Comparative Efficacy of Interventions for Analgesia During Heel Prick in Newborn Infants - A Systematic Review and Network Meta-Analysis
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Date
2024-09
Journal Title
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Publisher
The Indian Academy of Pediatrics
Abstract
Context: Heel prick is one among the common painful procedures in neonates. We performed a systematic review and network meta- analysis (NMA) to compare the efficacy of different interventions for analgesia during heel prick in neonates. Evidence acquisition: Medline, Cochrane, Embase and CINAHL databases were searched from inception until February 2023. Randomized and quasi-randomized trials that evaluated different pharmacological and non-pharmacological interventions for analgesia during heel prick for neonates were included. Data from the included trials were extracted in duplicate. A NMA with a frequentist random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. We adhered to the PRISMA-NMA guidelines. Results: One-hundred-and-three trials comparing 51 different analgesic measures were included. Among the 38 interventions, for pain “during” heel prick, non-nutritive suckling (NNS) plus sucrose [SMD -3.15 (-2.62, -3.69)], followed by breastfeeding, glucose, expressed breast milk (EBM), sucrose, NNS and touch massage, had a high certainty of evidence (CoE) to reduce pain scores when compared to no intervention. Among the 23 interventions for pain at 30 seconds after heel-prick, moderate CoE was noted for facilitated tucking plus NNS plus music, glucose, NNS plus sucrose, sucrose plus swaddling, mother holding, EBM, sucrose and NNS. Conclusions: Oral sucrose 2 minutes before combined with NNS during the procedure, was the best intervention for reducing pain during heel prick. It also effectively reduced pain scores 30 seconds and 1 minute after the procedure. Other interventions with moderate to high CoE for a significant reduction in pain during and at 30 seconds after heel prick are oral sucrose, oral glucose, EBM and NNS. All these are low-cost and feasible interventions for most of the settings.
Description
Keywords
Neonatal analgesia, Non-pharmacological pain relief, Pharmacological pain relief, Procedural pain
Citation
Abiramalatha Thangaraj, Ramaswamy Viraraghavan Vadakkencherry, Anne Rajendra Prasad, Amuji Nalina, Thinesh Jayaraman, Venkateshwarlu Vardhelli, Rao Vadije Praveen, Shaik Nasreen Banu, Pullattayil Abdul Kareem, Balachander Bharathi, Sivanandhan Sindhu, Kumar Jogender, Gupta Neeraj, Chawla Deepak, Kumar Praveen, Rao Suman . Comparative Efficacy of Interventions for Analgesia During Heel Prick in Newborn Infants - A Systematic Review and Network Meta-Analysis. Indian Pediatrics. 2024 Sep; 61(9): 851-996