Effect of nesting on pain during heel -stick procedure among term neonates: A prospective clinical trail

The essential criterion of neonatal intensive care unit is prevention of pain among preterm and term neonates. Evidences suggested that a painful procedure at early life affects the neuro developmental outcome in their future. Though it is a minor procedure like heel prick or changing diaper, neonates perceive it, as a painful procedure. Neonatal pain management is an important nursing care aspect while they care the babies in intensive care units. Some pain relieving measures like kangaroo mother care, facilitated tucking, music therapy are available, it is under used. The current study was carried out to assess the effect of nesting on pain during heel stick procedure among term neonates, JIPMER, Puducherry. Methods: This is a prospective clinical trial study. The target population of the study was the term neonates who undergo two times heel prick procedure either in post natal ward or neonatal intensive care unit of WCH, JIPMER, Puducherry. All the available term neonates who got admitted in post natal ward and neonatal intensive care unit of WCH during the study period were the study population. Seventy three term neonates who fulfilled the inclusion and exclusion criteria were participated in this study. The pain was assessed by using standardized tool- Neonatal Infant Pain Scale (NIPS). For analyzing the data, descriptive statistics (frequency, percentage, median and inter quartile range) and inferential statistics (wilcoxson signed rank sum test, Fishers exact test) were used. All the statistical analyses were carried out at 5% level of significance. Results: Among 73 term neonates, during heel prick without nesting, 39(53.4%) of term neonates had severe pain, 3(4.1%) had mild to moderate pain and 31(42.5%) of term neonates had no to mild pain. During heel prick with nesting, majority of term neonates 39(53.4%) had no to mild pain and only 2(2.7%) of term neonates had mild to moderate pain remaining 32(43.8%) of neonates had severe pain. The pain score median (inter quartile range) of neonates without nesting was 6(2, 7) where as with nesting it was 2(1,6).Though the percentage of neonates without nesting who had severe pain 39(53.4%) had been decreased to 32(43.8%) with nesting, the statistical significance was p>0.05.There was no association between level of pain with selected demographic variables such as gender & birth weight. Conclusion: The present study revealed that all the neonates who undergone heel stick procedure had pain. Though nesting provided comfort to the baby by reducing pain during heel prick, there was no statistical significance. There is no significant association between the level of pain and the selected demographic variables. Hence many studies should be conducted in future to find a method to relieve pain among neonates during painful procedures.