• Hsueh-Fang Peng, Ti Yin, Luke Yang, Chi Wang, Yue-Cune Chang, Mei-Jy Jeng, and Jen-Jiuan Liaw.
• Department of Nursing, Veteran General Hospital, Taipei, Taiwan.
• Int J Nurs Stud. 2018 Jan 1; 77: 162-170.

BackgroundPreterm 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.AimsWe 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.DesignA prospective, randomized controlled trial.SettingsLevel III neonatal intensive care unit and a neonatal unit at a medical center in Taipei.Participants/SubjectsPreterm infants (N=109, gestational age 29-37 weeks, stable disease condition) needing procedural heel sticks were recruited by convenience sampling and randomly assigned to three treatment conditions: routine care, sucking+ breast milk, and sucking+breast milk+ tucking.MethodsPain was measured by watching video recordings of infants undergoing heel-stick procedures and scoring pain at 1-min intervals with the Premature Infant Pain Profile. Data were collected over eight phases: baseline (phase 1, 10min without stimuli before heel stick), during heel stick (phases 2 and 3), and a 10-min recovery (phases 4-8).ResultsFor infants receiving sucking+ breast milk, pain-score changes from baseline across phases 2-8 were 2.634, 4.303, 2.812, 2.271, 1.465, 0.704, and 1.452 units lower than corresponding pain-score changes of infants receiving routine care (all p-values <0.05 except for phases 6 and 7). Similarly, for infants receiving sucking +breast milk+ tucking, pain-score changes from baseline were 2.652, 3.644, 1.686, 1.770, 1.409, 1.165, and 2.210 units lower than corresponding pain-score changes in infants receiving routine care across phases 2-8 (all p-values <0.05 except for phase 4). After receiving sucking +breast milk +tucking and sucking +breast milk, infants' risk of mild pain (pain score ≥6) significantly decreased 67.0% and 70.1%, respectively, compared to infants receiving routine care. After receiving sucking +breast milk +tucking and sucking +breast milk, infants' risk of moderate-to-severe pain (pain score ≥12) decreased 87.4% and 95.7%, respectively, compared to infants receiving routine care.ConclusionThe combined use of sucking+breast milk +tucking and sucking+breast milk effectively reduced preterm infants' mild pain and moderate-to-severe pain during heel-stick procedures. Adding facilitated tucking helped infants recover from pain across eight phases of heel-stick procedures. Our findings advance knowledge on the effects of combining expressed breast milk, sucking, and tucking on preterm infants' procedural pain.Copyright © 2017 Elsevier Ltd. All rights reserved.

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