CLINICAL TRIAL article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1622357
Efficacy of Expressed Breast Milk, Facilitated Tucking and Combination Therapy for Pain Management During Heel-Stick in Preterm Neonates:A Randomised Controlled Trial
Provisionally accepted
- Bharati Vidyapeeth Deemed University Medical College, Pune, India
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Background: Heel-stick procedures for glucose monitoring are frequent in Neonatal Intensive Care Units(NICUs) and can have negative physiological and developmental effects on preterm neonates. The National Neonatology Forum(NNF) of India and the American Academy of Pediatrics(AAP) recommend routine use of non-pharmacological measures during such procedures. Our study aimed to evaluate the efficacy of expressed breast milk(EBM), facilitated tucking(FT), and their combination in reducing heel-stick pain in preterm neonates, assessed using the PIPP(Premature Infant Pain Profile) score at 1 and 4 minutes post-procedure. Methods: In randomized controlled trial, preterm neonates born between 27 and 36+6 weeks gestation after eligibility had been randomly allocated to 3 categories: EBM (n = 56), FT (n = 56), and EBM+FT (n = 56) following Institutional Ethics Committee approval and parenteral consent at a tertiary level NICU in Pune. Neonates were videotaped by a senior resident/clinical fellow for 2 minutes prior to until 4 minutes after heel-sticking. The PIPP score was used to determine infants’ pain at time of heel-sticking, at 1 minute and at 4 minutes after heel-sticking. Results: Repeated measures ANOVA revealed significant reductions in pain from baseline (EBM: 8.55+3.19, FT: 8.63+2.83 and EBM+FT: 9.46+2.82; p<0.001) to both 1 minute (EBM: 5.68+2.77, FT: 6.39+3.17 and EBM+FT: 6.45+2.87; p<0.001) and 4 minutes (EBM: 4.05+1.85, FT: 4.66+2.59 and EBM+FT: 4.82+2.39; p<0.001) post-procedure. Bonferroni post-hoc analyses confirmed significant pain reductions within each group across the time points. Conclusions: EBM and FT, either alone or in combination, are effective in pain reduction in preterm neonates during heel-stick procedures.
Keywords: preterm, heel-stick, PIPP score, Expressed breast milk, Facilitated Tucking
Received: 03 May 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Das, Deshmukh, Sohane, Suryawanshi, Malshe and Deshmukh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Nandini Malshe, Bharati Vidyapeeth Deemed University Medical College, Pune, India
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