I just read the summary in Medscape
<http://cme.medscape.com/viewarticle/712142?src=cmenews&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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