Analgesic effect of kangaroo position method versus sucrose during heel punctures in newborn: randomized clinical trial

Montanholi, Liciane Langona; Daré, Mariana Firmino; Leite, Adriana Moraes; Guarda, Laíse Escalianti Del-Alamo; Scochi, Carmen Gracinda Silvan

doi:10.5935/2595-0118.20220060-en

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ORIGINAL ARTICLE • BrJP 5 (4) • Oct-Dec 2022 • https://doi.org/10.5935/2595-0118.20220060-en copy

Analgesic effect of kangaroo position method versus sucrose during heel punctures in newborn: randomized clinical trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

25% sucrose and kangaroo position are effective for neonatal analgesia in single procedures and sucrose is also effective in repeated procedures. Behavioral and physiological responses and adverse effect on newborns submitted to kangaroo position or 25% sucrose for analgesia were compared in two heel punctures applied during the first hours of life.

METHODS:

Randomized clinical trial with 80 newborns and 40 mothers. Data were collected during two heel punctures. The kangaroo position was performed for three minutes before, during and three minutes after the punctures. Oral 25% sucrose (0.5 mL/kg) was administered two minutes before the punctures and the newborns were kept in a crib. Each data collection was divided into nine phases. The facial action, crying and heart rate data were analyzed using descriptive and comparative analyses. Facial actions, assessed by the Newborn Facial Coding System scale, was used to test the hypothesis. The frequency of gastric side effects was calculated. Ethical aspects were preserved.

RESULTS:

Facial actions did not differ (p>0.05) between groups in the two data collections. There were no relevant changes in heart rate between and within groups. The newborns in the kangaroo group cried more than in the sucrose group (p<0.05) in the second collection. In the administration of sucrose, more side effects were observed in the first (p=0.02) and second collection (p=0.007).

CONCLUSION:

The kangaroo position is as effective as the administration of 25% sucrose to relieve pain resulting from two repeated heel punctures.

Keywords
Crying; Heart rate; Kangaroo-mother care method; Newborn; Pain; Sucrose

HIGHLIGHTS

Neonatal analgesia in repeated procedures.
Neonatal analgesia on the first day of life.
Microlithic analysis of the data, enabling detailed comprehension of the observed phenomenon.

Phases	Basal	Treatment	Antisepsis	T0	T15	T30	T60	T120	T180
Duration	3 minutes	1 minute	33-82 sec.	15 sec.	15 sec.	30 sec.	60 sec.	60 sec.	60 sec.
Description of procedures performed in each phase.	Preparation NB remained in a regular crib, wearing only a diaper. Two cardiac electrodes were placed under the nipples, which were connected to Polar RS800® equipment to assess heart rate. A tripod camera was placed to record facial action and crying. Data Collection NB were filmed without intervention. Heart rate was collected continuously from baseline to T180 phase.	Preparation of sucrose NB received a dose of 25% sucrose (0.5 mL/kg - maximum 2 mL) orally, with a syringe on the anterior part of the tongue, two minutes before the procedure¹⁴14 Hospital das Clínicas de Ribeirão Preto da Universidade de São Paulo. Protocolo de triagem e manejo da hipoglicemia em RN a termo e pré-termo tardios (≥ 34 <37 sem) durante as primeiras 24 horas de vida. Ribeirão Preto: Hospital das Clínicas de Ribeirão Preto, 2013.. They were positioned in dorsal decubitus and remained unmanipulated until the end of data collection. Sucrose data collection Data were collected from the last minute after sucrose administration. Kangaroo position preparation NB were positioned upright on their mother’s chest, wearing only a diaper and with their heads sideways11. They remained in the kangaroo position for three minutes before the painful procedure¹⁴14 Hospital das Clínicas de Ribeirão Preto da Universidade de São Paulo. Protocolo de triagem e manejo da hipoglicemia em RN a termo e pré-termo tardios (≥ 34 <37 sem) durante as primeiras 24 horas de vida. Ribeirão Preto: Hospital das Clínicas de Ribeirão Preto, 2013., maintaining it until the end of data collection. Data collection in the kangaroo position Data were collected from the last minute before the painful procedure.	Antisepsis was performed with cotton and 70% alcohol. The images of facial actions and crying were recorded continuously.	The moment of heel puncture, performed with a lancet Pro Uno Accu-Chek® lancet (United States) by the same trained nurse.	T15-T180: recovery after the painful procedure. Data is collected continuously, without intervention from the researchers. After the end of each data collection, the camera was turned off, the heart monitor was disconnected, and the NB remained in the rooming-in unit with their mothers. The painful procedures (type of procedure and analgesia received) that the NB received in the interval between the two data collections were recorded. At the end of the second data collection, the cardiac leads were removed and the NB continued to be housed together with their mothers.

Groups	Kangaroo (n=40)	Sucrose (n=40)	p-value
Gender [n(%)] Female Male	21 (52.5%) 19 (47.5%)	19 (47.5%) 21 (52.5%)	0.65^* * Fisher’s Exact Test
Average weight (g)	3.713 g	3.746 g	0.77^ Chi Squared Test
Gestational age [n(%)] > 37 weeks < 37 weeks	37 (92.5%) 03 (7.5%)	39 (97.5%) 01 (2.5%)	0.34^* * Fisher’s Exact Test
Type of delivery [n(%)] Vaginal Cesarean section	16 (40.0%) 24 (60.0%)	15 (37.5%) 25 (62.5%)	0.81^* * Fisher’s Exact Test
Labor duration (minutes)	355	491	0.34^ Chi Squared Test
Drugs used in childbirth [n(%)]
Bupivacaine Sufentanil Morphine	34 (85.0%) 36 (91.0%) 21 (51.4%)	35 (87.5%) 38 (94.4%) 22 (55.6%)	0.99^ Chi Squared Test

	1^st data collection					2^nd data collection
Groups	Kangaroo		Sucrose		p-value^* * Mann-Whitney test	Kangaroo		Sucrose		p-value^* * Mann-Whitney test
Phase	$\bar{x}$	SD	$\bar{x}$	SD	p-value^* * Mann-Whitney test	$\bar{x}$	SD	$\bar{x}$	SD	p-value^* * Mann-Whitney test
Baseline	6.60	12.64	7.70	18.74	0.44	8.53	6.53	1.28	23.27	0.58
Treatment	6.03	17.85	3.53	6.41	0.18	9.00	17.11	6.43	16.77	0.53
Antisepsis	7.38	17.50	6.58	13.58	0.50	14.68	1.23	9.00	18.09	0.58
T0	18.58	27.72	14.10	2.41	0.80	25.28	26.70	13.80	15.70	0.80
T15	26.80	34.28	28.50	34.13	0.67	42.15	38.21	28.15	31.17	0.12
T30	11.43	21.83	8.48	14.45	0.76	16.60	26.66	9.93	17.8	0.60
T60	12.63	28.10	10.18	22.43	0.37	15.53	29.0	7.65	17.18	0.39
T120	3.60	10.00	6.23	14.41	0.16	12.38	20.87	8.50	16.95	0.43
T180	3.79	8.62	11.80	22.00	0.18	9.80	20.34	3.33	6.43	0.24

		1^st Data collection					2^nd Data collection
	Crying	Kangaroo		Sucrose		p-value^* * p<0.05 (Mann-Whitney test)	Kangaroo		Sucrose		p-value^* * p<0.05 (Mann-Whitney test)
	Crying	$\bar{x}$	SD	$\bar{x}$	SD	p-value^* * p<0.05 (Mann-Whitney test)	$\bar{x}$	SD	$\bar{x}$	SD	p-value^* * p<0.05 (Mann-Whitney test)
Baseline	Total	1.79	6.42	4.63	16.13	0.67	2.38	8.78	4.28	12.19	0.71
	High	1.45	6.00	4.65	16.12	0.32	1.93	6.59	4.20	12.22	0.32
	Weak	0.33	2.69	0	0	0.32	0.48	3.00	0	0	0.90
Treatment	Total	1.58	10.01	0	0	0.32	3.18	11.22	1.67	10.54	0.04^* * p<0.05 (Mann-Whitney test)
	High	1.58	9.96	0	0	1.00	3.18	10.40	0	0	1.00
	Weak	0	0	0	0	1.00	0	0	0	0	1.00
Antisepsis	Total	2.50	15.81	0.93	5.86	0.99	3.18	11.22	1.67	10.54	0.02^* * p<0.05 (Mann-Whitney test)
	High	2.50	15.81	0.93	7.27	1.00	4.85	15.05	0	0	1.00
	Weak	0	0	0	0	1.00	0	0	0	0	1.00
T0	Total	10.00	22.39	3.33	16.12	0.09	14.00	26.79	0.83	4.32	0.04^* * p<0.05 (Mann-Whitney test)
	High	9.20	22.17	3.33	16.11	0.32	13.33	26.79	0.85	4.38	0.32
	Weak	0.83	5.22	0	0	1.00	0.68	4.27	0	0	0.32
T15	Total	7.33	21.13	6	18.35	0.74	14.00	10.00	4.32	26.67	0.03^* * p<0.05 (Mann-Whitney test)
	High	5.65	18.78	5.18	17.89	0.49	10.97	25.13	4.32	10.15	0.32
	Weak	1.67	10.54	0	0	0.32	3.02	8.38	0	0	0.32
T30	Total	7.58	24.42	1.92	7.47	0.62	7.25	22.08	0	0	0.02^* * p<0.05 (Mann-Whitney test)
	High	5.50	21.15	1.90	7.43	0.32	7.25	22.07	0	0	1.00
	Weak	2.08	13.12	0	0	0.94	0	0	0	0	1.00
T60	Total	4.71	18.97	0.83	5.27	0.17	5.71	18.25	0	0	0.02^* * p<0.05 (Mann-Whitney test)
	High	4.58	18.17	0.83	5.22	0.32	5.70	18.25	0	0	1.00
	Weak	0.13	0.79	0	0	0.52	0	0	0	0	1.00
T120	Total	5.55	20.15	1.29	6.74	0.38	4.25	12.35	0	0	0.01^* * p<0.05 (Mann-Whitney test)
	High	5.55	20.16	1.30	6.79	1.00	3.98	12.33	0	0	0.32
	Weak	0	0	0	0	1.00	0.30	1.90	0	0	0.32
T180	Total	2.95	14.15	2.65	13.07	0.98	6.04	17.44	0	0	0.02^* * p<0.05 (Mann-Whitney test)
	High	2.93	20.73	2.58	12.85	1.00	4.57	12.78	0	0	1.00
	Weak	0	0	0	0	1.00	1.50	9.48	0	0	1.00

	1^st Data Collection					2^nd Data Collection
	Kangaroo		Sucrose		p-value^* * p<0.05, Chi-squared test	Kangaroo		Sucrose		p-value^* * p<0.05, Chi-squared test
	$\bar{x}$	SD	$\bar{x}$	SD	p-value^* * p<0.05, Chi-squared test	$\bar{x}$	SD	$\bar{x}$	SD	p-value^* * p<0.05, Chi-squared test
Basal	122.90	10.10	124.80	10.20	0.54	126.10	9.70	127.40	11.10	0.96
Treatment	126.80	9.00	130.90	10.70	0.12	127.60	9.10	134.50	14.00	0.04^* * p<0.05, Chi-squared test
Antisepsis	126.10	8.60	128.30	9.70	0.33	127.50	11.00	132.20	13.30	0.11
T0	128.50	8.90	129.40	10.20	0.76	128.50	9.90	133.00	14.40	0.40
T15	128.50	10.40	132.20	11.60	0.11	129.70	10.80	132.90	12.50	0.27
T30	127.60	9.70	128.10	9.90	0.99	127.60	11.60	129.90	12.80	0.48
T60	126.90	9.20	125.10	10.10	0.33	128.20	10.80	127.90	11.70	0.93
T120	126.10	12.00	124.30	10.50	0.39	127.90	10.50	130.10	12.10	0.47
T180	126.20	11.50	123.80	10.10	0.33	128.70	11.30	127.30	9.40	0.57

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[1] Correspondence to: Liciane Langona Montanholi, E-mail: licianemontanholi28@gmail.com