Article Reviews & Commentary
Article Reviews by Thomas J. Mancuso, MD, FAAP
Breastfeeding in Analgesic in Healthy
Newborns.
Gray L, Miller LW, Philipp BL et al. Pediatrics
2002:109;590-593
This paper reports the results of prospective randomized study of a sample of 30 term infants. The infants in the study were held and breastfed by their mother during heel lance and blood collection for a Newborn Screening Program. Control infants underwent the same test while swaddled in their bassinets. Each observation lasted 7-8 minutes. There was a 2 minute baseline period, followed by the procedure itself and then a 2 minute recovery. Infants were filmed during rest and breastfeeding, heart rates were measured every 10 seconds and in order to reduce variability, a spring loaded heel lance was used for all heel lance procedures. Outcome measures were facial grimacing (from the video), crying and heart rate. Interrater reliability was 95% for all measures. Breastfeeding during the blood drawing procedure virtually eliminated crying and grimacing and also prevented the heart rate increase that normally accompanies heel lance. Breastfed infants cried 4% of the total time compared to controls who cried 43% of the time. Grimacing occurred 8% of the time in breastfed infants vs. controls who grimaced 50% of the time. Eleven of 15 breastfed infants did not cry or grimace at all during the entire study period. Mean increase in heart rate during the procedure was 6 bpm for breastfed infants vs. 29 bpm for control infants.
Commentary
This and earlier work demonstrating the effectiveness of various interventions to combat the pain newborns experience during routine procedures is welcome news. Recently, various nutritional substances (i.e. milk, fat, glucose) have been given infants as analgesics with generally good results and nonnutritive suckling has also been shown to be analgesic. The authors of this paper have also shown that skin to skin contact is analgesic during heel lance procedures. Analgesia provided by skin to skin contact or sucrose is well-enough established the authors comment at the conclusion of their paper that subsequent use of "normal controls" who receive no interventions to combat their pain would be difficult to defend. #include ./footer_include.iphtml