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Breast-feeding can help pain in some NICU patients

Sunday October 23, 2011
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Breast-feeding during minor procedures in the NICU can mitigate pain in preterm neonates with mature breast-feeding behaviors, according to a study.

Poorly managed pain in the NICU has serious short- and long-term consequences, the authors noted in background information in the article, which appears in the November issue of the journal Pain. It can cause physiological and behavioral instability in preterm infants and long-term changes in their pain sensitivity, stress arousal systems and developing brains.

Currently, pain associated with minor procedures such as pricking for blood tests is managed with interventions such as skin-to-skin contact, pacifiers and sweet tastes, but these produce only modest or inconsistent relief. In infants born at normal term, breast-feeding during painful procedures has been shown to reduce pain response by 80% to 90% with no serious side effects, but this approach had not previously been tested in preterm infants. One concern is that preterm infants might come to associate breast-feeding with the painful procedure, jeopardizing their ability to feed effectively enough to adequately gain weight.

In a randomized clinical trial, investigators from the Child & Family Research Institute at BC Children's Hospital and The University of British Columbia in Vancouver conducted a study to learn whether preterm infants would show lower pain scores when breast-fed during blood collection. They also looked at whether breast-feeding during the painful procedure would have a negative impact on the development of breast-feeding skills, and whether infants who had more mature breast-feeding behaviors would have lower pain scores and heart rates during blood collection than less experienced feeders.

The researchers divided 57 infants born at 30 to 36 weeks gestational age into two groups. One group was breast-fed during blood collection. The other group was given a pacifier. During the procedure, their faces and hands were videotaped, their responses were scored using the Behavioral Indicators of Infant Pain and their heart rates were measured. Breast-fed babies were also scored according to the Premature Infant Breastfeeding Behaviors scale.

For the group as a whole, breast-feeding did not reduce either behavioral or physiological pain during blood collection. Nevertheless, no immediate adverse effects were found on breast-feeding skill development.

"Our sample of infants was assessed early in their breast-feeding experience; none of our infants were fully established on breast-feeds," lead investigator Liisa Holsti, PhD, clinician scientist at the Child & Family Research Institute, said in a news release. "For infants whose breast-feeding skills are inconsistent, it is unlikely to mitigate pain effectively."

In the breast-fed group, however, infants who were more advanced in their ability to feed did have significantly lower behavioral pain scores. Despite concerns that blood sampling during breast-feeding may be more difficult, the authors reported that the time taken for the procedure in the breast-fed group was significantly shorter, making blood collection more efficient.

"Finding creative ways to apply breast-feeding for pain mitigation in premature infants is important because recent research suggests that sweetening agents used to reduce minor procedural pain may act as sedatives rather than analgesics, and they may have negative effects on development," said Holsti, also an assistant professor in the Department of Occupational Science and Occupational Therapy at the University of British Columbia and a Canada Research Chair in Neonatal Health and Development.

"Our findings support further research on the effects of breast-feeding for more mature feeders over repeated events to assess both the short- and long-term benefits of the treatment."

To read the study abstract, visit http://tinyurl.com/4xxn2nr.


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