ARTICLE INFO

Article Type

Original Research

Authors

Sajjadi   M. (1)
Basirimoghadam   M. (2)
Amiri Shadmehri   E. (* )






(* ) “Student Research Committee” and “Pediatrics Nursing Department", Nursing & Midwifery Faculty, Gonabad University of Medical Sciences, Gonabad, Iran
(1) “Social Development & Health Promotion Research Center” and “Medical-Surgical Nursing Department", Nursing & Midwifery Faculty, Gonabad University of Medical Sciences, Gonabad, Iran
(2) “Social Development & Health Promotion Research Center” and “Pediatrics Nursing Department", "Nursing & Midwifery Faculty”, Gonabad University of Medical Sciences, Gonabad, Iran

Correspondence

Address: Gonabad University of Medical Sciences, Near the Asian Road, Gonabad, Iran
Phone: +98 (51) 57225813
Fax: +98 (51) 57225813
amiri602013@gmail.com

Article History

Received:  May  30, 2016
Accepted:  December 20, 2016
ePublished:  July 22, 2017

BRIEF TEXT


Pain is a complex phenomenon that relates to the stages of guidance, transmission, understanding and integration of a specific stimulus in the nervous system and includes physiological, behavioral and social elements [1].

…I2-16}. According to the conducted studies, some of the physiological characteristics of the baby are affected by stimulating olfactory sense using breast milk. However, studies on the effect of milk smell on infant's pain are rare, including the study of Nishitani et al. [17], in which the effect of smelling breast milk on behavioral responses and cortisol level of salivation has been studied. …] 18-27].

The aim of this study was to determine the effect of breast milk smell on the physiological and behavioral responses of hepatitis B vaccine pain in term infants.

This is a randomized double-blind controlled trial.

This study was conducted in 2015, in 9th of Dey Hospital of Torbat Heydarieh City, Iran, on one to three day healthy and term infants and gestational age between 37 to 42 weeks.

… [10]. 30 neonates were selected for each group and a total of 60 neonates were selected by random sampling.

Data were collected using a checklist of demographic characteristics, physiological responses register form, and Modified Behavioral Pain Scale (MBPS). The validity of the form of demographic characteristics and the physiological responses register form was confirmed by content validity i.e. the tool was presented to 10 faculty members of Gonabad University of Medical Sciences and after collecting comments, necessary corrections were applied and used for study. Behavioral Pain Scale in Iran has been used in the study by Simin Taavoni et al. [25] and its validity and reliability have been confirmed. In order to determine the reliability of the tool, the correlation method was used among the observes that the Pearson correlation coefficient was equal to 0.862. This scale consists of three parameters: face mode, crying mode and body movements. Face mode has 4 options; crying mode has 5 options and body movement has 6 options. The parameters of face and body movement have been ranked from zero to 3 scores, and parameter of crying mode has been ranked from zero to 4. The highest score is 10 and the lowest score is zero. The Pulse Oximeter (Pooyandegan Health Road Co. Iran) was used to record heart rate and arterial oxygen saturation. The equilibrium reliability method was used to determine the reliability of pulse oximeter device. On the bases of random numbers, the newborns with even number were placed in the experimental group (breast milk smell) and infants with an odd number were placed in the control group. To perform hepatitis B vaccination, each baby was individually brought to a quiet room with no noise, and placed on a hot bed at 37 ° C. Room temperature was 25 ° C for all the samples and light condition was also the same for all babies. Injection of vaccine in both groups under the same conditions was done with the same devices and person. In the vaccination room, apart from the research team, there was no other person. Prior to starting, the probe pulse oximeter was fastened on the baby's wrist without excessive pressure by the researcher. In the group of smell of breast milk, a sample of mother`s breast milk was used in early morning before breakfast to stimulate the infant's olfactory sense, because the purest smell is related to this time, and 2 to 4 hours after receiving the breakfast, the smell of dietetic substance is entered the breast milk. Then 2 cc of the milk poured over the oven, was placed within 3 cm of the infant`s nose. This work started from 3 minutes before vaccination and continued until the procedure was completed. Physiological data (heart rate and arterial oxygen saturation) were recorded by pulse oximeter, immediately prior to the intervention as basal time and immediately after the intervention, that was the end of vaccination. Behavioral responses were also evaluated using its tool from the beginning to the end of the procedure. Statistical analysis: Data were analyzed by SPSS 20 software. Independent T-test was used to examine the difference in the mean before and after the intervention between the two groups and paired t-test was used for measuring the difference in mean before and after intervention in each group. The normal distribution of data was also assessed by Kolmogorov-Smirnov test.

All infant were one-day old and the mean of their birth weight was 3134.67±332.99 and 3098.62±342.66 grams in the control and experimental groups respectively. Also, the means of gestational age in the control and experimental groups were 39.13±1.14 and 38.89±1.34 weeks respectively. The two groups did not differ significantly in terms of demographic and clinical characteristics (p>0.05). In the intergroup study, there was no significant difference between the control and experimental groups in terms of mean heart rate per minute and the mean oxygen saturation percentage. However, significant difference was observed between the groups after the intervention. Also, there was a significant difference between the two groups after the intervention for the mean of behavioral responses, so that the mean behavioral responses in the experimental group was 0.73 lower than the control group. In the intra-group study, the mean heart rate per minute and the mean oxygen saturation did not change significantly in the intervention group after the intervention. However, in the control group, the mean heart rate per minute was significantly increased and the mean oxygen saturation percentage was significantly decreased (Table 2).

The results of the study by Nishitani et al. [17], also, indicated that the smell of breast milk as a familiar smell stimulus was associated with a reduction in the duration of crying of infants during the blood taking procedure from the heel. Also, in a study by Varandy et al. [26], the stimulation with the smell of amniotic fluid (as a familiar smell for the baby), could significantly reduce the crying period after the birth that these results are in line with the findings of the current study.

Further studies and further control of infant conditions are recommended before intervention. It is also suggested that in subsequent researches, the scores of behavioral responses in different parts of this scale be investigated separately so that more accurate results can be obtained about the effect of this method on different aspects of behavioral responses.

The impossibility of controlling all the factors involved in intervention, such as the unification of the conditions of the infants from the hours before the intervention, was one of the limitations of the present study.

Olfactory stimulation with breast milk has a positive effect on the reduction of neonatal pain during hepatitis B vaccination.

All the parents of newborns participating in the research and staff of the 9th Day Hospital in the Torbat-e-Heidarieh, as well as the Department of Educational and Research Affairs of Gonabad University of Medical Sciences (Regional Committee for Ethics in Research, Department of Graduate Studies and Research Affairs of the University) are appreciated.

Non-declared

The ethical confirmation of this study was obtained from the Ethics Committee of Gonabad University of Medical Sciences with the IR.GMU.REC.1394.22 code and was registered with the IRCT2015072423323N1code in clinical trial database.

This article is the result of a student dissertation, in a graduate degree level from Gonabad University of Medical Sciences.

TABLES and CHARTS

Show attach file


CITIATION LINKS

[1]Henry PR, Haubold K, Dobrzykowski TM. Pain in the healthy full-term neonate: Efficacy and safety of interventions. Newborn Infant Nurs Rev. 2004;4(2):106-13.
[2]Kharasch S, Saxe G, Zuckerman B. Pain treatment: Opportunities and challenges. Arch Pediatr Adolesc Med. 2003;157(11):1054-6.
[3]Im H, Kim E, Park E, Sung K, Oh W. Pain reduction of heel stick in neonates: Yakson compared to non-nutritive sucking. J Trop Pediatr. 2008;54(1):31-5.
[4]Azari M, Dargahi R, Moradi A. The effect of breastfeeding and skin to skin contact of mothers and infants on first injection pain of newborn infants. J Ardabil Univ Med Sci. 2011;2(4):44-9. [Persian]
[5]Moradi F, Imani A, Keyghobdi S, Nazari H, Ghorbani R, Keyghobadi T. Effects of intra-oral intake of different concentrations of sucrose on biobehavioral pain response to immunizations in infants. Koomesh. 2012;13(4): 414-9. [Persian]
[6]Maroufi M, Nikoubakht F, Alimohamadi N, Badiei Z. Comparison of mother’s milk and melody on severity heel stick pain in neonates admitted in NICU. J Anesthesiol Pain. 2015;5(3):45-54. [Persian]
[7]Jain S, Kumar P, Mcmillan D. Prior leg massage decreases pain responses to heel stick in preterm babies. J Paediatr Child Health. 2006;42(9):505-8.
[8]Eriksson M, Storm H, Fremming A, Schollin J. Skin conductance compared to a combined behavioral and physiological pain measure in newborn infant. Acta Pediatr. 2008;97(1):27-30.
[9]Badiee Z, Asghari M, Mohammadizadeh M. The calming effect of breast milk odor on preterm infants. Pediatr Neonatol. 2013;54(5):322-5.
[10]Mirzarahimi M, Mehrnoosh N, Shahizadeh S, Samadi N, Amani F. Effect of non-nutritive sucking and leg massage on physiological and behavioral indicators of pain following heel blood sampling in term neonates. Int J Adv Nurs Stud. 2013;2(2):74-9.
[11]Bellieni CV, Bagnoli F, Perrone S, Nenci A, Cordelli DM, Fusi M, et al. Effect of multisensory stimulation on analgesia in term neonates: A randomized controlled trial. Pediatr Res. 2002;51(4):460-3.
[12]Khoddam H, Ziyaee T, Hossaini A. Effect of skin to skin contact between mother and neonate in pain of neonate. J Gorgan Univ Med Sci. 2002;4(9):11-8. [Persian]
[13]Potter B, Rindfleisch K. Breastfeeding reduces pain in neonates. J Fam Pract. 2003;52(5):349, 352.
[14]Golchin M, Sheikhan Soudani E, Bahrami P, Shams Soulari Z. The effect of combined use of nonnutritive sucking and sucrose on cardio-respiratory indices and pain behavior during blood drawing-phelebotomy procedures in preterm infants in intensive care unit. J Anesthesiol Pain. 2016;6(4):41-54. [Persian]
[15]Sadat Hossaini A, Negarande R, Mehran A, Movahedi Z. The effect of olfactory stimuli familiar on pain responses following venipuncture in newborns. J Hamedan Univ Med Sci. 2011;18(1):10-9. [Persian]
[16]Goubet N, Strasbaugh K, Chesney J. Familiarity breeds content? soothing effect of a familiar odor on full term newborn. J Dev Behav pediatr. 2007;28(3):189-94.
[17]Nishitani S, Miyamura T, Tagawa M, Sumi M, Takase R, Doi H, et al. The calming effect of a maternal breast milk odor on the human newborn infant. Neurosci Res. 2009;63(1):66-71.
[18]Rattz C, Goubet N, Bullinger A. The calming effect of familiar odor on full-term newborn. J Dev Behav Pediatr. 2005;26(2):86-92.
[19]Wimberg J, Porter RH. Olfaction and human neonatal behaviour: Clinical implications. Acta Paediatr. 1998;87(1):6-10.
[20]Schaal B, Montagner H, Heartling E, Bolzoni D, Moyse A, Quichon R. Olfactory stimulation in the relationship between child and mother. Reprod Nutr Dev. 1980;20(3B):843-58. [French]
[21]Raimbault C, Saliba E, Porter RH. The effect of the odor of mother, s milk on breast feeding behavior of premature neonates. Acta Paediatr. 2007;96(3):368-71.
[22]Shamsi A, Movahedi Z, Pouraboli B, Iranmanesh S. The effect of olfactory stimulation with breast milk smell on the duration of feeding transitional time from gavage to oral feeding and hospital stay in premature infants hospitalized in neonatal intensive care unit. Med Surg Nurs J. 2014;3(1):17-23. [Persian]
[23]Bingham PM, Abassi S, Sivieri E. A pilot study of milk odor on nonnutritive sucking by premature newborns. Arch Pediatr Adolesc Med. 2003;157(1):72-5.
[24]Aoyama S1, Toshima T, Saito Y, Konishi N, Motoshige K, Ishikawa N, et al. Maternal breast milk odour induces frontal lobe activation in neonates: a NIRS study. Early Hum Dev. 2010;86(9):541-5.
[25]Taavoni S, Shah Ali SH, Haghani H, Neisani Samani L. Comparison the effect of breast feeding with routhin clinical procedure on pain relieving during immunization injection. J Arak Univ Med Sci. 2008;11(4):33-40. [Persian]
[26]Varendi H, CHristensson K, Porter RH, Winberg J. Soothing effect of amniotic fluid smell in newborn infants. Early Hum Dev. 1998;51(1):47-55.
[27]Karbandi S, Dehghanian N, Pourarian SH, Salari M. The effect of breast milk odor on concentration percentage of oxygen saturation and respiratory rate in premature infants. Evid Based Care J. 2015;5(14):25-33.