Kangaroo Care (Skin Contact) Reduces Crying Response to Pain in Preterm Neonates: Pilot Results

Crying commonly occurs in response to heel stick and adversely affects the infant's physiologic stability. Minimal crying in response to pain is desired. “Kangaroo Care,” skin contact between mother and infant, reduces pain and may reduce crying in response to pain. The purpose of this pilot study was to test Kangaroo Care's effect on the preterm infant's audible and inaudible crying response to heel stick. Inaudible crying has not been previously studied. A prospective randomized cross-over study with 10 preterm infants 2-9 days old (30-32 weeks' postmenstrual age) was conducted. Infants were randomly assigned to two sequences (sequence A: day 1 heel stick in Kangaroo Care [after 30 min of prone skin contact upright between maternal breasts] and day 2 heel stick in incubator [inclined, nested and prone]; or sequence B: opposite of sequence A) was conducted. Videotapes of baseline, heel warming, heel stick, and recovery phases were scored for audible and inaudible crying times. Audible and inaudible crying times for each subject in each phase were summed and analyzed by repeated-measures analysis of variance. Subject characteristics did not differ between those in the two sequences. Crying time differed between the study phases on both days (p ≤ .001). When in Kangaroo Care compared with the incubator, crying time was less during the heel stick (p = .001) and recovery (p = .01) phases, regardless of sequence. Because Kangaroo Care reduced crying in response to heel stick in medically stable preterm infants, a definitive study is merited before making recommendations.     

Human Touch Effectively and Safely Reduces Pain in the Newborn Intensive Care Unit

This was a feasibility pilot study to evaluate the efficacy of the nonpharmacologic pain management technique of gentle human touch (GHT) in reducing pain response to heel stick in premature infants in the neonatal intensive care unit (NICU). Eleven premature infants ranging from 27 to 34 weeks' gestational age, in a level III NICU in a teaching hospital, were recruited and randomized to order of treatment in this repeated-measures crossover-design experiment. Containment with GHT during heel stick was compared with traditional nursery care (side lying and “nested” in an incubator). Heart rate, respiratory rate, oxygen saturation, and cry were measured continuously beginning at baseline and continuing through heel warming, heel stick, and recovery following the heel stick. Infants who did not receive GHT had decreased respiration, increased heart rate, and increased cry time during the heel stick. In contrast, infants who received GHT did not have decreased respirations, elevated heart rates, or increased cry time during the heel stick. No significant differences were noted in oxygen saturation in either group. GHT is a simple nonpharmacologic therapy that can be used by nurses and families to reduce pain of heel stick in premature infants in the NICU.     

Kangaroo Care and Behavioral and Physiologic Pain Responses in Very-Low-Birth-Weight Twins: A Case Study

The purpose of this case study was to describe pain responses in three study conditions: longer (30 minutes) kangaroo care (KC) before and throughout heel stick (KC30), shorter (15 minutes) KC before and throughout heel stick (KC15), and incubator care throughout heel stick (IC) in 28-week gestational age twins. Pain responses were measured by crying time, Preterm Infant Pain Profile (PIPP), and heart rate variability indexes, including low-frequency power (LF, representing sympathetic activity), high-frequency power (HF, parasympathetic activity), and LF/HF ratio (sympathetic-parasympathetic balance). Both twins cried more and had higher PIPP pain scores and tachycardia during heel stick in the IC condition. Infant B had an incident of apnea and tachycardia by the end of the heel stick and a bradycardia episode during recovery in the IC condition. The twins had lower LF/HF ratios (better autonomic nervous system balance) during recovery in both longer and shorter KC conditions compared with the IC condition. Infant B had difficulty returning to LF/HF ratio baseline level after the painful procedure in the IC condition. These data suggest that both longer and shorter KC before and throughout painful procedures can be helpful in reducing behavioral and physiologic pain responses in preterm infants.     

Effects of skin-to-skin contact on autonomic pain responses in preterm infants

The purpose of this randomized crossover trial was to determine the effects on autonomic responses in preterm infants of longer Kangaroo Care (30 minutes, KC30) and shorter KC (15 minutes, KC15) before and throughout heel stick compared with incubator care (IC). Beat-to-beat heart rate (HR) and spectral power analysis of heart rate variability, low frequency power (LF), high frequency power (HF), and LF/HF ratio were measured in 26 infants. HR changes from Baseline to Heel Stick were significantly less in KC30 and KC15 than in IC, and more infants had HR decrease in IC than in 2 KC conditions. In IC, LF and HF significantly increased from Baseline to Heel Stick and dropped from Heel Stick to Recovery; in 2 KC conditions, no changes across study phases were found. During Heel Stick, LF and HF were significantly higher in IC than in KC30. In all 3 conditions, LF/HF ratio decreased from Baseline to Heel Stick and increased to Recovery; no differences were found between IC and two KC conditions. Both longer and shorter KC before and throughout heel stick can stabilize HR response in preterm infants, and longer KC significantly affected infants' sympathetic and parasympathetic responses during heel stick compared with incubator care. PERSPECTIVE: This study showed that KC has a significant effect on reducing autonomic pain responses in preterm infants. The findings support that KC is a safe and effective pain intervention in the neonatal intensive care unit.     

Effect of Kangaroo Care and Oral Sucrose on Pain in Premature Infants: A Randomized Controlled Trial

BackgroundPremature infants hospitalized in the neonatal intensive care unit are routinely exposed to many painful procedures. Pain experienced during the neonatal period may lead to negative outcomes, especially in preterm neonates, hence pain in infants should be reduced. Kangaroo care and oral sucrose are some of the methods that can help reduce pain.AimThis study aimed to compare the effects of kangaroo care and oral sucrose on pain relief in preterm infants during heel lancing.MethodsOur study involved 64 infants. The infants were randomly divided into two groups using a randomized block design of drawing out slips from a thick, non-transparent envelope. There were 64 slips in this envelope (32 for kangaroo care and 32 for oral sucrose). Kangaroo care was given to the preterm infants in the first group and oral sucrose to those in the second group. In both groups, heart rate and oxygen saturation were measured and pain score was evaluated by two observers using the Premature Infant Pain Profile (PIPP) before, during, and 2 minutes after blood sampling by heel lancing.ResultsThere was a statistically significant difference between the groups in favor of the kangaroo group in terms of change in the PIPP values after heel lancing. Kangaroo care is more effective than oral sucrose in pain relief during heel lancing in preterm infants.ConclusionsIn addition to many benefits it offers to infants, kangaroo care can be used to reduce pain during painful procedures in premature infants.     

Randomized crossover trial of kangaroo care to reduce biobehavioral pain responses in preterm infants: a pilot study

Kangaroo care (KC), skin-to-skin contact between mother and infant, is a promising method for blunting pain responses. This crossover pilot tested KC effects on biobehavioral responses to heel stick in preterm infants (30-32 weeks' gestational age, 2-9 days old) measured by Premature Infant Pain Profile (PIPP) and salivary and serum cortisol. Mother-infant dyads were randomly assigned to KC heel stick (KCH) first or incubator heel stick (IH) first. Study 1 (80-min study, N = 18) tested the effect of 80 min of KC before and throughout the heel stick procedure versus incubator care. Study 2 (30-min study, N = 10) tested 30 min of KC before and throughout the heel stick versus incubator care. KCH and IH began during a premeasurement phase and continued through four data collection phases: baseline, heel warming, heel stick, and recovery. PIPP responses were measured every 30 s during data collection; salivary cortisol was measured at the end of baseline and recovery; and serum cortisol was measured during heel stick. Study 1 showed no differences between KCH and IH. Study 2 showed lower PIPP scores at four time points during recovery (p < .05 to p < .001), lower salivary cortisol at the end of recovery (p < .05), and lower serum cortisol during heel stick for the KCH condition (p < .05) as well as clinically lower PIPP scores in the KCH condition during heel stick. Thirty minutes of KC before and throughout the heel stick reduced biobehavioral responses to pain in preterm infants.     

The effects of skin‐to‐skin contact during acute pain in preterm newborns

Background and purpose: Several promising non‐pharmacological interventions have been developed to reduce acute pain in preterm infants including skin‐to‐skin contact between a mother and her infant. However, variability in physiological outcomes of existing studies on skin‐to‐skin makes it difficult to determine treatment effects of this naturalistic approach for the preterm infant. The aim of this study was to test the efficacy of mother and infant skin‐to‐skin contact during heel prick in premature infants. Method: Fifty nine stable preterm infants (born at least 30 weeks gestational age) who were undergoing routine heel lance were randomly assigned to either 15min of skin‐to‐skin contact before, during and following heel prick (n=31, treatment group), or to regular care (n=28, control group). Throughout the heel lance procedure, all infants were assessed for change in facial action (NFCS), behavioral state, crying, and heart rate. Results: Statistically significant differences were noted between the treatment and control groups during the puncture, heel squeeze and the post phases of heel prick. Infants who received skin‐to‐skin contact were more likely to show lower NFCS scores throughout the procedure. Both groups of infants cried and showed increased heart rate during puncture and heel squeeze although changes in these measures were less for the treated infants. Conclusions: Skin‐to‐skin contact promoted reduction in behavioral measures and less physiological increase during procedure. It is recommended that skin‐to‐skin contact be used as a non‐pharmacologic intervention to relieve acute pain in stable premature infants born 30 weeks gestational age or older.     

The effects of auditory interventions on pain and comfort in premature newborns in the neonatal intensive care unit; a randomised controlled trial

ObjectiveThis study investigated the effects of three auditory interventions; white noise, recorded mother's voice, and MiniMuffs, applied during a heel lance on pain and comfort in premature infants in the neonatal intensive care units.Design and methodsThis experimental, parallel, randomised controlled research was conducted in a state hospital tertiary-level neonatal intensive care unit. The sample comprised sixty-four premature infants with gestational ages of 31–36 weeks. The infants were randomly assigned to four groups: i) white noise, ii) recorded mother’s voice, iii) MiniMuffs, and iv) control. Pain and comfort of newborns were evaluated according to the Neonatal Infant Pain Scale (NIPS) and the COMFORTneo scale. Oxygen saturation, heart rate, and crying time were also measured.ResultsThe mean of oxygen saturation levels in the white noise, recorded mother's voice, and MiniMuffs group were higher than the control group. The heart rate, crying time, mean NIPS score, COMFORTneo score of the premature neonates in the white noise, recorded mother’s voice, and MiniMuffs groups were significantly lower than the control group (p < .001).ConclusionAuditory interventions used during heel lance reduce the pain and increase the comfort of the premature infants. White noise is extremely effective in preventing infants’s pain.     

非营养性吸吮联合拥抱抚触对缓解新生儿疼痛的效果观察

目的:探讨非药物治疗措施缓解新生儿疼痛的效果。方法:将80例住院新生儿随机分为非营养性吸吮组(对照组)和非营养性吸吮联合拥抱抚触组(观察组)各40例,在采足跟血疼痛刺激前,刺激后20 s、1 min、3 min分别记录心率、呼吸、经皮氧饱和度和哭声持续时间,并在穿刺1 min后根据新生儿面部编码系统、新生儿疼痛评估量表进行疼痛评分。结果:穿刺后20 s两组新生儿心率加快(P<0.05),1 min时心率恢复到穿刺前水平;穿刺后20 s、1 min两组新生儿呼吸频率均加快(P<0.05),3 min时恢复到穿刺前水平;两组新生儿穿刺前后经皮血氧饱和度均无明显变化(P>0.05),穿刺后非营养性吸吮联合拥抱抚触组新生儿哭声持续时间少于非营养性吸吮组(P<0.05);且新生儿面部编码系统和新生儿疼痛评估量表评分均低于非营养性吸吮组(P<0.05)。结论:新生儿对急性疼痛很敏感,非药物治疗干预措施有较好的止痛作用,综合两种非药物治疗措施缓解新生儿疼痛效果更明显。     

Pain in infancy: neonatal reaction to a heel lance

A combined single subject and group design was used to investigate changes in heart rate and crying in response to a heel lance, non-invasive tactile stimulation and baseline periods in 10 male and 10 female infants, each in their second full day of life. Heart rate was measured with an electrocardiogram. Percentage of time crying was computed from observations of audiotapes. Results for individual subjects indicated that heart rate and percentage of crying were consistently increased by the heel lance but that there was often wide baseline variability in the two measures. Analysis of variance indicated that responses to heel lance were higher than responses to tactile stimulation which were in turn higher than responses to baseline for both heart rate and percentage of crying (P less than 0.01). No significant sex differences were found. It was suggested that the increases in heart rate and crying in the context of a tissue damaging stimulus indicated that the infants experienced pain and that pain in infants can be reliably measured in clinical settings.     

Effect of non-nutritive sucking and sucrose alone and in combination for repeated procedural pain in preterm infants: A randomized controlled trial

BackgroundSucrose combined with non-nutritive sucking provided better pain relief than sucrose or non-nutritive sucking alone in a single painful procedure. However, whether the combination of non-nutritive sucking with sucrose could obtain a significant difference in analgesic effect of the repeated procedural pain than any single intervention has not been established.ObjectiveTo compare the effect of non-nutritive sucking and sucrose alone and in combination of repeated procedural pain in preterm infants.DesignRandomized controlled trial.SettingA level III neonatal intensive care unit of a university hospital in China.MethodPreterm infants born before 37 weeks of gestation were randomly assigned to four groups: routine care group (routine comfort through gentle touch when infants cried; n = 21), non-nutritive sucking group (n = 22), sucrose group (0.2 ml/kg of 20%; n = 21), sucrose (0.2 ml/kg of 20%) plus non-nutritive sucking group (n = 22). Each preterm infant received three nonconsecutive routine heel sticks. Each heel stick included three phases: baseline (the last 1 min of the 30 min without stimuli), blood collection, recovery (1 min after blood collection). Three phases of 3 heel stick procedures were videotaped. Premature infant pain profile (PIPP) score, heart rate, oxygen saturation and percentage of crying time were assessed by five independent evaluators who were blinded to the purpose of the study at different phases across three heel sticks. Data were analyzed by analysis of variance, with repeated measures at different evaluation phases of heel stick.Results86 preterm infants completed the protocol. During the blood collection and recovery phases, combination group, had lower PIPP score (4.4 ± 1.5; 3.0 ± 0.8), lower heart rate (138.6 ± 7.9; 137.4 ± 4.7), higher oxygen saturation (95.2 ± 1.6; 96.0 ± 1.2), and smaller percentage of crying time (11.5 ± 8.6; 4.6 ± 3.4), compared with the group has given non-nutritive sucking (9.3 ± 1.3, 6.8 ± 1.4; 154.2 ± 9.0, 148.0 ± 9.3; 92.9 ± 2.4, 94.1 ± 1.0; 44.2 ± 9.6, 31.2 ± 10.5; respectively) or sucrose (10.1 ± 2.0, 7.4 ± 1.6; 151.6 ± 9.6, 147.9 ± 6.9; 93.5 ± 1.7, 94.5 ± 1.2; 53.8 ± 16.7, 35.2 ± 13.9; respectively) or routine care (13.3 ± 1.6, 10.6 ± 1.9; 156.8 ± 7.2, 151.7 ± 7.9; 92.9 ± 2.1, 93.8 ± 1.6; 80.6 ± 7.6, 68.2 ± 9.9; respectively). Both non-nutritive sucking and sucrose were more effective in reducing preterm infants’ PIPP score and percentage of crying time than routine care. There was no difference in PIPP score, heart rate, oxygen saturation and percentage of crying time between the non-nutritive sucking and sucrose groups.ConclusionThe combination of non-nutritive sucking with sucrose provided better pain relief during repeated painful procedures than when non-nutritive sucking or sucrose was used alone. The effect of non-nutritive sucking was similar to that of sucrose on repeated procedural pain.     

袋鼠式护理在66例早产儿护理中的应用效果

目的 探讨袋鼠式护理在早产儿护理中的应用价值。方法 选择南京鼓楼医院集团宿迁市人民医院2018年6月至2018年12月收治的132例早产儿为对象。采用随机数字表法将早产儿随机分为观察组和对照组各66例。对照组予以常规护理，观察组在常规护理基础上，予以袋鼠式护理。比较两组早产儿住院期间生命体征（呼吸频率、心率、血氧饱和度、体温）和生长发育情况（头围增长、身长增长和体质量增长）。在出院时采用自制的护理满意度调查表进行护理满意度调查。结果 观察组早产儿住院期间呼吸频率、心率、血氧饱和度、体温、头围增长、身长增长和体质量增长等情况均优于对照组早产儿，差异均有统计学意义（均P<0.05）。观察组护理满意率为95.46%，高于对照组（81.82%，P<0.05）。结论 在常规护理的基础上，为早产儿提供袋鼠式护理，能够更好地维持早产儿生命体征稳定，促进生长发育，并赢得家长对护理的认可。     

母乳吸吮对足月新生儿足跟采血疼痛的影响

目的探索母乳吸吮对足月新生儿足跟采血疼痛的影响。方法便利抽取北京某医院产科病房60例接受足跟采血筛查的足月新生儿,随机分为两组,各30例。干预组新生儿在足跟采血前2min至采血结束后8min吸吮母乳。对照组按常规给予足跟采血。使用疼痛面容、啼哭、心率、血氧饱和度指标评估新生儿疼痛反应。结果干预组新生儿足跟针刺后疼痛面容和啼哭出现的时间晚于对照组(P0.05),啼哭人数少于对照组(P0.05),疼痛面容和啼哭的持续时间也短于对照组(P0.05),采血过程中和采血结束后1-4min的血氧饱和度均高于对照组(P0.05),采血结束后血氧饱和度的恢复时间也显著短于对照组(P0.05)。结论母乳吸吮能有效减轻足月新生儿足跟采血的疼痛程度。     

非营养性吸吮和吸吮8%葡萄糖水对缓解新生儿疼痛的效果观察

目的探索非药物治疗缓解新生儿疼痛的有效方法。方法将130例住院新生儿随机分为非营养性吸吮组和吸吮8%葡萄糖水组,各65例,在采足跟血疼痛刺激前30s、穿刺后20s、1min、3min分别记录心率、呼吸、经皮血氧饱和度和哭声持续时间,并在穿刺1min后根据新生儿面部编码系统、新生儿疼痛评估量表进行疼痛评分。结果穿刺后20s两组新生儿心率加快(P0.01),1min时恢复到穿刺前水平;穿刺后20s、1min两组新生儿呼吸频率均加快(P0.05),3min时恢复到穿刺前水平;两组新生儿穿刺前后经皮血氧饱和度均无明显变化(P0.05);穿刺后吸吮8%葡萄糖水组新生儿哭声持续时间少于非营养性吸吮组(P0.01);吸吮8%葡萄糖水组新生儿面部编码系统和新生儿疼痛评估量表评分均低于非营养性吸吮组(P0.05或P0.01)。结论新生儿对急性疼痛很敏感,吸吮8%葡萄糖水对新生儿有相对较好的止痛作用,在临床护理中,可应用非药物治疗干预措施。     

Effects of White Noise and Holding on Pain Perception in Newborns

This experimental study on newborns was conducted to compare the effects of various atraumatic care procedures during an infant's crying response to pain.Included in this study were 120 newborns chosen from among healthy infants admitted to the Obstetrics Department of Çanakkale State Hospital between April 2010 and June 2010. The patients were divided into three physically homogeneous groups. Infants in group 1 were held on the mothers' laps, infants in group 2 were held on the mother's laps and listened to white noise, and infants in group 3 lay in their cribs and listened to white noise while undergoing a painful procedure. Data collection included the Neonatal Infant Pain Scale, which was used to evaluate the behavioral responses to pain during a heel prick blood draw and a newborn information sheet developed by the researcher.Changes in cardiac and respiratory rates recorded during the invasive procedure were statistically significant among the three groups (p < .05). The shortest crying period and the lowest behavioral reactions were among those infants lying in their cribs and listening to white noise. This group was then followed by the infants who listened to white noise while being held by their mothers. The highest behavioral reaction was reported by those infants who were held by their mothers but did not listen to white noise.According to the results, white noise is an effective nonpharmacologic method to control pain, reduce crying time, and positively effect vital signs. Therefore, it is recommended that the use of white noise be practiced on newborns when they undergo painful procedures.     

袋鼠式护理减轻新生儿足跟采血疼痛的效果观察

目的探讨袋鼠式护理在减轻新生儿足跟采血疼痛的效果。方法将行足跟采血的60例新生儿随机分为干预组与对照组,每组各30例,干预组从足跟采血前20min至足跟采血结束后1min实施袋鼠式护理,对照组按常规护理。比较从足跟采血前10s至足跟采血结束后10s8个时间点两组新生儿心率、血氧饱和度、面部疼痛表情、啼哭持续时间和新生儿急性疼痛行为评分量表(douleur aigue nouveaune,DAN)评分情况。结果足跟采血后7个时间点新生儿心率重复测量资料分析结果:时间与主效应的交互效应比较,P<0.01,说明两组新生儿不同时间点心率是不相等的;时间效应比较,P<0.01,说明随着时间的延长,两组新生儿心率具有加快的趋势;两组新生儿穿刺后7个时间点心率比较,差异具有统计学意义(均P<0.05),干预组新生儿心率变化幅度较少。足跟采血后7个时间点两组新生儿血氧饱和度重复测量资料分析结果:时间与主效应的交互效应比较,P<0.05,说明两组新生儿不同时间点血氧饱和度是不相等的;时间效应比较,P<0.05,说明随着时间的延长,两组新生儿血氧饱和度具有降低的趋势;两组新生儿穿刺时30s、40s、50s及穿刺后血氧饱和度比较,差异具有统计学意义(均P<0.05),干预组新生儿血氧饱和度变化幅度较少。干预组新生儿啼哭持续时间明显短于对照组,DAN评分明显低于对照组(均P<0.05)。结论足跟采血可引起新生儿中重度疼痛,袋鼠式护理可有效缓解足跟采血时新生儿的疼痛程度。     

Rocking and pacifiers: Two comforting interventions for heelstick pain

The effects of behavioral interventions in reducing the stress of infant pain are not well documented. Two comfort interventions, rocking andpacifiers, were compared with routine care administered to 60 newborn infants randomly assigned to the three conditions following a neonatal screening heelstick. Heart rate, state of arousal, and crying were recorded continuously. Both pacifiers and rocking reduced crying, but pacifiers predominantly produced sleep states and rocking predominantly produced alert states. Pacifiers reduced heart rate levels significantly more than did rocking. Thus, newborns clearly benefit from both comforting methods. Several mechanisms are proposed to account for these findings.     

Warmth is analgesic in healthy newborns

This study identifies a behavioral and nonpharmacologic means of preventing and reducing newborn pain. Our objective was to determine whether warmth is analgesic in newborn infants undergoing vaccination-a routine painful hospital procedure. We used a prospective randomized controlled trial of 47 healthy full-term newborn infants. Infants were randomized into 1 of 3 conditions prior to vaccination: warmth exposure, pacifier suckling, or sucrose taste. Crying, grimacing, and heart rate differences were analyzed between groups before, during, and after vaccination as outcome measures. Warmer infants cried significantly less than sucrose taste or pacifier suckling after vaccination. Heart rate patterns reflected this analgesia. Core temperature did not differ between study groups. Providing natural warmth to newborn infants during a painful procedure decreases the crying and grimacing on par with the "gold" standard treatments of sucrose or pacifier.     

非药物治疗缓解新生儿疼痛的护理干预

目的探讨非药物治疗缓解新生儿疼痛的有效方法。方法将150例住院新生儿随机分为空白对照组、非营养性吸吮组和拥抱安抚组,每组各50例,在疼痛刺激(采足跟血)前、刺激后20s、1min、3min分别记录新生儿的心率、呼吸、经皮血氧饱和度及哭闹持续时间,并在刺激1min后根据新生儿面部编码系统(neontal facial coding system,NFCS)、新生儿疼痛评估量表(neonatal infant pain scale,NIPS)进行疼痛评分。结果穿刺后20s,各组新生儿心率、呼吸与穿刺前差异均有统计学意义(P0.01或0.05);穿刺后1min,各组新生儿呼吸频率均比穿刺前明显加快,差异有统计学意义(P0.05),NNS组和拥抱安抚组心率恢复至穿刺前水平;穿刺后2min,NNS组和拥抱安抚组呼吸频率恢复至穿刺前水平;各组新生儿经皮血氧饱和度穿刺前后差异均无统计学意义(P0.05);NNS组和拥抱安抚组新生儿穿刺后哭闹持续时间均短于对照组(P0.01),且拥抱安抚组又短于NNS组(P0.05);穿刺后NNS组和拥抱安抚组的NFCS和NIPS评分均低于对照组(P0.01)。结论新生儿对急性疼痛很敏感,非营养性吸吮和拥抱安抚对新生儿均有明显的止痛作用。在临床护理中可采用以上非药物干预措施缓解新生儿的疼痛。     

Comparison of sucrose, expressed breast milk, and breast-feeding on the neonatal response to heel prick.

Newborns endure many heel pricks and other uncomfortable procedures during their first hospital stay. The aim of this study was to investigate the effectiveness of breast-feeding in reducing pain in newborns undergoing heel prick tests. One hundred thirty healthy term infants requiring a heel prick blood sampling for the Guthrie test were studied. Infants were randomly allocated to 1 of the following treatment groups: group 1, 25% sucrose (n = 35); group 2, breast milk (n = 33); group 3, sterile water (n = 34); and group 4, breast-feeding (n = 28). The median values of crying and recovery time and percent change in heart rate at 1, 2, and 3 minutes were recorded. A behavioral pain scale was applied according to the infant body coding system. The median crying time was 36, 62, 52, and 51 seconds in groups 1, 2, 3, and 4, respectively (P =.002). Similarly, there was a significant overall difference among groups for the duration of recovery time (P =.006) and the percent change in heart rate at 1 (P =.03), 2 (P =.01), and 3 (P =.009) minutes favoring the sucrose group. But when we compared the groups, the significance remained for the sucrose versus breast milk (P =.007) and water (P =.001) groups for the recovery time and sucrose versus all other groups for the percent change in heart rate at 3 minutes. The infant body coding system showed that babies in the sucrose group had significantly lower scores followed by the breast-fed and breast milk groups (P =.0001). Our study revealed that 25% sucrose is superior to breast-feeding in pain relief, which is reflected mainly in crying time and behavioral variables. The behavioral effects of breast-feeding did not provide any additional benefit.