Procedural Pain Response to Various Heel Prick Devices in Neonates

The heel prick is a frequently performed, painful procedure in neonates, and various devices are available for this purpose. Evaluating and comparing the procedural pain responses triggered by these devices is necessary.

The aim of a recent study was to evaluate and compare the neonatal pain responses associated with three different heel prick devices; vis, automatic lancet, manual lancet, and a 26-gauge hypodermic needle.

In this parallel-group three-arm randomized controlled trial, clinically stable neonates with a gestational age greater than 28 weeks and a birth weight exceeding 800 g, undergoing heel prick for random blood sugar estimation, were included.

Here, the neonates (n=180) were randomly assigned to three groups – automatic lancet (n=59), manual lancet (n=59), or needle (n=62), between 2021-2022. The primary outcome measured was the premature infant pain profile-revised (PIPP-R) score. Secondary outcomes included post-intervention cerebral regional oxygen saturation (CrSO2), changes in CrSO2 (ΔCrSO2), time for CrSO2 normalization using near-infrared spectroscopy, duration of audible cry, and the number of squeezes and pricks required. The analysis was conducted on an intention-to-treat basis.

The results revealed that the median (IQR) PIPP-R scores were similar in the automatic lancet [6 (4, 7.5)], manual lancet [5.5 (3.5, 8)], and needle [6 (3-9.6)] groups, with no statistically significant difference. There were no significant differences in post-intervention CrSO2, ΔCrSO2, and the number of pricks among the groups. However, the time needed for CrSO2 normalization and the number of squeezes were significantly higher with the needle.

All three devices produced comparable pain responses during heel prick procedures in neonates. However, the needle required a higher number of squeezes. Further studies are necessary to compare heel prick devices with long-term neurological follow-up.

Source: Devi R, Priyadarshi M, Singh P, Chaurasia S, Basu S. Indian Pediatrics. 2023 Nov;60(11):893-8.