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 Researchers randomly assigned 80 healthy three-day-old infants
getting a needle stick in their heel for blood tests to receive one
of four types of pain relief: sugar water while they were on a
changing table; pumped breast milk while they were on a changing
table; sugar water while they were held by their mothers; or
breastmilk directly from their mothers.
Researchers watched babies for expressions of pain. They also used a
noninvasive device to measure oxygen level changes in their brain as
a way of detecting which brain areas were activated by pain and the
effect of the different types of pain relief.
"Clinically, mother's lap, in combination with either glucose or
breastfeeding, provided better analgesia than expressed breast milk
and glucose alone," said senior study author Dr. Sergio Demarini of
the Institute for Maternal and Child Health at IRCCS Burlo Garofolo
in Trieste, Italy.
"The reason why a combination of methods works better is likely due
to the fact that they have different mechanism of action," Demarini
said by email. "Therefore, the effects may be cumulative."
Nonpharmacological pain relief is often used with infants during
minor painful procedures like heel sticks, researchers note in
Pediatrics. Several methods have been found effective at reducing
babies' visible pain during these procedures, including sugar water,
breastfeeding, swaddling infants in blankets and placing babies
against their mothers' bare chest for skin-to-skin contact.
While some previous research has also tried to measure changes in
babies' brains associated with different approaches to pain relief,
results have been mixed and left an unclear picture of what approach
might work best, the authors write.
In the current study, researchers used what's known as near-infrared
spectroscopy (NIRS). It uses sensors on the outside of the head
emitting and receiving light, instead of electrodes detecting
electrical impulses, and can detect changes in oxygenation,
representing blood flow to areas where brain activity increases
during a heel stick.
The different pain relief methods in the study were associated with
different responses in the brain.
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With sugar water, there appeared to be less transmission of pain in
the cerebral cortex than with breast milk babies took from a bottle
while they were on the changing table, Demarini said.
Breastfeeding is associated with a widespread activation of the
cerebral cortex with positive feelings that may overwhelm any pain
from the heel stick, so infants show little if any sign of pain,
Demarini said.
Researchers didn't study the effect of maternal holding alone
because this has been shown to help ease babies' pain in other
studies, particularly when it involves skin-to-skin contact, the
study authors note.
The study found only a slight difference in pain relief between
breastfeeding and holding babies who got sugar.
"The fact that (sugar) combined with holding was more effective than
(sugar) alone once again shows the power of the multisensory
approach. Holding also means speaking to the baby, movement, warmth,
all which can further reduce pain responses in newborn babies," said
Denise Harrison, a researcher at Children's Hospital of Eastern
Ontario and the University of Ottawa who wasn't involved in the
study.
But whenever possible, breastfeeding is best, Harrison said by
email.
"As the large majority of mothers do breastfeed their newborn
infants in the first days to weeks after birth, this makes
breastfeeding the perfect strategy to use during newborn bloodwork,"
Harrison said. "If breastfeeding cannot occur, or skin-skin contact
cannot occur, small volumes of (sugar) given before and immediately
after the bloodwork can be used."
SOURCE: https://bit.ly/2wsM5cS Pediatrics, online August 30, 2018.
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