The analgesic effect and comfort provided to newborns by skin-to-skin contact versus sucrose during two repeated and successive heel punctures: a randomized clinical trial

Author(s)

Liciane Langona Montanholi

• Document type: Doctoral Thesis
• Press: Ribeirão Preto.
• Institution: Universidade de São Paulo (USP). Escola de Enfermagem de Ribeirão Preto (PCARP/BC)
• Defense date: 2014-12-18

Examining board members

Carmen Gracinda Silvan Scochi; Maria Vera Lúcia Moreira Leitão Cardoso; Thaíla Corrêa Castral

• Advisor: Carmen Gracinda Silvan Scochi; Fay Warnock

Abstract

Skin-to-skin contact and the oral administration of sucrose have been effective in alleviating pain in single instance procedures. There is, however, a lack of studies assessing the effect of skin-to-skin contact in repeated procedures. This study\'s general objective was to compare the effectiveness of skin-to-skin contact in comparison with 25% sucrose in alleviating pain and providing comfort to newborns during two repeated and successive heel punctures in the first hours of life. This randomized and controlled clinical trial was conducted with 40 newborns >= 36 weeks of gestational age, and 40 mothers in the skin-to-skin contact group (3 minutes before, during and after the heel puncture) and 40 newborn in the 25% sucrose group all newborn were hospitalized in rooming-in, of a university hospital in Ribeirão Preto, SP, Brazil The participant mothers signed free and informed consent forms before data collection. Data were collected in 18 phases divided into two heel punctures with nine phases each: (T0), 15 segundos (T15), 30 segundos (T30), 60 segundos baseline, treatment (Tto, the 3rd minute skin-to-skin contact and the 2nd minute after administration of sucrose), antisepsis (Anti), heel puncture until 15 following seconds (T0), 15 seconds (T15), 30 seconds (T30), 60 seconds (T60), 120 seconds (T120) and 180 seconds (T180) after heel puncture. The following variables were measured: facial movements; sleep and wakefulness state; crying (duration and quality); newborn\'s self-regulation; and comfort provided by the mother to the newborn. Data were presented in descriptive form comparing the progression of measures over time in the treatment groups (Freedman test) and between groups in each phase (Mann-Whitney test), duration and average percentage of facial movements for the two heel punctures. In the second puncture, the skin-to-skin group remained a significantly longer time in deep sleep in five phases (Tto 2, p=0.010; T0 2, p= 0.0026; T15 2, p=0.005; T30 2, p=0.018 and T60 2, p=0.012), while the sucrose group remained in active alertness in three phases of the procedure (T0 2, p=0.007; T15 2, p=0.007 and T30 2, p=0.035). In the second puncture, crying was more frequently observed in the skin-to-skin group in all the phases (Tto 2, p=0.010; Anti 2, p=0.022; T0 2, p=0.004; T15 2, p=0.032; T30 2, p=0.022; T60 2, p=0.022; T120 2, p=0.022 and T180 2, p=0.022), while strong crying predominated in most instances in both groups. The sucrose group manifested sugar means (frequency, duration and average percentage) significantly higher than the skin-to-skin group in various phases of data collection. Caressing and hugging were the most frequent actions observed among the mothers. Heart rate did not differ between groups, except for treatment phase 2 (p=0.04), which was higher among the sucrose group in comparison to the skin-to-skin group. The conclusion is that skin-to-skin contact is as effective as orally administering 25% sucrose in alleviating pain in newborns exposed to two repeated and successive heel punctures, confirming the study\'s hypothesis (AU)

• FAPESP's process: 12/01938-0 - Analgesic and neonatal comfort effects of skin-to-skin versus sucrose during two repeated and successive heel punctures in neonates: a randomized clinical trial
• Grantee: Liciane Langona Montanholi
• Support Opportunities: Scholarships in Brazil - Doctorate