, Goubet N, Bullinger A (2005) The Calming Effect of a Familiar Odor on Full-Term Newborns. J Dev Behav Pediatr 26:86–92PubMedCrossRefGoogle Scholar
  54. 54.
    Bellieni CV, Buonocore G, Nenci A et al (2001) Sensorial saturation: an effective analgesic tool for heel-prick in preterm infants: a prospective randomized trial. Biol Neonate 80:15–18PubMedCrossRefGoogle Scholar
  55. 55.
    Bellieni CV, Bagnoli F, Perrone S et al (2002) Effect of multisensory stimulation on analgesia in term neonates: a randomized controlled trial. Pediatr Res 51:460–463PubMedCrossRefGoogle Scholar
  56. 56.
    Bellieni C, Maffei M, Ancora G et al (2007) Is the ABC pain scale reliable for premature babies? Acta Paediatr 96:1008–1010PubMedCrossRefGoogle Scholar
  57. 57.
    Bellieni CV, Cordelli DM, Marchi S et al (2007) Sensorial saturation for neonatal analgesia. Clin J Pain 23:219–221PubMedCrossRefGoogle Scholar
  58. 58.
    Cignacco E, Hamers JPH, Stoffel L et al (2007) The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain 11:139–152PubMedCrossRefGoogle Scholar
  59. 59.
    American Academy of Pediatrics, Committee on Fetus and Newborn, Canadian Paediatric Society, Fetus and Newborn Committee (2007) Prevention and management of pain in the neonate. An update. Adv Neonatal Care 7:151–160Google Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Celeste Johnston
    • 1
    • 2
  • Ananda M. Fernandes
  • Marsha Campbell-Yeo
  1. 1.School of NursingMcGill UniversityMontrealCanada
  2. 2.Women and Newborn ProgramIWK Health CentreHalifaxCanada

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