Location
Virtual
Start Date
1-3-2024 8:00 AM
End Date
1-3-2024 3:30 PM
Keywords:
texas; covenant
Description
Background:
Newborns encounter many painful events, including heel sticks, venous blood sampling, peripheral intravenous insertions, and more. Newborns cannot verbally express pain, and caregivers rely on changes in vital signs (increased heart rate, decreased oxygen saturations) behavior (long periods of inconsolable crying), and facial expressions to grade newborn pain. Pain management in neonates is critical to preserve neurodevelopment. Due to adverse effects of pharmacological pain management interventions in neonatal populations, non-pharmacological pain management interventions are often utilized in newborns, such as swaddling, non-nutritive sucking, kangaroo care, oral sucrose, holding, touching, music, and breastfeeding. However, the most effective pain management intervention, or combination of interventions, among neonatal populations remain unclear.
Purpose:
To complete an integrative review of the literature to understand effective single and multi-modal non-pharmacological pain relief strategies among neonatal populations.
Methods:
An integrative research review was conducted using CINAHL plus with full text, MEDLINE complete, PubMed, and Cochrane. Search terms used were “neonates or newborns” and “swaddle or swaddling” and “pain management or pain control.” Exclusion criteria consisted of articles which did not address study question, articles descriptive of interventions only, lacking control groups, different hospital settings other than neonatal intensive care units or newborn nursery, or suggestive articles. Article quality was determined using the GRADE criteria, and level 1 articles were appraised using the PRISMA checklist. Level 2 and 4 articles were appraised using the Mixed Methods Appraisal Tool version 2018.
Results:
Sixty articles were located. Nineteen duplicates and twenty-four ineligible articles were removed. The 17 remaining studies in this research review demonstrated non-pharmacological interventions alone can reduce pain in neonates. Single use of interventions including swaddling, oral sucrose administration, and non-nutritive sucking led to lower infant heart rates, increased oxygen saturations, influenced shorter periods of crying, and lowered neonatal pain scores. Furthermore, various combinations of non-pharmacological interventions were demonstrated as superior pain management strategies based on improved physiological statistics, behavior and pain scores in infants when compared to single use interventions.
Conclusion:
Evidence for the study came from one level four, nine level two, and three level one studies. Research reviews suggest single use pain management strategies such as swaddling the newborn during painful procedures has a positive effect on behavior, physiological statistics, and pain scores in neonates. Evidence suggests a multimodal approach to non-pharmacological interventions of swaddling, non-nutritive sucking, and oral sucrose has stronger benefits on pain relief than swaddling alone. Further studies need to be conducted to study the concentration, sucrose amount, and administration time frame of all interventions.
Implications for practice:
Swaddling, oral sucrose, and non-nutritive sucking alone, are effective for pain control in newborns. Combining swaddling with non-nutritive sucking or oral glucose is more effective than swaddling alone. The most effective method for pain control in newborn is a multimodal approach utilizing all three interventions. Different gestational ages benefit from different approaches to non-pharmacological pain interventions. Nurses in the clinical setting should utilize any non-pharmacological pain intervention when performing potentially painful procedures.
Recommended Citation
Shaw, Staci, "Effective Non-pharmacological Pain Relief Interventions Among Neonates: An Integrative Research Review" (2024). Providence Nursing Research Conference 2023 – Present. 16.
https://digitalcommons.providence.org/prov_rn_conf_annual/2024/posters/16
Clinical Institute
Women & Children
Department
Perinatology/Neonatology
Department
Pediatrics
Department
Nursing
Effective Non-pharmacological Pain Relief Interventions Among Neonates: An Integrative Research Review
Virtual
Background:
Newborns encounter many painful events, including heel sticks, venous blood sampling, peripheral intravenous insertions, and more. Newborns cannot verbally express pain, and caregivers rely on changes in vital signs (increased heart rate, decreased oxygen saturations) behavior (long periods of inconsolable crying), and facial expressions to grade newborn pain. Pain management in neonates is critical to preserve neurodevelopment. Due to adverse effects of pharmacological pain management interventions in neonatal populations, non-pharmacological pain management interventions are often utilized in newborns, such as swaddling, non-nutritive sucking, kangaroo care, oral sucrose, holding, touching, music, and breastfeeding. However, the most effective pain management intervention, or combination of interventions, among neonatal populations remain unclear.
Purpose:
To complete an integrative review of the literature to understand effective single and multi-modal non-pharmacological pain relief strategies among neonatal populations.
Methods:
An integrative research review was conducted using CINAHL plus with full text, MEDLINE complete, PubMed, and Cochrane. Search terms used were “neonates or newborns” and “swaddle or swaddling” and “pain management or pain control.” Exclusion criteria consisted of articles which did not address study question, articles descriptive of interventions only, lacking control groups, different hospital settings other than neonatal intensive care units or newborn nursery, or suggestive articles. Article quality was determined using the GRADE criteria, and level 1 articles were appraised using the PRISMA checklist. Level 2 and 4 articles were appraised using the Mixed Methods Appraisal Tool version 2018.
Results:
Sixty articles were located. Nineteen duplicates and twenty-four ineligible articles were removed. The 17 remaining studies in this research review demonstrated non-pharmacological interventions alone can reduce pain in neonates. Single use of interventions including swaddling, oral sucrose administration, and non-nutritive sucking led to lower infant heart rates, increased oxygen saturations, influenced shorter periods of crying, and lowered neonatal pain scores. Furthermore, various combinations of non-pharmacological interventions were demonstrated as superior pain management strategies based on improved physiological statistics, behavior and pain scores in infants when compared to single use interventions.
Conclusion:
Evidence for the study came from one level four, nine level two, and three level one studies. Research reviews suggest single use pain management strategies such as swaddling the newborn during painful procedures has a positive effect on behavior, physiological statistics, and pain scores in neonates. Evidence suggests a multimodal approach to non-pharmacological interventions of swaddling, non-nutritive sucking, and oral sucrose has stronger benefits on pain relief than swaddling alone. Further studies need to be conducted to study the concentration, sucrose amount, and administration time frame of all interventions.
Implications for practice:
Swaddling, oral sucrose, and non-nutritive sucking alone, are effective for pain control in newborns. Combining swaddling with non-nutritive sucking or oral glucose is more effective than swaddling alone. The most effective method for pain control in newborn is a multimodal approach utilizing all three interventions. Different gestational ages benefit from different approaches to non-pharmacological pain interventions. Nurses in the clinical setting should utilize any non-pharmacological pain intervention when performing potentially painful procedures.
