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Adv Neonatal Care 2021 Mar 25. Epub 2021 Mar 25.

Medical University of South Carolina, Charleston.

Background: In premature and critically ill infants, a complete blood count (CBC) is commonly collected via the heel-stick method, which is preferred because of the ongoing requirements to preserve intravenous sites. However, because of sample clotting, these specimens are often rejected, leading to unnecessary repeat heel sticks, painful stimuli, and increased costs.

Purpose: The purpose of this quality improvement project was to decrease the rate of clotted CBC samples obtained from neonates admitted in the neonatal intensive care unit. Read More

Paediatr Anaesth 2021 Mar 4;31(3):330-337. Epub 2021 Jan 4.

Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.

Background: Heel sticks account for most blood tests performed in neonates without analgesia because topical local anesthetics are ineffective on heel glabrous skin. We investigated the antinociceptive effect of an alternative topical analgesic, a vapocoolant spray, on hind paw glabrous skin of rat pups. The spray was applied by two methods: method 1 for 4 s at a distance of 8 cm and method 2 for 10 s at a distance of 18 cm. Read More

Clin Pharmacokinet 2021 Feb;60(2):249-259

Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 6018, Cincinnati, OH, 45229-3039, USA.

Background And Objective: Buprenorphine has been shown to be effective in treating infants with neonatal opioid withdrawal syndrome. However, an evidence-based buprenorphine dosing strategy has not been established in the treatment of neonatal opioid withdrawal syndrome because of a lack of exposure-response data. The aim of this study was to develop an integrated pharmacokinetic and pharmacodynamic model to predict buprenorphine treatment outcomes in newborns with neonatal opioid withdrawal syndrome. Read More

Early Hum Dev 2020 10 24;149:105139. Epub 2020 Jul 24.

University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany.

Background: Response to pain is altered in infants who were exposed to pain- and stressful events in the neonatal period. Infants of diabetic mothers receive several heel sticks after birth for measuring blood glucose and thus may show changes in their behavioral and physiologic response to pain. Moreover, maternal hyperglycemia may alter activity of the hypothalamic pituitary adrenal (HPA) axis reactivity. Read More

Environ Int 2020 06 17;139:105728. Epub 2020 Apr 17.

Center for Environmental Research and Children's Health, University of California, Berkeley School of Public Health, Berkeley, CA, USA.

Background: Maternal and neonatal thyroid function is critical for growth and neurodevelopment. Exposure to individual per- and polyfluoroalkyl substances (PFAS) can alter circulating thyroid hormone levels, but few studies have investigated effects of combined exposure to multiple PFAS.

Objectives: Estimate associations of exposure to multiple PFAS during early pregnancy with maternal and neonatal thyroid function. Read More

BMC Pediatr 2020 04 14;20(1):162. Epub 2020 Apr 14.

Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran.

Background: With the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required. This study aimed to compare the effect of oral dextrose and facilitated tucking in the reduction of pain during heel sticks in premature infants and assess their effectiveness and feasibility for use in emergency settings.

Methods: This study was a randomized controlled clinical trial with cross-over design. Read More

Eur J Pain 2020 07 6;24(6):1107-1118. Epub 2020 Apr 6.

Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.

Background: Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates' pain responses and may lead to inaccurate pain assessment when not appropriately considered.

Objectives: We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN.

Methods: We videotaped 154 full-term and preterm neonates of different GAs during 1-5 capillary heel sticks in their first 14 days of life. Read More

Sudan J Paediatr 2019 ;19(2):81-83

Department of Pediatrics, Faculty of Medicine, Red Sea University, Port Sudan, Sudan.

Neonatal polycythaemia has multifactorial causes, and can be designated as active (increased foetal erythropoiesis) or passive (red blood cell transfusion) polycythaemia. Hematocrit estimated from capillary blood (regularly obtained through "heel sticks" in newborns) is normally the principal laboratory feature facility by which polycythaemia is recognszed. An unusually high proportion of haematocrit builds the risk of hyperviscosity, microcirculatory hypoperfusion, and in the long run multisystem organ dysfunction. Read More

Pediatrics 2019 10 17;144(4). Epub 2019 Sep 17.

Hôpital Universitaire Justinien, Cap-Haïtien, Haiti.

Background: Newborn screening provides early diagnosis for children with sickle cell disease (SCD), reducing disease-related mortality. We hypothesized that rapid point-of-care (POC) Sickle SCAN would be reliable in Haiti and would assist newborn screening.

Methods: Dried blood specimens were obtained from infant heel sticks and analyzed by isoelectric focusing (IEF) at a public hospital in Cap-Haïtien during a 1-year period. Read More

BMC Pediatr 2019 01 15;19(1):20. Epub 2019 Jan 15.

Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.

Background: Assessing pain in neonates is challenging because full-term and preterm neonates of different gestational ages (GAs) have widely varied reactions to pain. We validated the Bernese Pain Scale for Neonates (BPSN) by testing its use among a large sample of neonates that represented all GAs.

Methods: In this prospective multisite validation study, we assessed 154 neonates between 24 2/7 and 41 4/7 weeks GA, based on the results of 1-5 capillary heel sticks in their first 14 days of life. Read More

Z Orthop Unfall 2019 Aug 27;157(4):411-416. Epub 2018 Nov 27.

Centrum für Muskuloskeletale Chirurgie, Abteilung für Kinder- und Neuroorthopädie, Charité - Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health.

This manuscript evaluates the recent standard concept for clubfoot treatment. With regard to the history of clubfoot therapy and the return to conservative methods, the focus is laid on Ponseti's treatment concept. Due to its development according to the precise analysis of the pathoanatomy, the practical principle is simple and easy to learn and consists basically of two redression maneuvers, percutaneous achillotenotomy, and boots and bar abduction treatment. Read More

Birth 2018 12 27;45(4):432-439. Epub 2018 May 27.

Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Background: Rooming-in, or keeping mothers and infants together throughout the birth hospitalization, increases breastfeeding initiation and duration, and is one of the Ten Steps to Successful Breastfeeding.

Methods: The Centers for Disease Control and Prevention's (CDC) Maternity Practices in Infant Nutrition and Care (mPINC) survey is a biennial census of all birth facilities in the United States and its territories. Data from the 2007-2015 mPINC surveys were used to assess trends in the prevalence of hospitals with most (≥90%) infants rooming-in more than 23 hours per day (ideal practice). Read More

Int J Nurs Stud 2018 Jul 7;83:25-33. Epub 2018 Apr 7.

Children's Hospital of Nanjing Medical University, China.

Background: Sucrose combined with non-nutritive sucking provided better pain relief than sucrose or non-nutritive sucking alone in a single painful procedure. However, whether the combination of non-nutritive sucking with sucrose could obtain a significant difference in analgesic effect of the repeated procedural pain than any single intervention has not been established.

Objective: To compare the effect of non-nutritive sucking and sucrose alone and in combination of repeated procedural pain in preterm infants. Read More

Environ Health Perspect 2018 02 27;126(2):027013. Epub 2018 Feb 27.

Center for Environmental Research and Children's Health, University of California , Berkeley School of Public Health, Berkeley, California, USA.

Background: Prenatal exposure to some per- and polyfluoroalkyl substances (PFASs) may disrupt maternal and neonatal thyroid function, which is critical for normal growth and neurodevelopment.

Objectives: We examined associations of PFAS exposure during early pregnancy with maternal and neonatal thyroid hormone levels.

Methods: We studied 732 mothers and 480 neonates in Project Viva, a longitudinal prebirth cohort in Boston, Massachusetts. Read More

Int J Nurs Stud 2018 Jan 8;77:162-170. Epub 2017 Oct 8.

School of Nursing, National Defense Medical Center, Taipei, Taiwan. Electronic address:

Background: Preterm infant pain can be relieved by combining non-nutritive sucking (sucking), oral sucrose, and facilitated tucking (tucking), but the pain-relief effects of oral expressed breast milk (breast milk) are ambiguous.

Aims: We compared the effects of combined sucking+ breast milk, sucking+breast milk+tucking, and routine care on preterm infant pain during and after heel-stick procedures.

Design: A prospective, randomized controlled trial. Read More

BMC Pediatr 2017 Jul 19;17(1):171. Epub 2017 Jul 19.

Department of Neonatology, Children's University Hospital, Bern, Switzerland.

Background: The Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already widely used in clinical settings in the German speaking areas of Europe. Recent findings indicate that pain responses in preterm neonates are influenced by individual contextual factors, such as gestational age (GA), gender and the number of painful procedures experienced. Currently, the BPSN does not consider individual contextual factors. Read More

Int J Nurs Stud 2017 Jul 11;72:24-29. Epub 2017 Apr 11.

Nursing coordinator S.I.T.R.A. Basic Education Sector - Neonatology and Neonatal Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background: The heel stick is the method of choice in most neonatal units for capillary blood sampling, and it represents the most common event among all painful procedures performed on newborns. The type and design of heel stick device and the clinical procedure to collect a blood sample may have an impact on newborn pain response as well.

Objective: To compare the pain response and efficiency of different automated devices for capillary blood collection in newborns. Read More

Ital J Pediatr 2016 Mar 9;42:29. Epub 2016 Mar 9.

Division of Neonatology, Department of Pediatrics, UniversityHospital "A.Gemelli" CatholicUniversity of the Sacred Heart, Rome, Italy.

Background: Continuous glucose monitoring using subcutaneous sensors has been validated in adults and children with diabetes, and was found to be useful in the management of glucose control. We aimed to assess feasibility and reliability of a new continuous glucose monitoring system (CGMS) in a population of preterm neonates using a Clarke error grid (CEG) specifically modified for preterm infants.

Methods: Preterm infants were recruited within 24 h from delivery. Read More

J Trop Pediatr 2016 06 10;62(3):246-9. Epub 2016 Feb 10.

College of Nursing, Eulji University, Daejeon, 301-746 South Korea

Blood sampling for a newborn screening test is necessary for all neonates in South Korea. During the heel stick, an appropriate intervention should be implemented to reduce neonatal pain. This study was conducted to identify the effectiveness of kangaroo care (KC), skin contact with the mother, on pain relief during the neonatal heel stick. Read More

Cochrane Database Syst Rev 2015 Dec 2(12):CD006275. Epub 2015 Dec 2.

Department of Psychology, York University, 4700 Keele Street, OUCH Laboratory, 2004/6 Sherman Health Sciences Building, Toronto, ON, Canada, M3J 1P3.

Background: Infant acute pain and distress is commonplace. Infancy is a period of exponential development. Unrelieved pain and distress can have implications across the lifespan. Read More

Iran J Nurs Midwifery Res 2015 May-Jun;20(3):405-8

Department of Pediatric Nursing School and Midwifery, Isfahan University of Medical Science, Isfahan, Iran.

Background: During health care in the neonatal intensive care unit (NICU), infants undergo extremely painful procedures, which may cause problems, if not controlled, such as changes in the pattern of respiratory rate, heart rate, and blood oxygen saturation. The present study aimed to find the effect of melody on the physiological responses of neonates' heel stick pain.

Materials And Methods: This quasi-experimental study was conducted in Alzahra Hospital (Isfahan, Iran) for 5 months. Read More

Int J Nurs Stud 2015 Aug 23;52(8):1288-99. Epub 2015 Apr 23.

School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address:

Background: Preterm infants manifest pain and stress by behavioural agitation and state change. Few studies have explored the effects of combining nonpharmacological interventions, i.e. Read More

Int J Nurs Stud 2015 Jul 9;52(7):1157-65. Epub 2015 Apr 9.

School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.

Background: Preterm infants' repeated exposure to painful procedures may lead to negative consequences. Thus, non-pharmacological pain management is essential due to medication side effects. Kangaroo Mother Care, which aims at offering human care to neonates, has been established for the treatment of a single painful procedure, but the effectiveness of Kangaroo Mother Care across repeated painful procedures is unknown. Read More

Med Acupunct 2013 08;25(4):285-290

Department of Neurobiology, Center for Translational Neuroscience, University of Arkansas for Medical Sciences , Little Rock, AR. ; Department of Pediatrics and Neonatology, College of Medicine, University of Arkansas for Medical Sciences , Little Rock, AR.

Background: Hospitalized infants may undergo frequent painful procedures with inadequate pain relief. Alternative pain relief interventions are needed.

Objective: The aim of this research was to determine the safety of noninvasive electrical stimulation of acupuncture points (NESAP) in neonates who were receiving routine heel sticks. Read More

Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2013 Oct;27(5):392-4

Objective: This study compared two newborn Cytomegalovirus (CMV) IgG antibody screening ELISA kits and evaluated the detection effectiveness of Abnova kit.

Methods: CMV IgG antibodies were detected by both SeraQuest and Abnova kits from dried blood spot (DBS) samples of 488 newborn heel sticks. The detection abilities of these two kits were compared in different sample dilution concentrations. Read More

Neonatal Netw 2013 Sep-Oct;32(5):353-7

University of Connecticut School of Nursing, 231 Glenbrook Road, Unit 2026, Storrs, CT 06269-2026, USA.

Kangaroo Care (KC) has been recommended as a pain-reducing strategy in neonates; however, KC has not been widely used to minimize procedural pain caused in part by nurses'/phlebotomists' discomfort when positioning themselves and the infant for blood drawing and injections. Therefore, an ergonomically designed setup incorporating the use of KC was introduced into clinical practice to facilitate blood draws and injections. The step-by-step procedure used for heel sticks and injections is presented in this manuscript. Read More

Eur J Pain 2013 Feb 2;17(2):255-63. Epub 2012 Jul 2.

Institute of Nursing Science, University of Basel, Basel, Switzerland.

Background: Evidence indicates that medical and demographic contextual factors (cFs) impact pain responses in preterm neonates, but the existing evidence is very heterogeneous.

Aim: To explore the effect of cFs on pain responses to heel-stick procedures of preterm infants.

Methods: This study was a secondary analysis of data collected during a randomized controlled trial examining pain response to non-pharmacological interventions across repeated heel sticks. Read More

Int J Nurs Stud 2013 Jul 12;50(7):883-94. Epub 2012 Oct 12.

School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.

Background: Pain and stress agitate preterm infants, interrupting their sleep. Frequent high arousal states may affect infants' brain development and illness recovery. Preserving infants' sleep and relieving their pain during painful procedures are both important for their health. Read More

Pediatrics 2012 Feb 9;129(2):299-308. Epub 2012 Jan 9.

Institute of Nursing Science, University of Basel, Basel, Switzerland.

Objectives: To test the comparative effectiveness of 2 nonpharmacologic pain-relieving interventions administered alone or in combination across time for repeated heel sticks in preterm infants.

Methods: A multicenter randomized controlled trial in 3 NICUs in Switzerland compared the effectiveness of oral sucrose, facilitated tucking (FT), and a combination of both interventions in preterm infants between 24 and 32 weeks of gestation. Data were collected during the first 14 days of their NICU stay. Read More

Int J Nurs Stud 2012 Mar 14;49(3):300-9. Epub 2011 Oct 14.

School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.

Background: Preterm infants' repeated exposure to painful procedures may contribute to negative consequences. Thus, improving preterm infants' neurodevelopmental outcomes requires prioritising their pain management.

Objectives: To compare the effectiveness of two non-pharmacological pain-relief strategies (non-nutritive sucking and facilitated tucking) with routine care on preterm infants' pain, behavioural, and physiological responses before, during, and after heel-stick procedures. Read More