Efficacy of swaddling and heel warming on pain response to heel stick in neonates: a randomised control trial

Authors

  • Shao-Hui Shu RN, MSN,

    Doctoral Student, Lecturer
    1. College of Nursing, Kaohsiung Medical University, Taiwan
    2. Faculty of Nursing, Tzu Chi College of Technology, Taiwan
    Search for more papers by this author
  • Ying-Li Lee RN, MSN,

    Specialist of Nursing Department
    1. Chi Mei Medical Center, Taiwan
    Search for more papers by this author
  • Mark Hayter PhD, RN, MMed. Sci, BA Cert. Ed, FAAN,

    Head of Department of Nursing and Professor
    1. Faculty of Health and Social care, University of Hull, UK
    Search for more papers by this author
  • Ruey-Hsia Wang PhD, RN

    Professor, Corresponding author
    1. College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Correspondence: Ruey-Hsia Wang, Professor, College of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung, Taiwan, 80708, China. Telephone: +0886-7-3121101 ext. 2641.

      E-mail: wrhsia@kmu.edu.tw

    Search for more papers by this author

Abstract

Aims and objectives

To determine the efficacy of swaddling and heel warming on pain response in neonates following heel stick.

Background

Swaddling has been suggested to reduce pain response in neonates during heel stick. Heel warming is also often performed for drawing blood easily before heel stick. However, the efficacy of both on pain response is unclear.

Design

A randomised controlled study was used.

Methods

Twenty-five neonates were randomly assigned to each of the control, swaddling and heel-warming groups. Heart rate, oxygen saturation Neonatal Infant Pain Scale and duration of crying were used to assess pain reactivity and pain recovery. A greater heart rate and Neonatal Infant Pain Scale increase, or oxygen saturation decrease, indicated higher pain reactivity. A longer duration of heart rate and oxygen saturation changes after heel stick back to baseline indicated a longer pain recovery.

Results

The decrease in oxygen saturation in swaddling group was significantly greater than that in heel-warming group. The increase in the Neonatal Infant Pain Scale in control group was significantly higher than that in swaddling group. The heart rate recovery time in control group and swaddling group was significantly longer than that in heel-warming group. The oxygen saturation recovery time in control group was significantly longer than that in heel-warming group. The duration of crying in control group was significantly longer than those in swaddling group and heel-warming group.

Conclusion

Both swaddling and heel warming decreased the pain response of neonates during heel stick. Heel warming resulted in a lower pain response than did swaddling for neonates, particularly in terms of pain recovery.

Relevance to clinical practice

Heel warming could become a routine practice to decrease the pain response of neonates during heel stick.

Ancillary