@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2017;23(4):251-256

Background
As defined by the International Association of the Study of the Pain, pain is an unpleasant feeling and a psychological experience of possible or actual injuries [1]. Among the goals of achieving health, improving the quality of healthy life, increasing its duration and elimination are factors that cause health impairment [2]. Therefore, identifying pain as one of its most common disruptive causes can be the goals of health care providers [3].
Previous Studies
… [3-6]. Pain in newborns can be controlled by non-prescriptive methods such as oral sucrose, non-nutritional sucking, breast-feeding, infant`s skin contact with the mothers` skin, and music playback during the procedure [7]. Stevens et al. believe that neonatal pain can be effectively reduced by non-medical measures such as hugging, touching, massage, cold and hot compresses, relaxation, and attention deviations [8]. … [9-15]. Also, in order to provide enough blood samples and preventing re-bleeding from the heel of the baby, it is advised to warm the heel before the kneading in the sampling procedure [16].
Aim(s)
Considering the fact that a healthy infant is exposed to several painful actions in the first few days after birth, pain control is necessary in order to modify its malignant effects and since non-prescriptive methods of controlling pain control the pain with different mechanisms, the choice of methods that is necessary to reduce the pain of infants is necessary. The aim of this study was to investigate the effect of local heat by a heater along with sound generation (hair dryer) on pain control and balance after bleeding from heel in term neonates.
Research type
This is a randomized triangular clinical trial study.This is a randomized triangular clinical trial study.
Research society, place and time
This research was conducted in 2015 among all healthy 3 to 5-day-old infants who had been brought to Shahid Delkhah Health Center in Ferdows City.
Sampling method and number
63 neonates were selected by random sampling and were randomly assigned into three groups of experimental, placebo, and control (each group included 21 subjects).
Used devices&materials
The data collection tool was a demographic questionnaire of the infant (such as fetal age, sex, weight, body temperature, age based on days) and the scale of measuring pain in the infants was NIPS. This scale has recently been used in many studies to measure pain in newborns and has a score between zero and seven [3]. In this scale, six items of facial condition, infant crying, respiratory pattern, hand mobility, leg mobility, and alertness are examined. Generally, a score of 0-3 indicates pain relief, a score of 3-5 indicates moderate pain and a score of 5-7 indicates severe pain [17]. The validity and reliability of the instrument for measuring neonatal pain has been confirmed according to the study by Daily et al. [16], and the study by Borumandfar et al. [18]. SPSS 14.5 software and descriptive and inferential statistics were used to analyze the data. The difference between groups based on gender was studied using Chi-square test, and based on the variables of fetal age, the weight at time of birth, body temperature, and infant age using one-way analysis of variables. The intensity of the pain in the three groups in each stage before, during and after blood sampling was analyzed by one-way ANOVA test and then Tukey`s post hoc test. For analysis of pain intensity in each group during and after the intervention, the variance analysis with repeated observation was used.
Findings by Text
In the experimental group (local warmth), there were 12 female (57.1%) and 9 males (42.9%). In the placebo group (hairdryer sound), there were 11 (52.4%) males and 10 (47.6%) females, and in the control group, there were 14 males (66.7%) and 7 females (33.3%) that there was no significant difference between the groups in this regard (p>0.05). Also, the mean age of embryo, birth weight, body temperature, and age of infants were not significantly different in the three groups. In other words, the three groups were almost identical in terms of demographic characteristics (p>0.05; Table 1). The mean of pain intensity scores in three groups was not significantly different before the intervention (p=0.86). While the mean of pain intensity during the bleeding was significantly different in the three groups (p=0.006) that this difference was due to the lower mean of pain intensity in the experimental group compared to the other two groups. The mean pain severity after bleeding also had a significant difference in the three groups (p<0.001). Therefore, there was a significant difference between each two groups, and the mean pain intensity was the lowest in the experimental group, and it was the highest in the control group. Also, the mean pain intensity was significant in the three groups during and after the intervention (p<0.001), and the reduction of pain intensity was the highest in the experimental group, and it was lower in placebo group compared to the experimental group, and it was higher in the placebo group compared to the control group (Table 2).
Main comparison to the similar studies
In a study, it was found that infant warming by the heater prior to muscle infusion of hepatitis B, significantly reduced the duration of crying of healthy term infants during and after infusion compared to two other interventions (paclitaxel and oral glucose) [18]. The researchers also found that infant warming by human touch before bleeding from the heel could reduce the crying time and physiological indices (heart rate and respiration) after painful treatment in premature infants [19]. … [20-24]. Researchers in a study about the effect of thought diversion on the pain of infant vaccination achieved similar results to the present study i.e. the pain intensity of the newborns after the vaccination in the deviation group was significantly lower than that of the control group [25]. … [26, 27]. In a study also it was concluded that music can moderate physiological responses (heart rate), and behavioral responses (sleep and wakefulness and facial expressions) in premature newborns aged over 31 weeks following bleeding from the heel [28].
Suggestions
It is suggested that studies be conducted using local heat for a longer time before and during bleeding from the heel and in other painful invasive methods and being compared with other pain control methods.
Limitations
Individual differences related to neonatal pain threshold were uncontrollable, and that was considered as a research constraint.
Conclusions
The use of local heat reduces the pain intensity during and after heel bleeding in term neonates.
Acknowledgments
Researchers appreciate and thank all parents of newborns and the staff of Shahid Delkhah Health Center in Ferdows City, who cooperated in conducing this study. We also express our gratitude to the respected deputy of the research center of Gonabad University of Medical Sciences, who, with their spiritual and financial support facilitated the study.
Conflict of interest
Non-declared
Ethical Permissions
This research was approved on May 24th, 2015 in Gonabad University of Medical Sciences with the ethical code IR.GMU.REC.1394.18.
Funding Sources
This research is a part of a master's thesis which has been registered in the clinical trial registration database with IRCT2015072223999 N1 code and has been sponsored by the vice chancellor of research of Gonabad University of Medical Sciences.

TABLES and CHARTS

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