Comparison of Pain Responses of Premature Infants to the Heelstick between Containment and Swaddling

比較早產兒使用寧握護理及布包裹對扎足跟血之疼痛反應

黃金梅(Chin-Mei Huang)；董宛姝(Wan-Shu Tung)；郭麗玲(Li-Lin Kuo)；張瑩如(Ying-Ju Chang)

早產兒 ； 扎足跟血 ； 寧握護理 ； 布包裹 ； 疼痛 ； premature ； heelstick ； containment ； swaddling ； pain

The Journal of Nursing Research

12卷1期（2004 / 03 / 01）

31 - 40

英文

The objective of this study was to compare the effects of containment and swaddling on premature infants’ heart rates (HR), oxygen saturation (SpO2), and the Premature Infant Pain Profile (PIPP) scores after heelstick. The study used a cross-over experimental design, 32 premature infants with gestational age ＜ 37 weeks, bodyweight 2,500 grams, and no diagnosis of congenital heart disease, deformity, sepsis or Grade 3 intraventricular hemorrhage were selected as subjects. Each subject was randomly assigned to containment or swaddling once while undergoing two heelsticks in different time periods. Heart rate, oxygen saturation, facial expression and PIPP score were recorded from 5 minutes before to 11 minutes after heelstick. According to the paired t test, the results showed (1) that mean HR was higher and mean SpO2 was lower than their respective baseline values under the two interventions after heelstick (p ＜ .05), and that premature infants in swaddling returned to their baseline HR and SpO2 values in shorter time periods compared to those in containment, though the variations of HR and SpO2 between the two interventions exhibited no significant differences; and (2) that pain responses to heelstick under swaddling yielded lower scores than those under containment according to the total PIPP scores, but significant difference between the two interventions was only found at the 3rd and 7th minute. As a whole, there is little difference between the effects of swaddling and containment on attenuating physiological and behavioral stress caused by acute pain. The results of this study can serve as an evidence basis for nursing interventions in acute pain for premature infants. In clinical practice, containment and swaddling can be administered interchangeably according to patients’ individual differences.

The objective of this study was to compare the effects of containment and swaddling on premature infants’ heart rates (HR), oxygen saturation (SpO2), and the Premature Infant Pain Profile (PIPP) scores after heelstick. The study used a cross-over experimental design, 32 premature infants with gestational age ＜ 37 weeks, bodyweight 2,500 grams, and no diagnosis of congenital heart disease, deformity, sepsis or Grade 3 intraventricular hemorrhage were selected as subjects. Each subject was randomly assigned to containment or swaddling once while undergoing two heelsticks in different time periods. Heart rate, oxygen saturation, facial expression and PIPP score were recorded from 5 minutes before to 11 minutes after heelstick. According to the paired t test, the results showed (1) that mean HR was higher and mean SpO2 was lower than their respective baseline values under the two interventions after heelstick (p ＜ .05), and that premature infants in swaddling returned to their baseline HR and SpO2 values in shorter time periods compared to those in containment, though the variations of HR and SpO2 between the two interventions exhibited no significant differences; and (2) that pain responses to heelstick under swaddling yielded lower scores than those under containment according to the total PIPP scores, but significant difference between the two interventions was only found at the 3rd and 7th minute. As a whole, there is little difference between the effects of swaddling and containment on attenuating physiological and behavioral stress caused by acute pain. The results of this study can serve as an evidence basis for nursing interventions in acute pain for premature infants. In clinical practice, containment and swaddling can be administered interchangeably according to patients’ individual differences.

1. Als, H.(1982).Toward a synactive theory of development: Promise for the assessment and support of infant individuality.Infant Mental Health Journal,3,329-243.
2. Als, H.,Lawhon, G.,Duffy, F. H.,McAnulty, G. B.,Gibes-Grossman, R.,Blickman, J. G.(1994).Individualized developmental care for the very low birth weight preterm infant: Medical and neurofunctional effects.Journal of the American Medical Association,272(11),853-858.
3. Anand, K. J. S.,Carr, D. B.(1989).The neuroanatomy, neurophysiology, and neurochemistry of pain, stress, and analgesia in newborns and children.Pediatric Clinics of North America,36,795-822.
4. Anand, K. J. S.,Phil, D.,Hickey, P. R.(1992).Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative anesthesia in neonatal cardiac surgery.New England Journal of Medicine,326,1-9.
5. Anand, K. J. S.,Phil, D.,Hickey, P. R.(1987).Pain and its effect in the human neonate and fetus.New England Journal of Medicine,317(21),1321-1329.
6. Campos, R. G.(1989).Soothing pain: Elicited distress in infants with swaddling and pacifier.Child Development,60,781-792.
7. Corff, K. E.,Seideman, R.,Venkataraman, P. S.,Lutes, L.,Yates, B.(1995).Facilitated tucking: A nonpharmacologic comfort measure for pain in preterm neonates.Journal of Obstetric Gynecologic and Neonatal Nursing,24(2),143-147.
8. Field, T.(1990).Alleviating stress in newborn infants in the intensive care unit.Clinics in Perinatology,17(1),1-9.
9. Fitzgerald, M.,K. J. S. Anand (Eds.),P. J. McGrath (Eds.)(1993).Pain in neonates.Amsterdam:Elsevier.
10. Franck, L.,C. Kenner (Eds.),A. Brueggemeyer (Eds.),L. Gunderson (Eds.)(1993).Comprehensive neonatal nursing: A physiologic perspective.Philadelphia:WB Saunders.
11. Gorski, P. A.,Huntington, L.,Lewkowicz, D. J.(1990).Handling preterm infants in hospitals: Stimulating controversy controversy about timing of stimulation.Clinics in Perinatology,17(1),103-112.
12. Gray, J. E.,Richardson, D. J.,McCormick, M. C.,Workman-Daniels, K.,Goldmann, D. A.(1992).Neonatal therapeutic intervention scoring system: A therapy-based severity-of-illness index.Pediatric,90(4),516-567.
13. Grossman, R. G.,Lawhon. G.,K. J. S. Anand (Eds.),P. J. McGrath (Eds.)(1993).Pain in neonates.Amsterdam:Elsevier.
14. Grunau, R.(2002).Early pain in preterm infant. A model of long-term effects.Clinics in Perinatology,29(3),373-394.
15. Grunau, R. V. E.,Whitfield, M.,Petrie, J.(1994).Pain sensitivity and temperament in extremely low-birth-weight premature toddlers and preterm and full-term controls.Pain,58,341-346.
16. Grunau, R. V. E.,Whitfield, M.,Petrie, J.,Fryer, E. L.(1994).Early pain experience, child and family factors, as precursors of somatization: Aprospective study of extremely premature and fullterm children.Pain,56,353-359.
17. Johnston, C. C,Stevens, B. J.,Frank, L. S.,Jack, A.,Stremler, R. Platt, R.(1999).Factors explaining lack of response to heel stick in preterm newborns.Journal of Obstetric Gynecologic and Neonatal Nursing,28(6),587-594.
18. Liang, S. R.,Wang, R. H.,Chang, Y. K.,Wang, M. S.(2000).Study of containment for premature infants in alleviating pain from heelstick.Medical Research (Chinese),20(7),368-376.
19. Neu, M.,Browne, J. V.(1997).Infant physiologic and behavioral organization during swaddled versus unswaddled weighing.Journal of Perinatology,17(3),193-198.
20. Stevens, B. J.,Franck, L.(1995).Special needs of preterm infants in the management of pain and discomfort.Journal of Obstetric Gynecologic and Neonatal Nursing,24(9),856-862.
21. Stevens, B. J.,Johnston, C. C.(1994).Physiological responses of premature infants to a painful stimulus.Nursing Research,43(4),226-231.
22. Stevens, B. J.,Johnston, C. C.,Grunau, R. V. E.(1995).Issues of assessment of pain and discomfort in neonates.Journal of Obstetric Gynecologic and Neonatal Nursing,24(9),849-855.
23. Stevens, B. J.,Johnston, C. C.,Petryshen, P.,Taddio, A.(1996).Premature infant pain profile: Development and initial validation.The Clinical Journal of Pain,12(1),13-22.
24. Taso, P. N.,Teng, R. J.,Wu, T. J.,Tang, J. R.,Yau, K. I. T.(1998).Early outcome of extremely low birth weight infants in Taiwan.The Journal of Formosa Medicine Association,97(7),471-476.
25. Velasco-Whetsell, M.,Even, J. C.,Wang, M.S.(1992).Do postsuctioning transcutaneous PO2 values change when a neonate's movements are restrained?.Journal of Perinatology,12,333-337.
26. Wang, M. S.,Gu, S. M.(1995).Assessing effects of containment on premature infants with suctioning.Nursing in Veterans General Hospital (Chinese),14(4),406-414.
27. Yu, Y. M.,Tien, S. F.,Jiang, S. S.(1991).Qualitative study Application of field study in nursing.Taipei:Liwen.