Poorly managed pain in the neonatal intensive care unit has serious short- and long-term consequences, causing physiological and behavioral instability in preterm infants and long-term changes in their pain sensitivity, stress arousal systems, and developing brains. In a study published in the November issue of PAIN®, researchers report that breastfeeding during minor procedures mitigated pain in preterm neonates with mature breastfeeding behaviors.
Preterm infants can develop various serious short- and long-term consequences, including physiological behavioral instability, long-term changes in their pain sensitivity, stress arousal symptoms and brain development if pain management in neonatal intensive care has been poor. According to a study published in the November issue of PAIN®, researchers have reported that breastfeeding during minor procedures alleviates pain in preterm neonates with mature breastfeeding behaviors.
At present, pain management in preterm neonates for minor procedures, such as pricking for blood tests, is done by using skin-to-skin contact, pacifiers as well as sweet tastes however these interventions only produce a moderate and/or inconsistent pain relief. Research has demonstrated that babies born in normal-term showed a reduced pain response of 80-90% with no serious side effects when they were breastfed during painful procedures.
This has not yet been tested in preterm infants’ as it was believed that preterm infants might associate breastfeeding with pain, hence jeopardizing their ability to feed sufficiently enough to gain proper weight.
Researchers from the Child & Family Research Institute at BC Children’s Hospital and The University of British Columbia in Vancouver, BC, conducted a randomized clinical trial to examine whether preterm infants would demonstrate lower pain scores when breastfed during blood collection. Other objectives of their study were to evaluate whether breastfeeding during a painful procedure would produce a negative impact on the development of breastfeeding skills, and if infants with more experience in breastfeeding would demonstrate lower pain levels and heart rates compared with less experienced feeders when blood was taken.
Researchers divided 57 infants that were born at 30 to 36 weeks gestational age into two groups. When blood was taken, one group was breastfed whilst the other group was given a pacifier. The infants’ heart rates where measured and their faces and hands were videotaped during the procedure whilst researchers measured their responses by using the Behavioral Indicators of Infant Pain. Those babies that were breastfed were also categorized according to the Premature Infant Breastfeeding Behaviors scale.
Overall, researchers established that breastfeeding did not result in a reduction of either behavioral or physiological pain when blood was taken but infants neither showed any immediate adverse effects on breastfeeding skill development.
Leading researcher of the study, Liisa Holsti, PhD, Clinician Scientist at the Child & Family Research Institute; Assistant Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia; and a Canada Research Chair in Neonatal Health and Development, comments:
“Our sample of infants was assessed early in their breastfeeding experience; none of our infants were fully established on breastfeeds. For infants whose breastfeeding skills are inconsistent, it is unlikely to mitigate pain effectively.”
However, researchers established that in the breastfed group, infants with more experience in breastfeeding showed significantly lower behavioral pain scores. According to the authors, the duration in which a blood sample was obtained from infants amongst the breastfed group was remarkably shorter, making the procedure more efficient despite concerns that the procedure may be more difficult.
Professor Holsti explained:
“Finding creative ways to apply breastfeeding for pain mitigation in premature infants is important, because recent research suggests that sweetening agents used to reduce minor procedural pain may act as sedatives rather than analgesics, and they may have negative effects on development. Our findings support further research on the effects of breastfeeding for more mature feeders over repeated events to assess both the short- and long-term benefits of the treatment.”
Written by Petra Rattue