Comparison of the Effect of Maternal Breast Milk Odor, Facilitated Tucking, and Nonnutritive Sucking Applied to Preterm Neonates During Heel Stick on Pain and Physiological Parameters: A Randomized Controlled Trial

Akbari N., MUTLU B., Khoddam H.

BREASTFEEDING MEDICINE, vol.20, no.4, pp.244-255, 2025 (SCI-Expanded, Scopus) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 20 Issue: 4
  • Publication Date: 2025
  • Doi Number: 10.1089/bfm.2024.0123
  • Journal Name: BREASTFEEDING MEDICINE
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CAB Abstracts, CINAHL, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.244-255
  • Keywords: facilitated tucking, heel stick, maternal breast milk odor, nonnutritive sucking, pain, physiological parameters, preterm neonates
  • Istanbul University-Cerrahpasa Affiliated: Yes

Abstract

Background: Preterm infants in the neonatal intensive care unit (NICU) frequently undergo painful procedures, which can lead to both short-term and long-term complications, including potential mortality. Effective pain management is crucial in this context. Although numerous studies have explored non-pharmacological pain relief methods for preterm infants, no research has simultaneously compared the effects of maternal breast milk odor, facilitated tucking, and nonnutritive sucking. Aim: This study aims to comparatively investigate the efficacy of nonnutritive sucking, facilitated tucking, and maternal breast milk odor in reducing pain in preterm neonates during heel sticks. Methods: A randomized controlled trial was conducted in a tertiary-level NICU with 144 preterm neonates (gestational age 31-36 weeks) requiring heel sticks. The infants were randomly assigned to four groups: control, nonnutritive sucking, facilitated tucking, and maternal breast milk odor. Pain and physiological parameters were assessed through video recordings of the procedures and scored at 1-minute intervals using the Premature Infant Pain Profile and Data Evaluation Form. Data were collected at baseline and at 1, 2, and 3 minutes before, during, and after the heel stick. Results: The study found significant effects of the interventions on physiological parameters and pain (heart rate: F = 7.5, p < 0.001; oxygen saturation: F = 16.39, p < 0.001; respiratory rate: F = 6.56, p < 0.001; pain: F = 61.45, p < 0.001). Facilitated tucking resulted in significantly lower pain scores (6.61 +/- 1.44) compared with the control group (14.22 +/- 3.61), maternal breast milk odor (12.22 +/- 3.08), and nonnutritive sucking (10.41 +/- 1.71) (p < 0.001). Conclusions: All interventions demonstrated effectiveness in maintaining physiological stability and alleviating pain. Nevertheless, the intervention identified as most effective in reducing pain was facilitated tucking group.