Journal of Isfahan Medical School

Journal of Isfahan Medical School

Frequency and effectiveness of pain relief methods used in newborns hospitalized in neonatal special care units of Ardabil medical training centers in 1403

Document Type : Original Article(s)

Authors
Elham Abdolahzadeh Mahlani 1
Mahdi Heidarzade 2
Habibeh Sallehi Ali 3
Pouran Akhavan Akbari 4
1 MSc Student in Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
2 Professor, Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
3 Instructor, Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
4 Assistant Professor, Department of Midwifery, Faculty of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
10.48305/jims.v44.i849.0001
Abstract

Background: pain management and assessment is one of the most important therapeutic goals for neonates. This study aimed to determine the frequency and effectiveness of pain relief methods in neonates admitted to the intensive care units of educational-therapeutic centers in Ardebil.
Methods: This prospective study was conducted on 150 neonates admitted to the neonatal intensive care units of educational-therapeutic centers in Ardebil using convenience sampling. The frequency of pharmacological and non-pharmacological pain relief methods used for each neonate during 7 days of hospitalization was recorded using a study checklist. Pain scores before and after each pain relief method were calculated for various procedures using the NPASS tool. Data were analyzed using SPSS version 23 software.
Findings: Non-pharmacological and pharmacological strategies used in infants were swaddling (75.33%), sucrose (27.33%), breastfeeding (31.33%), pacifier (23.33%), midazolam and acetaminophen drops (0.66%). Swaddling was the most common method of relief in various procedures. Midazolam had the highest frequency in tracheal suction, intubation and chest tube procedures. The use of midazolam significantly (p<0.05) reduced pain.
Conclusion: Despite the fact that neonates in the NICU experience multiple painful procedures, pain management strategies are used to a limited extent, and the use of effective pain relief methods in neonatal intensive care units requires revision.

Keywords: Pain, Infant, Pain Relief, Intensive Care units

Highlights

Pouran Akhavan Akbari: PubMed, Google Scholar 

Keywords
Pain
Infant
Pain Relief
Intensive Care units

Subjects

1.     Barzegari AA, Akbarian Rad Z, Nikbakht HA, Qalehsari MQ, Jafarian Amiri SR, Zabihi A, et al. Frequency and pain intensity of painful procedures in premature infants hospitalized in the neonatal intensive care unit. J Educ Health Promot 2024; 13: 467.
2.     Tahmasbikouhpaie N, Zareiyan A, Pishgooie SAH. Translation, review, and validation of non-verbal pain scale [in Persian]. Military Caring Sciences 2018; 5(1): 34-45.
3.     Chanques G, Jaber S, Barbotte E, Violet S, Sebbane M, Perrigault PF, et al. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 2006; 34(6): 1691-9.
4.     Cheraghi F, Pakseresht M, Parsa P, roshanaei g, Basiri B. Effect of Kangaroo Mother Care on Premature Newborns’ Pain due to Invasive Procedures in Neonatal Intensive Care Unit of Hospital Fatemieh, Hamadan [in Persian]. J Ilam Univ Med Sci 2014; 22(1): 31-40.
5.     Grabska J, Walden P, Lerer T, Kelly C, Hussain N, Donovan T, et al. Can oral sucrose reduce the pain and distress associated with screening for retinopathy of prematurity? J Perinatol 2005; 25(1): 33-5.
6.     Assefa E, Dinkiye M, Geleta T, Tantu T, Wondwosen M, Zewdu D. The practice of procedural pain assessment and management in neonatal intensive care unit in Ethiopia: Cross-sectional study. Health Sci Rep 2022; 5(2): e533.
7.     Wang Y, Li Y, Sun J, Feng S, Lian D, Bo H, et al. Factors influencing the occurrence of neonatal procedural pain. J Spec Pediatr Nurs 2020; 25(2): e12281.
8.     Johnston C, Campbell-Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, et al. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2017; 2(2): Cd008435.
9.     Heidarpour K, Akhavan Akbari P, Hosseini Z, Moshfeghi S, Heidarzadeh M. Investigating the psychometric properties of the Persian version of Neonatal Pain, agitation, and sedation scale. Pediatr Neonatol 2022; 63(5): 496-502.
10.  Kim SS. Prevention and management of pain in the neonatal intensive care unit. Clin Exp Pediatr. 2020;63(1):16-7.
11.  Mehrnoush N, Ashktorab T, heidarzadeh M, momenzadeh S. Pain Management Perceptions of the Neonatal Nurses in NICUs and Neonatal Units in Ardabil, Iran. Iranian Journal of Neonatol 2016; 7(4): 23-9.
12.  Färnqvist K, Olsson E, Garratt A, Paraskevas T, Soll RF, Bruschettini M, et al. Clinical rating scales for assessing pain in newborn infants. Cochrane Database Syst Rev 2025; 4(4): Mr000064.
13.  Hoda F, Mansour D, Zahra S. The effect of empowerment program on improving nurses' knowledge, attitude and performance in neonatal pain control [in Persian]. Feyz Med Sci J 2024; 28(5): 529-36.
14.  Abebe D, Orcho A, Chane J, Mesfin S, Seifu W. Neonatal pain management practices in Somali region of Ethiopia: insights from neonatal intensive care unit providers. Front Pediatr 2024; 12: 1344244.
15.  Rocha VA, Silva IA, da Silveira Cruz-Machado S, Bueno M. Painful procedures and pain management in newborns admitted to an intensive care unit. Rev Esc Enferm USP 2021; 55: e20210232.
16.  Kassab M, Alhassan AA, Alzoubi KH, Khader YS. Number and Frequency of Routinely Applied Painful Procedures in University Neonatal Intensive Care Unit. Clin Nurs Res 2019; 28(4): 488-501.
17.  Perry M, Tan Z, Chen J, Weidig T, Xu W, Cong XS. Neonatal Pain: Perceptions and Current Practice. Crit Care Nurs Clin North Am 2018; 30(4): 549-61.
18.  Cong X, Delaney C, Vazquez V. Neonatal nurses' perceptions of pain assessment and management in NICUs: a national survey. Adv Neonatal Care 2013; 13(5): 353-60.
19.  Yilmaz D, Inal S. Effects of three different methods used during heel lance procedures on pain level in term neonates. Jpn J Nurs Sci. 2020; 17(4): e12338.
20.  Pillai Riddell R, Bucsea O, Shiff I, Chow C, Gennis H, Badovinac S, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 2023; 6(6): CD006275.
21.  Pölkki T, Laukkala H, Korhonen A. Nurses' and Parents' Perceptions of Parental Guidance on Using Nonpharmacological Pain-Relieving Methods Among Neonates in the NICU. Pain Manag Nurs 2016; 17(4): 272-80.
22.  Erkut Z, Yildiz S. The effect of swaddling on pain, vital signs, and crying duration during heel lance in newborns. Pain Manag Nurs 2017; 18(5): 328-36.
23.  Ayyıldız TK, Tanrıverdi E, Tank DY, Akkoç B, Topan A. The effect of swaddling method applied to preterm infants during the aspiration procedure on pain. J Pediatr Nurs 2023; 70: 61-7.
24.  Dezhdar S, Jahanpour F, Firouz Bakht S, Ostovar A. The effect of swaddling method on venous sampling pain in premature infant (Randomized clinical trials) [in Persian]. Iranian Journal of Pediatric Nursing 2015; 1(4): 52-61.
25.  Pillai Riddell RR, Bucsea O, Shiff I, Chow C, Gennis HG, Badovinac S, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 2023; 6(6): Cd006275.
26.  Dixley A, Ball HL. The effect of swaddling on infant sleep and arousal: A systematic review and narrative synthesis. Front Pediatr 2022; 10: 1000180.
27.  Harrison D, et al. Combined use of sucrose and pacifier for pain relief in neonates. (2021);Pain Management Nursing 22(3): 345-53.
28.  Chen Y, Zhou L, Tan Y. The effect of maternal voice and non-nutritional sucking on repeated procedural pain of heel prick in neonates: a quasi-experimental study. BMC Pediatr 2024; 24(1): 256.
29.  Napiórkowska-Orkisz M, Gutysz-Wojnicka A, Tanajewska M, Sadowska-Krawczenko I. Evaluation of Methods to Minimize Pain in Newborns during Capillary Blood Sampling for Screening: A Randomized Clinical Trial. Int J Environ Res Public Health 2022; 19(2): 870.
30.  Collados-Gómez L, Ferrera-Camacho P, Fernandez-Serrano E, Camacho-Vicente V, Flores-Herrero C, García-Pozo AM, et al. Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks. Acta Paediatr 2018; 107(3): 436-41.
31.  Mangat AK, Oei JL, Chen K, Quah-Smith I, Schmölzer GM. A review of non-pharmacological treatments for pain management in newborn infants. Children (Basel). 2018; 5(10): 130.
32.  Shah PS, Torgalkar R, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2023; 8(8): Cd004950.
33.  Campbell-Yeo M, Eriksson M, Benoit B. Assessment and Management of Pain in Preterm Infants: A Practice Update. Children (Basel) 2022; 9(2): 244.
34.  Karga Yilmaz T, Yavuz B. Comparison of different methods for reducing pain during a heel lance in newborns: a randomized trial. Ital J Pediatr 2025; 51(1): 73.
35.  Akbari N, Mutlu B, Nadali J. Effect of Non-nutritive Sucking during Heel-stick Procedure in Pain Management of Term Infants in the Neonatal Intensive Care Unit: A Systematic Review and Meta-analysis. Curr Pediatr Rev 2022; 19(1): 90-8.
36.  Gurlu R, Kahvecioglu D, Aksoy H, Yilmaz A, AlİOglu B. Investigation of the effects of two nonpharmacological methods; using pacifiers and maternal holding, on pain of neonates in the outpatient clinic and neonatal intensive care unit. J Contemp Med 2022; 12(1): 33-7.
37.  Nguyen N, Pendyala G. Sedation with midazolam in the NICU: implications on neurodevelopment. NeuroImmune Pharmacology and Therapeutics 2024; 3: 195-210.
38.  Abushanab D, Abounahia FF, Alsoukhni O, Abdelaal M, Al-Badriyeh D. Clinical and Economic Evaluation of the Impact of Midazolam on Morphine Therapy for Pain Relief in Critically Ill Ventilated Infants with Respiratory Distress Syndrome. Paediatr Drugs 2021; 23(2): 143-57.
39.  Cui Y, Tang M, Mu Q, Wu Q, Kang L, Chen Q, et al. Four-year review of safe and effective procedural sedation in neonates and young infants. Front Pharmacol 2024; 15: 1381413.
40.  Mahoney L, Raffaeli G, Beken S, Ünal S, Kotidis C, Cavallaro G, et al. Grading the level of evidence of neonatal pharmacotherapy: midazolam and phenobarbital as examples. Pediatr Res 2024; 95(1): 75-83.
41.  Arribas C, Cavallaro G, Decembrino N, González JL, Lagares C, Raffaeli G, et al. A global cross-sectional survey on neonatal analgosedation: unveiling global trends and challenges through latent class analysis. Eur J Pediatr 2025; 184(4): 241.
42.  Bueno M, Rao M, Aujla P, Victor C, Stevens B. A scoping review of the epidemiology and treatment of painful procedures in hospitalized neonates: What has changed in the past three decades? Eur J Pain 2024; 28(9): 1468-85.
Journal of Isfahan Medical School
Volume 44, Issue 849
1st Week,, April
March and April 2026
Pages 1-10

  • Receive Date 01 March 2025
  • Accept Date 21 January 2026