Dear Jeanette, thanks for posting this interesting study. I learned how to
do PKU tests by following a lab tech around for a morning at our local hosp.
The plastic boxes were lined up in the nursery and the heel pricks were done
systematically.  The babies were not held or soothed in any way.  Only the
premature babies had their foots warmed and that was done by soaking a
disposable diaper in hot water and wrapping the foot. If the mother came in
during the testing time, she would turn around and leave rather than comfort
her baby.  I've never forgotten it---quite ghastly.

 

With homeborn babies, the test is done on the 4th day of life.  The baby is
put to the breast during the heel-lancing.  A warmed face cloth is wrapped
around the foot and the leg is gently massaged toward the heel to bring the
maximum circulation to the site. The baby makes a little squeak but doesn't
cry when the Tenderfoot (brandname of device) is triggered-too busy nursing.
The blood is expressed with a pumping action of the attendant's hand.  No
bandages are applied as the bleeding stops when the pumping action stops.

 

I'd like someone to include that method in a study.  Gloria Lemay, Vancouver
BC Canada

http://www.glorialemay.com/blog

 

<<I just read the summary in Medscape

<http://cme.medscape.com/viewarticle/712142?src=cmenews
<http://cme.medscape.com/viewarticle/712142?src=cmenews&uac=26875CK>
&uac=26875CK> of the

article that is summarized in the abstract below.  Note that the responses

to pain by the infants being BREASTFED was lower than that of the infants

that were being fed "oral formula" - however, THAT information is not

highlighted in the reports.

 

Heel-Lancing in Newborns: Behavioral and Spectral Analysis Assessment of

Pain Control Methods PEDIATRICS Vol. 124 No. 5 November 2009, pp. e921-e926

(doi:10.1542/peds.2009-0598) Amir Weissman, MDa, Michal Aranovitch, RN,

MScb,c, Shraga Blazer, MDb,d and Etan Z. Zimmer, MDa,b 

 

a Departments of Obstetrics and Gynecology

d Neonatology, Rambam Health Care Campus

b Rappaport Faculty of Medicine, Technion-Israel Institute of Technology,

Haifa, Israel

c Department of Neonatology, Lady Davis Carmel Medical Center, Haifa, Israel

 

 

OBJECTIVE: Pain experience can alter clinical outcome, brain development,

and subsequent behavior in newborns, primarily in preterm infants. The aims

of this study were (1) to evaluate several simple, commonly used methods for

pain control in newborns and (2) to evaluate the concordance between

behavioral and autonomic cardiac reactivity to pain in term neonates during

heel-lancing. 

 

METHODS: A prospective study was conducted of 180 term newborn infants who

were undergoing heel-lancing for routine neonatal screening of

phenylketonuria and hypothyroidism. Newborns were assigned to 6 groups: (1)

control (no pain relief intervention); (2) nonnutritive sucking; (3) holding

by mother; (4) oral glucose solution; (5) oral formula feeding; or (6)

breastfeeding. Outcome measures included the Neonatal Facial Coding System

score; cry duration; and autonomic variables obtained from spectral analysis

of heart rate variability before, during, and after heel-lancing. 

 

RESULTS: Infants with no pain control showed the highest pain manifestation

compared with newborns to whom pain control was provided. Infants who

breastfed or received an oral formula showed the lowest increase in heart

rate (21 and 23 beats per minute, respectively, vs 36; P < .01), lowest

neonatal facial score (2.3 and 2.9, respectively, vs 7.1; P < .001), lowest

cry duration (5 and 13 seconds, respectively, vs 49; P < .001), and lowest

decrease in parasympathetic tone (-2 and -2.4, respectively, vs 1.2; P <

.02) compared with the other groups. 

 

CONCLUSIONS: Any method of pain control is better than none. Feeding and

breastfeeding during heel-lancing were found to be the most effective

methods of pain relief. 

 

CONCLUSION - we don't want to make moms feel "guilty" so we have to make it

sound as if breastfeeding and "oral formula" is equivalent!  

 

(I know, the rationale will be that there were only 30 formula-fed infants

and 31 breastfed infants, so they did not achieve statistical significance!

WHY - because they never bothered to design it so that it COULD!)

 

Jeanette Panchula, BSW, RN, PHN, IBCLC

 

California, USA>>

 


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