Analgesic and neonatal comfort effects of skin-to-skin versus sucrose during two repeated and successive heel punctures in neonates: a randomized clinical trial

Abstract

The skin-to-skin contact and sucrose are effective for pain relief in newborns undergoing a single painful procedures, however, studies are needed to assess the effectiveness of these interventions in relieving pain in repeated procedures , especially skin-to-skin contact. The general objective of this study is to evaluate the effectiveness of skin-to-skin contact compared with 25% sucrose for pain and stress relief in newborns during exposure to repeated heel punctures in the first hours of life in rooming in care. This is a randomized, controlled clinical trial trial, with 60 infants with gestational age e 36 weeks in a hospital in Ribeirão Preto-SP. Will be included newborn with Apgar e 7 at 5 minutes, with clinically stable heart rate and maintenance that have not been exposed to sucrose or skin-to-skin contact as pain relief and who need at least two heels punctures after the hospitalization in the rooming in care. The mothers of the newborns in the skin-to- skin contact group should be in physical and emotional conditions to stay in this position with their newborns during the data collection. Will be excluded infants who are small for gestational age, who had congenital or neurological or clinical diagnosis of birth asphyxia, difficulty swallowing, birth trauma, use of opioids in newborn and / or mother. Newborn between the 4th and 15th hour of life wll receive skin-to-skin contact or sucrose in two consecutive heel puncture. In the skin- to-skin contact group newborns, using only diaper will be positioned in the chest vertically and skin-to-skin for 3 minutes before, during and 3 minutes after the PC. In the sucrose group, newborn will receive 25% sucrose (0.5 ml / kg - maximum 2ml) 2 minutes before the procedure. The pain will be evaluated by the NFCS, heart rate, state of sleeping and waking and crying. The behavior of the newborn will be compared within and between groups by calculating the mean value of the average, minimum, maximum heart hate. The analysis of quantitative variables will be done using the t "Student" or "Mann-Whitney" and for the qualitative or quantitative be categorized using the chi-square or Fisher's exact test. The bivariate analysis of quantitative variables also consider the difference between the scores of puncturing and basal as well as between puncture and recovery for the analysis of effectiveness between the treatments administered. Will use a significance level of 5%. Parents and guardians will sign the term of free and informed consent before the start of data collection .The project was approved by the Ethics Committee of the School of Nursing of Ribeirão Preto (CAAE. 17228713.5.0000.5393).