CLINICAL S TUDIES

Facilitated Tucking: A Nonpharmacologic Comfort Measure for Pain in Preterm Neonates

La gestion de la douleur chez les nouveau-nés prématurés en unités de soins mère kangourou occupe une place prédominante dans la prise en charge de ces patients. Le massage, l’alimentation et la posture en peau à peau sont trois méthodes non-pharmacologiques élémentaires utilisées pour gérer cette douleur.

L’objectif principal de cette étude était d’émettre des recommandations sur les différentes techniques choisies et recensées dans la littérature : le massage, l’alimentation et la posture.

Cette revue systématique s’est appuyée sur les recommandations PRISMA 2020. La recherche d’articles a été réalisée de novembre 2020 à décembre 2022 dans les base de données PubMed, Cochrane et Pediatrics selon les mots clés : nouveau-nés prématurés, comparaison à un autre traitement, recevoir l’intervention. La qualité méthodologie des études a été déterminée au moyen de l’échelle PEDro. La douleur était l’unique paramètre étudié.

Quatorze essais contrôlés randomisés ont été inclus dans l’étude parmi les 376 études identifiées. Treize avaient un niveau de preuve 1 (score PEDro ≥ 7), le dernier un niveau de preuve 2 (score PEDro < 7). Le massage, l’alimentation et la posture ont montré un effet significativement positif sur le critère de jugement de la douleur.

Cette revue systématique permet de conclure que ces techniques sont efficaces indépendamment les unes des autres. Les associer lors des soins est donc indispensable. Il est conseillé aux professionnels de santé des unités de soins mère kangourou d’ajouter ces techniques à leur prise en charge afin d’obtenir une moindre douleur lors des actes médicaux. Ces techniques peuvent également être pratiquées par les parents.

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Preterm neonates pain management in kangaroo mother care units is a major part of the management of these patients. Massage, nutrition and the skin-to-skin kangaroo posture are three basic non-pharmacological methods that allow pain management for preterm neonates.

The main objective of this study was to make recommendations on the different techniques chosen and identified in the literature scientific, i.e. massage, nutrition and kangaroo posture.

This systematic review was based on the 2020 PRISMA recommendations. Articles were searched between 2020 November and 2021 November on the search engines PubMed, Cochrane, Pediatrics, according to key words such as preterm infants, comparison to another treatment, receiving the intervention. The methodological quality of the studied was based on the PEDro scale. Pain was the only parameter studied in three non-pharmacological techniques: massage, nutrition and kangaroo posture.

Fourteen randomized controlled trials were included in the study out of the 376 studies identified through the various research equations. Thirteen articles had a level 1 of evidence (PEDro score ≥ 7) and one a level 2 of evidence (PEDro score < 7). Massage, nutrition and the kangaroo posture showed a definitive improvement on pain.

This review concludes that these techniques are effective independently of each other. Associating them during care is thereby essential. It is therefore advisable for health professionals in kangaroo care units to add these techniques to their care in order to decrease the patients’ pain during medical procedures. These techniques can also be practiced by the parents.

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To investigate the effect of facilitated tucking on pain intensity and comfort during heel stick blood sampling among full-term newborns in Jordan.

A quasi-experimental, with a pretest-posttest non-equivalent control group design was conducted.

A convenience sample of 64 full-term newborns was assigned into two groups: an intervention (N = 32) and a control group (N = 32). Pain and comfort scores were measured three times using the Neonatal Infant Pain Scale and Comfort Behavior Scale before the heel stick procedure and the tenth minute after the stick. A split-plot ANOVA was used to investigate the mean differences in pain and comfort scores.

ANOVA results have shown no significant differences between both groups at the beginning of the study. In contrast, the intervention group reported a lower pain score than the control group in the second measurement (2.44 ± 0.50 vs 4.09 ± 0.78 p < 0.001) and third measurement (1.81 ± 0.74 vs 3.63 ± 0.83 p < 0.001). Additionally, the intervention group has also reported better comfort scores in the second measurement (15.41 ± 0.87 vs 19.22 ± 1.60 p < 0.001) and third measurement (13.97 ± 1.86 vs. 18.41 ± 1.12 p < 0.001) and the impact of facilitated tucking technique has continued its effect for 15 min after heel stick with the overall large effect size for clinical significance.

Facilitated tucking is a simple, safe, and inexpensive technique that was effective in reducing newborns’ pain and improving their comfort during heel-stick procedures. Evidence-based practices should be an essential element of neonatal pain management.

This study's aim to determine the effect of facilitated tucking position applied to late preterm infants on physiological parameters, comfort, and breastfeeding performance.

The study was conducted in a randomized controlled experimental design (Clinical Trial number: NCT04704180).

The study was conducted in the neonatal intensive care unit of a state hospital in eastern Turkey between November 2018 and July 2019. The sample consisted of 89 neonates meeting the inclusion criteria. Data were collected using the Neonatal Introductory Information Form, Physiological Parameter Follow-Up Chart, Neonatal Comfort Behavior Scale (NCBS), and Latch Breastfeeding Diagnosis Measurement Form. Facilitated tucking position was applied to the neonates in the experimental group (n = 44) in the early postnatal period. The routine application of the unit was performed on neonates (n = 45) in the control group. Ethical principles were followed at every stage of the study.

It was determined that the physiological parameters (heart rate, oxygen saturation, body temperature, respiratory rate) in the experimental group positioned with facilitated tucking showed a significant improvement compared to the control group (p<0.001). When the mean comfort (Experiment: 9.79±3.63, Control: 15.73±5.13) and LATCH (Experiment: 8.00±1.76, Control: 5.82±2.18) scores of neonates in the experimental group were compared with the control group, a significant difference was found in favor of the experimental group (p<0.001).

It was determined that the physiological parameters, comfort level and sucking success of late preterm infants who were positioned with facilitated tucking in the early postnatal period were positively affected.

This study was conducted to assess the effect of recorded maternal voice, breast milk odor, and incubator cover on the pain and comfort of preterm infants during peripheral cannulation.

This study was a randomized controlled trial. The sample of the study included 136 preterm infants who met the case selection criteria. The infants were randomly assigned to different groups.

In the study, a recorded maternal voice was played to the maternal voice group. The breast milk odor group was exposed to the odor of breast milk. The incubator cover group was covered by using an incubator cover before, during, and after the peripheral cannulation procedure on the infants in the experimental group.

While no difference was observed between the groups before the peripheral cannulation procedure in terms of the total Premature Infant Pain Profile (PIPP) scores, a significant difference existed between the PIPP scores during and after the procedure. This difference was due to the incubator cover group.

Breast milk odor, recorded maternal voice, and incubator cover in preterm infants are recommended as simple, safe, and supportive stimuli that facilitate positive effects during painful procedures.

Preterm infants manifest pain and stress by behavioural agitation and state change. Few studies have explored the effects of combining nonpharmacological interventions, i.e. non-nutritive sucking, oral sucrose, and facilitated tucking, on infants’ behaviours across painful procedures.

To explore the effects of combined use of three nonpharmacological interventions (non-nutritive sucking, oral sucrose, and facilitated tucking) on infants’ pain- and stress-related behaviours during four assessment phases: baseline, intervention, heel stick, and recovery.

Prospective, randomised controlled trial.

Level III neonatal intensive care unit in Taipei.

A convenience sample of 110 infants (gestational age 27–37 weeks) needing heel sticks was randomly assigned to five combinations of nonpharmacological treatments: (1) routine care, (2) non-nutritive sucking + facilitated tucking, (3) oral sucrose + facilitated tucking, (4) non-nutritive sucking + oral sucrose, and (5) non-nutritive sucking + oral sucrose + facilitated tucking. Outcomes were infants’ withdrawal or stress (grimace, limb and trunk extension or squirming) and approach or self-soothing (sucking, sucking search, or mouthing; hand holding or grasping; and hand to mouth, face) behaviours.

The frequency of infants’ withdrawal behaviours decreased significantly when they received combinations of nonpharmacological interventions before heel stick. Specifically, grimace frequency decreased by 32.2%, 30.6%, 19.7%, and 13.8% in infants receiving oral sucrose + non-nutritive sucking + facilitated tucking, non-nutritive sucking + oral sucrose, oral sucrose + facilitated tucking, and non-nutritive sucking + facilitated tucking, respectively, compared to those receiving routine care across assessment phases. Furthermore, infants’ frequency of limb and trunk extension or squirming decreased by 24.0% when they received non-nutritive sucking + oral sucrose + facilitated tucking compared to those receiving routine care. Infants’ frequency of approach behaviours did not change significantly across all phases when they received non-nutritive sucking + oral sucrose + facilitated tucking, non-nutritive sucking + oral sucrose, and oral sucrose + facilitated tucking compared to those receiving routine care.

The combined use of nonpharmacological interventions (non-nutritive sucking + oral sucrose + facilitated tucking) effectively reduced the frequencies of infants’ withdrawal behaviours, i.e. grimace and limb and trunk extension or squirming. Our results provide evidence supporting clinicians’ incorporation of the combined use of facilitated tucking, oral sucrose, and non-nutritive sucking into clinical practice during painful procedures. Heel-stick procedures can be atraumatic when conducted while infants are stable and quiet, appropriately positioned, and stabilised and by offering facilitated tucking, oral sucrose, and non-nutritive sucking before gently sticking the heel and squeezing blood.