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Venepuncture is preferable to heel lance for blood sampling in term neonates

Division of Neonatology, Department of Pediatrics, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan

Correspondence to:
Correspondence to:
Dr Ogihara
Division of Neonatology, Department of Pediatrics, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan; ped025{at}poh.osaka-med.ac.jp

Background: The analgesic effect of oral sucrose in newborn infants undergoing painful procedures is generally accepted. For blood sampling, some studies have shown that venepuncture (VP) is less painful than heel lance (HL).

Objective: To determine the least painful and most effective method among blood sampling by VP or HL with or without sucrose.

Design: Randomised, double blind, placebo controlled trial.

Subjects: A total of 100 healthy, full term newborn infants being screened for inborn errors of metabolism were randomly allocated to one of four experimental groups (25 infants in each).

Intervention and outcome measure: Seven specially trained nurses took turns to carry out blood sampling two minutes after administration of oral sucrose or water. Neonatal pain was assessed by the neonatal facial coding system (NFCS), as well as by crying.

Results: Without sucrose, the NFCS score was higher in the HL group than the VP group during blood sampling (median 58 v 23, p<0.001). Oral sucrose significantly reduced the score of the HL group (58 v 47, p<0.01) and also tended to reduce the score of the VP group (23 v 2, p<0.1). However, the HL with sucrose group still had a higher score than the VP without sucrose group (47 v 23, p<0.01). Crying and the total procedure time showed the same trends as the NFCS score.

Conclusions: VP is less painful and more effective than HL for blood sampling in newborn infants. Although oral sucrose may have an additive analgesic effect, it is not necessarily required if VP is used for blood sampling.

Abbreviations: VP, venepuncture; HL, heel lance; NFCS, neonatal facial coding system

Keywords: venepuncture; heel lance; sucrose; pain; analgesia