Analgesic Effects of Breastfeeding on Heel Lancing
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《交互式心脏血管和胸部手术医学期刊》
Department of Pediatrics, Medical College, Baroda, Gujarat 390 001, India.
Pain is routinely experienced in hospital settings by healthy term newborns having a long lasting effect in form of exaggerated reactivity(1). Clinical interest was generated when it was observed that natural interventions like skin-to-skin contact and breast-feeding are effective at a time when many pharmacological interventions are not(1-3). The objective of this study was to assess the efficacy of such a natural intervention i.e., breastfeeding as an analgesic.
This was a prospective randomized case control study carried out from July 2003 to October 2003, in neonatal care unit of a major teaching institution with maternity services. Exclusively breastfed term neonates more than 48 hours old, more than 2500 grams, with no high-risk neonatal factors undergoing heel lancing were selected for study after well- informed and valid parental consent. Neonates who were heel lanced while being breastfed formed the study group whereas those newborns that were heel lanced after being swaddled and kept on a cradle away from their mothers acted as controls.
Both groups were assessed prior to and 1,5, and 15 minutes after heel lance for behavioral (state of arousal, cry, facial expression, body movements) and physiological (breathing pattern, heart rate) parameters and an individual composite score was calculated. Scores of both groups were analyzed with the help of computer statistical package ANOVA. Lower score was considered to be showing better analgesia.
One hundred cases were enrolled, of which fifty cases formed the study group (breastfeeding group) and fifty formed control group. Despite comparable pain scores observed at baseline before heel lancing, statistically significant lower scores were observed at 1, 5, and 15 minutes of lancing in breastfed group than non-breastfed group (Table I). Pain scores in study group were also found to decline much earlier to a lower value than the control group.
Many recent studies have shown analgesic effects of breastfeeding during acute, short lasting, repetitive painful procedures in term newborns(2,4,5). The act of breast-feeding in form of multimodal sensory stimulation potentiates analgesic effects of breast milk. Thus, it can be utilized for pain relief during minor procedures in newborns.
References
1. Anand KJS. Clinical importance of pain and stress in preterm newborn infants, Biol Neonate 1998; 73: 1-9.
2. Bilgen H. Ozek E, Cebeci D, Ors R. Comparison of sucrose, expressed breastmilk and brestfeeding on the neonatal responses to heel prick. J Pain 2001; 2: 301-305.
3. Blass EM, Barr RG. Evolutionary biology and the practice of medicine; the case of management of infant pain experience. J Dev Behav Pediatr 2000; 21: 283-284.
4. Craig KD, Korol CT, Pillai RR, Challenge of judging pain in vulnerable infants. Clin Perinatol 2002; 29: 445-457.
5. Gray L. Miller L W, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborn. Pediatrics 2002; 109: 590-593.(Niranjan Shendurnikar, Kinal Gandhi,)
Pain is routinely experienced in hospital settings by healthy term newborns having a long lasting effect in form of exaggerated reactivity(1). Clinical interest was generated when it was observed that natural interventions like skin-to-skin contact and breast-feeding are effective at a time when many pharmacological interventions are not(1-3). The objective of this study was to assess the efficacy of such a natural intervention i.e., breastfeeding as an analgesic.
This was a prospective randomized case control study carried out from July 2003 to October 2003, in neonatal care unit of a major teaching institution with maternity services. Exclusively breastfed term neonates more than 48 hours old, more than 2500 grams, with no high-risk neonatal factors undergoing heel lancing were selected for study after well- informed and valid parental consent. Neonates who were heel lanced while being breastfed formed the study group whereas those newborns that were heel lanced after being swaddled and kept on a cradle away from their mothers acted as controls.
Both groups were assessed prior to and 1,5, and 15 minutes after heel lance for behavioral (state of arousal, cry, facial expression, body movements) and physiological (breathing pattern, heart rate) parameters and an individual composite score was calculated. Scores of both groups were analyzed with the help of computer statistical package ANOVA. Lower score was considered to be showing better analgesia.
One hundred cases were enrolled, of which fifty cases formed the study group (breastfeeding group) and fifty formed control group. Despite comparable pain scores observed at baseline before heel lancing, statistically significant lower scores were observed at 1, 5, and 15 minutes of lancing in breastfed group than non-breastfed group (Table I). Pain scores in study group were also found to decline much earlier to a lower value than the control group.
Many recent studies have shown analgesic effects of breastfeeding during acute, short lasting, repetitive painful procedures in term newborns(2,4,5). The act of breast-feeding in form of multimodal sensory stimulation potentiates analgesic effects of breast milk. Thus, it can be utilized for pain relief during minor procedures in newborns.
References
1. Anand KJS. Clinical importance of pain and stress in preterm newborn infants, Biol Neonate 1998; 73: 1-9.
2. Bilgen H. Ozek E, Cebeci D, Ors R. Comparison of sucrose, expressed breastmilk and brestfeeding on the neonatal responses to heel prick. J Pain 2001; 2: 301-305.
3. Blass EM, Barr RG. Evolutionary biology and the practice of medicine; the case of management of infant pain experience. J Dev Behav Pediatr 2000; 21: 283-284.
4. Craig KD, Korol CT, Pillai RR, Challenge of judging pain in vulnerable infants. Clin Perinatol 2002; 29: 445-457.
5. Gray L. Miller L W, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborn. Pediatrics 2002; 109: 590-593.(Niranjan Shendurnikar, Kinal Gandhi,)