Blood sampling heel lance for neonatal screening is the most frequent painful manoeuvre in Neonatal Units in healthy neonates.~Some techniques showed efficacy evidence in reducing pain response: sucrose solutions, breastfeeding during blood sampling, topical local anaesthetics.~A Cochrane Review in 2004 recommends the administration of sucrose 0.24-0.48 g (1-2 ml of 24% sucrose solution). It reduces PIPP scale rate about 20%.~Our purpose is to compare the antinociceptive effect of 1 ml 30% sucrose solution administered 2 minutes before heel lancing vs blood sampling heel lance during breastfeeding.~PIPP scale is a validated 7-indicator scale for the assessment of procedural pain in preterm and term neonates.~Informant consent was asked parents during consultation by a Pediatrician of the Neonatal Unit of the Hospital in the last months of pregnancy.~After parent written consent was obtained, 100 three day old neonates were randomized for treatment A (breastfeeding) or B (sucrose solution administration). The nurse opened consecutively numbered envelopes.~Timing of operators: Group A Breastfeeding~The heel of neonate was warmed up by a glove full of water at 40° C for 2 minutes.~Monitoring of Oxygen Saturation and Heart Rate.~The neonate was breastfed by the mother till the nurse watched a continuous active suction.~Administration of first phase of PIPP scale (15 seconds before heel lance).~Digital Voice Record started~Heel Lance with an automated piercing device .~Squeezing for blood sampling till filling 4 catch basins for neonatal screening. If necessary a new heel lance was practiced.~Administration of the second phase of PIPP scale.~Record of duration of blood sampling and collateral effects~Stop Digital Voice Recording~Group B Sucrose administration~The neonate was laid on a baby-changing table.~The heel of neonate was warmed up by a gloves full of water a 40° C for 2 minutes.~Oral administration of 1 ml of 30% sucrose solution.~Monitoring of Oxygen Saturation and Heart Rate.~Administration of first phase of PIPP scale (15 seconds before heel lance).~Digital Voice Record starts~Heel Lance with an automated piercing device.~Squeezing for blood sampling till filling 4 catch basins for neonatal screening. If necessary a new heel lance was practiced.~Administration of the second phase of PIPP scale.Record of duration of blood sampling and collateral effects.~Stop Digital Voice Recording~Blood sampling was practiced by skilled pediatric nurses. Registration of data, PIPP scale, voice record was made by a second operator, blind to the pur pose of the study.~A third blind operator collected paper data and checked voice record (outcome cry behaviour).
The purpose of this study is to compare the antinociceptive effect of 1 ml of 30% sucrose solution vs breastfeeding on neonatal screening heel lance