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Assessment of cooling effect on neonatal pain during heel prick blood sampling: A randomized clinical trial

Arash Malakian, Masoud Dehdashtiyan, Mohammad Raza Aramesh, Seyyed Mohammad Hassan Aletayeb, Fatemeh Ghazanfari

Background: Heel prick blood sampling is a painful and stressful procedure performed in NICUs (Neonatal Intensive Care Unit) to collect blood samples for some diagnostic laboratory tests. The local cold is a simple, effective and safe analgesia in newborns. Due to the side effects of pharmacological methods of analgesia and also the relative impact of non-drug methods available, it can be a good alternative for them.

Methods: The current study was a double-blind clinical trial, the infants were born in Imam Khomeini Ahvaz in 2016 and randomly assigned to the case and control groups. In the case group, 20 s after exposure to cold compress on the heels, samples were taken and the control group without exposure to cold compress samples were taken. Pain assessment was performed by CRIES (Pain Scales and Pain Assessment) scale. Data collected by SPSS software version 22 and T-test were analyzed statistically.

Results: The current study was conducted on 68 infants assigned to the case and control groups. Study participants included more boys (60.95%) than girls. All infants enrolled in the current study were 1 d old with Apgar scores of 9-10. In the case group, 90.62% of the subjects had scores<4, and accordingly, 9.37% had scores>4. In the control group, 40.62% of the subjects had scores<4 and 59.37% had >4. There was a statistically significant difference in CRIES score between the groups (P-value<0.001) (according to the CRIES score a total score>4 indicates severe pain). There was no significant difference between the case and control groups in the level of arterial oxygen saturation.

Conclusions: This study showed that local cold can reduce the level of pain caused by heel prick blood sampling and can decrease early and late complications of pain in infants.