Effects of the facilitated tucking position in early period on physiological parameters, comfort and breastfeeding performance in late preterm infants: A randomized controlled trial.

OBJECTIVE: This study's aim to determine the effect of facilitated tucking position applied to late preterm infants on physiological parameters, comfort, and breastfeeding performance. DESIGN: The study was conducted in a randomized controlled experimental design (Clinical Trial number: NCT04704180). METHODS: The study was conducted in the neonatal intensive care unit of a state hospital in eastern Turkey between November 2018 and July 2019. The sample consisted of 89 neonates meeting the inclusion criteria. Data were collected using the Neonatal Introductory Information Form, Physiological Parameter Follow-Up Chart, Neonatal Comfort Behavior Scale (NCBS), and Latch Breastfeeding Diagnosis Measurement Form. Facilitated tucking position was applied to the neonates in the experimental group (n = 44) in the early postnatal period. The routine application of the unit was performed on neonates (n = 45) in the control group. Ethical principles were followed at every stage of the study. FINDINGS: It was determined that the physiological parameters (heart rate, oxygen saturation, body temperature, respiratory rate) in the experimental group positioned with facilitated tucking showed a significant improvement compared to the control group (p<0.001). When the mean comfort (Experiment: 9.79±3.63, Control: 15.73±5.13) and LATCH (Experiment: 8.00±1.76, Control: 5.82±2.18) scores of neonates in the experimental group were compared with the control group, a significant difference was found in favor of the experimental group (p<0.001). IMPLICATIONS FOR PRACTICE: It was determined that the physiological parameters, comfort level and sucking success of late preterm infants who were positioned with facilitated tucking in the early postnatal period were positively affected.

The Effect of Facilitated Tucking on the Pain Intensity Induced by Chest Tube Removal in Infants.

BACKGROUND: Removal of a chest tube is a painful procedure for infants. Medications, including narcotics, are used to control pain, but nonpharmacologic interventions are also effective in reducing pain during this procedure and are not associated with adverse effects. PURPOSE: To evaluate the additive effect of facilitated tucking to the use of morphine on infant pain associated at the time of chest tube removal. METHODS: This was a prospective, randomized control study. Sixty infants were randomized into 2 equal groups utilizing a coin flip. All infants received 0.05-mg/kg morphine 20 minutes before chest tube removal. The intervention group received facilitated tucking and the control group received standard care. Infant pain was measured using the Neonatal Infant Pain Scale. Pain was assessed at 3 time points by 2 independent evaluators: 5 minutes before, during, and 5 minutes after removal of the chest tube. Mann-Whitney and Fisher's exact (Chi-square) tests were used to compare the intervention and control groups. RESULTS: Pain scores were increased during chest tube removal for both the intervention and the control groups. Compared with the control group, pain scores for infants in the intervention group were less before, during, and after chest tube removal. IMPLICATIONS FOR PRACTICE: Facilitated tucking combined with morphine administration can be an effective additive intervention for pain control in infants during chest tube removal. IMPLICATIONS FOR RESEARCH: Evaluate the effect of the facilitated tucking on pain induced by chest tube removal in preterm infants. Preterm infants may respond differently to pain.

[Improving the Completeness of Facilitated Tucking for Preterm Infants in the Neonatal Intensive Care Unit].

BACKGROUND & PROBLEMS: Facilitated tucking (containment) is a strategy that has been demonstrated to improve insufficient muscle tone, reduce procedural pain, and stabilize vital signs in premature infants. PURPOSE: The aim of this study was to improve the accuracy and implementation rate of nursing staffs` facilitated tucking. METHODS: Formulate and standardize nursing care to reduce the burden on nursing staff and make staff implementation consistent. Decomposition diagrams of the production steps were posted in patient units, on-the-job education courses were held, and a short video was used to provide care guidelines to nursing staff. RESULTS: Compared to pretest levels, the rate of facilitated tucking implementation in the early, middle, and late invasive medical treatment periods, respectively, increased from 0% to 53.5%, 1.2% to 50%, and 6% to 48.8%, while the accuracy rate of facilitated tucking cognition increased from 61.1% to 91.9%. CONCLUSIONS: This project effectively promoted the standardization of facilitated tucking in our hospital, provided preterm infants with better care and neurological development, and improved mother-infant attachment.

The Effect of Breastfeeding, Kangaroo Care, and Facilitated Tucking Positioning in Reducing the Pain During Heel Stick in Neonates.

PURPOSE: Invasive intervention can negatively affect prognosis, behavior, environmental adaptation in neonates. Some nonpharmacological pain management methods are used for effective pain treatment. This study investigated the effect of breastfeeding, kangaroo care, and facilitated tucking positioning on heel-stick pain in neonates. DESIGN: A quasi-experimental design was employed. The study was conducted in three family health centers in Kütahya/Turkey. The sample consisted of 140 healthy neonates with the gestational age of 37 weeks or more, birth weight greater than 2500 g, and no sucking problems. The sample was divided into four groups (breastfeeding, kangaroo care, facilitated tucking position, and control). Data were collected using a Baby-Mother Characteristics Questionnaire, a Physiological Parameter Follow-up Form, and the Neonatal Infant Pain Scale. Data were analyzed using chi-square, the one-way analysis of variance (ANOVA), Kruskal-Wallis, Student t-test, and Mann-Whitney U tests. The research adhered to ethical principles. RESULTS: The facilitated tucking position group cried less and experienced less pain during heel stick than the other groups (p < 0.05). Breastfeeding, kangaroo care, and facilitating tucking help reduce heel-stick pain but facilitating tucking causes less crying and imposes less pain on neonates than the other methods. CONCLUSION: Facilitated tucking position may be preferred to reduce pain during heel stick. PRACTICE IMPLICATIONS: Using facilitated tucking positions and breastfeeding methods can assist healthcare professionals as supportive methods in pain management.

Comparison the Effect of Breast Milk Smell, White Noise and Facilitated Tucking Applied to Turkish Preterm Infants During Endotracheal Suctioning on Pain and Physiological Parameters.

PURPOSE: This study aimed to determine the effect of the breast milk smell, white noise and facilitated tucking during endotracheal suctioning (ES) on pain and physiological findings. DESIGN AND METHODS: The present study was conducted as a randomized, controlled experimental trial study. The sample of the study was composed of a total of 80 preterm infants. Pain was measured with PIPP-R pain scale. rMANOVA and bonferroni tests were used in the comparison of the pain scores of the groups. RESULTS: It was determined that white noise and facilitated tucking were more effective in relieving infants before ES procedure (p < .05). No statistically significant difference was found between the groups in reducing the pain during ES procedure (p > .05). After the procedure, facilitated tucking was determined more effective in the recovery of preterm infants (p < .05). PRACTICE IMPLICATIONS: It is recommended to use facilitated tucking and white noise for decreasing pain of ventilated preterm infants during the ES procedure. CONCLUSIONS: White noise and facilitated tucking were effective in relieving pain before procedure and facilitated tucking recovery in preterm infants after the ES procedure.

Comparison of facilitated tucking and oral dextrose in reducing the pain of heel stick in preterm infants: a randomized clinical trial.

BACKGROUND: With the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required. This study aimed to compare the effect of oral dextrose and facilitated tucking in the reduction of pain during heel sticks in premature infants and assess their effectiveness and feasibility for use in emergency settings. METHODS: This study was a randomized controlled clinical trial with cross-over design. Sixty infants were recruited from a Neonatal Intensive Care Unit (NICU) at Valiasr hospital in Tehran, Iran from March 2015 to September 2016. They were randomly allocated into three groups (no pain relief method, oral dextrose and facilitated tucking). Six blood samples were collected by heel stick for each infant. Oral dextrose and facilitated tucking were compared with the routine method of blood sampling and pain was measured two times for each method. The pain scores was measured by the Premature Infant Pain Profile (PIPP). Repeated Measure ANOVA, ANOVA and Scheffe post-hoc test were used with SPSS 16. RESULTS: The pain score's increase during heel stick was significantly lower after using oral dextrose (3.58 ± 0.34) and facilitated tucking (5.58 ± 0.53) in comparison to the routine method (8.91 ± 0.18) of blood sampling (P < 0.001, η2 = 0.971). Oral dextrose was more effective than facilitated tucking (P < 0.001, Cohen's d = 4.49). The emergency nurses rated oral dextrose as easier (t = 2.20, df = 118, p = 0.02, Cohen's d = 0.39) and more applicable method (t = 2.99, df = 118, p = 0.003, Cohen's d = 0.54) for the emergency department. CONCLUSIONS: Facilitated tucking is an effective method of pain reduction which can be used in the absence of oral dextrose, in a situation in which it is contraindicated or in combination with oral dextrose. Based on the increase of infant's admission in emergency department future studies are needed to identify the best method of pain reduction for procedures in this setting. TRIAL REGISTRATION: Current Controlled Trials IRCT201408029568N9, 2014-09-08.

The effect of facilitated tucking position during painful procedure in pain management of preterm infants in neonatal intensive care unit: a systematic review and meta-analysis.

We performed a systematic review and meta-analysis to investigate the effects of facilitated tucking position during painful procedure in pain management of preterm infants. We searched MEDLINE, PEDro, SciELO and the Cochrane Library (until June 2019) for randomized controlled trials. An α value ≤ 0.05 was considered significant. Heterogeneity among studies was examined with Cochran's Q and I2 statistic, in which values greater than 40% were considered indicative of high heterogeneity and random-effects model was chosen. Analyses were performed with Review Manager 5.3. Fifteen studies met the eligibility criteria, including 664 preterm infants. The meta-analyses showed a significant reduction in pain of - 1.02 (95% CI - 1.7 to - 0.4, N = 216) during endotraqueal suctioning for participants in the facilitated tucking position group (FTPG) compared with routine care group. The meta-analyses showed a non-significant difference in pain - 0.3 (95% CI - 2.05 to - 1.4, N = 88) during heel stick for participants in the FTPG compared with oral glucose group. The meta-analyses showed a non-significant difference in pain for participants in the FTPG compared with oral opioid group 0.2 (95% CI - 1.4 to 1.8, N = 140).Conclusion: Facilitated tucking position may improve the pain during painful procedures.What is Known:• Exposure of premature babies to painful procedures is associated with changes in brain development, regardless of other factors.• Facilitated tucking reduces the expression of pain in premature infants.What is New:• Facilitated tucking position was efficient in pain management of preterm infants when compared to routine care.• Facilitated tucking compared to opioid or oral glucose did not achieve a significant reduction in pain intensity.

The effect of expressed breast milk, swaddling and facilitated tucking methods in reducing the pain caused by orogastric tube insertion in preterm infants: A randomized controlled trial.

BACKGROUND: Orogastric tube feeding is used to support the nutrition of preterm infants. Although nonpharmacological methods are effective in reducing the pain caused by orogastric tube insertion, only limited studies have been found addressing this pain. No study has used combined nonpharmacological methods to reduce this orogastric tube insertion pain. OBJECTIVE: This randomized controlled study aims to compare the effects of expressed breast milk, swaddling, facilitated tucking, expressed breast milk+swaddling, expressed breast milk+facilitated tucking and routine care methods on preterm infant pain and the physiological parameters (i.e., heart rate, oxygen saturation) before, during and after orogastric tube insertion procedures. DESIGN: Randomised controlled trial. SETTING: Three level III neonatal intensive care units in Turkey. METHOD: Preterm infants born at 32-34 weeks gestation were randomly assigned to six groups: routine care (n = 33), swaddling (n = 30), facilitated tucking (n = 32), expressed breast milk (n = 31), swaddling+expressed breast milk group (n = 30), and facilitated tucking+expressed breast milk group (n = 31). Orogastric tube insertion included four phases: baseline (the last one minute of 30 min without stimuli), the insertion, recovery (one minute after insertion), and recovery (two minutes after insertion). The four phases were videotaped. Premature infant pain profile score, heart rate and oxygen saturation were assessed by two independent evaluators who were blinded to the purpose of the study. Data were assessed by analysis of variance for the multiple repeated measurements, bonferroni and generalised estimating equation logistic regression. RESULTS: There was a significant main effect of the intervention groups for all the pain and physiological parameters (heart rate: F = 3.99, p = 0.001; oxygen saturation: F = 5.22, p<0.001; pain profile 1 score: F = 9.55, p<0.001; pain profile 2 score: F = 9.74, p<0.001). The use of the nonpharmacological methods combined or alone was more effective in reducing infants' pain profile score and physiological variables than routine care. Infants receiving swaddling+expressed breast milk had significantly lower pain profile scores during the insertion (phase2) (5.2 ± 1.7) than those receiving routine care (9.5 ± 3.6), swaddling (8.8 ± 2.9), facilitated tucking (7.2 ± 3.2), expressed breast milk (7.9 ± 2.6), facilitated tucking+expressed breast milk (6.6 ± 2.3) (p<0.001). The breast milk group had 6.195 times more pain than the swaddling+expressed breast milk, while the facilitated tucking group had 6.301, the facilitated tucking+expressed breast milk group had 3.107, the control group had 13.015, and the swaddling group had 7.892 times more pain. CONCLUSION: The swaddling+expressed breast milk method is clinically better pain relief nonpharmalogical option and is the recommended method to nurses for the orogastric tube insertion procedures, preterm infants.

The effect of the facilitated tucking position on pain intensity during heel stick blood sampling in premature infants: a surprising result.

Background: According to research findings, pain experience in neonatal period leads to short- and long-term complications that could be prevented by means of neonatal pain relief. Therefore, this study aimed to investigate the effect of facilitated tucking position on neonatal pain during heel prick blood sampling. Methods: This is a cross over clinical trial was done on 40 premature neonates. During blood sampling, neonates were put in either facilitated tucking or routine positions randomly and Premature Infant Pain Profile (PIPP) was completed for each neonate. In the next sampling time, positions were changed and the process repeated. Data were analyzed using descriptive statistics, repeated measure ANOVA, and independent t-test. Results: Results showed that the mean pain intensity in each position was increased during sampling (p = .0001) and after that was decreased significantly (p = .001), but before, during, and after sampling there was no significant difference between the two positions (p > .05). Conclusions: Overall findings showed that comparing neonates in the two positions; there was no significant difference in their pain intensity. These results are almost in contrast with many researches findings in this area. It seems there is a need to further investigation regarding this subject.

Facilitated tucking during early neonatologist-performed echocardiography in very preterm neonates.

AIM: To assess the effect of facilitated tucking (FT), a nonpharmacologic nursing intervention, on echocardiographic parameters and infant comfort collected prospectively during neonatologist-performed echocardiography. METHODS: Echocardiography was performed twice, in standard conditions and with FT; the order was randomised by computer. Echocardiography provided data on pulmonary artery flow and pressure, right and left ventricular function, and persistent ductus arteriosus. Comfort was assessed by a behavioural scale of pain, variations in heart rate (HR) and SpO2 , and a newborn infant parasympathetic evaluation index based on the high-frequency variability in HR. RESULTS: Fifty newborns, with mean gestational age of 28 [26.6-29.0] weeks and mean birthweight of 950 [780-1190] g, were studied at a postnatal age of 13 [9-27] hours. FT was associated with longer acceleration time/right ventricular ejection time in the main pulmonary artery (p = 0.006), reduced averaged HR variations (p = 0.03) and lower pain scores (p < 0.001). The other haemodynamic parameters and the parasympathetic index were not influenced by FT. CONCLUSION: Echocardiography performed soon after birth in very premature neonates may generate mild discomfort. FT during echocardiography is associated with lower pulmonary artery pressures and improves infant's comfort during this examination.

Efficacy of facilitated tucking combined with non-nutritive sucking on very preterm infants' pain during the heel-stick procedure: A randomized controlled trial.

BACKGROUND: Reducing acute pain in premature infants during neonatal care improves their neurophysiological development. The use of pharmacological and non-pharmacological analgesia, such as sucrose, is limited per day, particularly for very preterm infants. Thus, the usual practice of non-nutritive sucking is often used alone. Facilitated tucking could be an additional strategy to non-nutritive sucking for reducing pain. To the best of our knowledge, no randomized trial has compared the combination of facilitated tucking and non-nutritive sucking to non-nutritive sucking alone. OBJECTIVES: To compare the efficacy of facilitated tucking in combination with non-nutritive sucking (intervention group) to non-nutritive sucking alone (control group) in reducing pain during the heel-stick procedure in very preterm infants. DESIGN: Prospective, randomized controlled trial. SETTINGS: Level III and II neonatal care units, including the neurosensory care management program. METHODS: Very preterm infants (gestational age between 28 and 32 weeks) were randomly assigned by a computer programme to the intervention or control group during a heel-stick procedure within the first 48 h of life. In both groups, infants were placed in an asymmetric position on a cushion; noise and light were limited following routine care. A heel-stick was performed first in the care sequence. In the intervention group, facilitated tucking was performed by a nurse or nursing assistant. The procedure was video recorded from 15 s (T-15 s) before the procedure until three minutes (T + 3 min) after the end of the procedure. Pain was blindly assessed by two independent specialist nurses. The primary outcome was the pain score evaluated 15 s before the procedure and 30 s immediately after by the premature infant pain profile (PIPP) scale. The secondary outcome was the pain score evaluated between T-15 s and T + 3 min by the DAN scale (a French acronym for the acute pain of a newborn). RESULTS: Sixty infants were included (30 in each group). The PIPP pain scores did not differ between the intervention group (median: 8.0; interquartile range (IQR): 6.0-12.0) and the control group (median: 9.5; IQR: 7.0-13.0, p = 0.32). Pain assessed by the DAN scale at T + 3 min was lower in the intervention group than in the control group (median: 0.3; IQR: 0.0-1.0 and 2.0; IQR: 0.5-3.0, respectively, p = 0.001). CONCLUSIONS: The combined use of facilitated tucking and non-nutritive sucking did not significantly alleviate pain during the heel-stick procedure. However, the addition of facilitated tucking facilitated faster pain recovery following the heel-stick procedure.

The effect of the facilitated tucking position in reducing vaccination-induced pain in newborns.

BACKGROUND: This study was conducted to evaluate the pain perceptions of newborns during the hepatitis B (HBV) vaccinations performed in the facilitated tucking position and the classical holding position, respectively. METHODS: The randomized controlled experimental study was conducted between 1 September 2014 and 30 December 2014 at the neonatal intensive care unit of a Turkish university hospital. One group of infants was held in the facilitated tucking position (the treatment group; n = 30) during HBV vaccination; infants in the other group were held in the classical holding position (the control group; n = 30) during HBV vaccination. The Neonatal Infant Pain Scale (NIPS) scores of the infants in the treatment and control groups were compared during procedure. Also, the infants' physiological parameters were compared before, during, and after the procedure. Descriptive statistics, a chi-square test, and an independent samples t-test were used to assess the data. RESULTS: The mean pain scores of infants vaccinated in the facilitated tucking position (2.83 ± 1.18) were significantly statistically lower than the scores of infants vaccinated in the classical holding position (6.47 ± 1.07) (p < 0.05). CONCLUSIONS: The pain perceptions of newborns held in the facilitated tucking position during HBV vaccination were lower. The facilitated tucking position, a non-pharmacological method, is recommended as an effective and useful method for reducing pain during the procedure.

Facilitated tucking to reduce pain in neonates: evidence for best practice.

BACKGROUND: Increasing survival rates of preterm infants and a greater understanding of the long-term consequences of early exposure to pain have generated a greater need for nonpharmacologic pain management strategies in the neonatal intensive care unit (NICU) setting. Facilitated tucking supports the preterm infant and is a valuable strategy to manage neonatal pain. Alternative nonpharmacologic approaches to pain management in neonates include nonnutritive sucking and kangaroo care. CLINICAL QUESTION: In premature and critically ill infants, what is the effect of facilitated tucking on pain behaviors in those who received the intervention compared with those who did not, and what alternative interventions for nonpharmacologic pain reduction are supported by strong research evidence? SEARCH STRATEGY: Studies were identified in the PubMed database using the search terms: facilitated tucking, NICU, pain management, preterm infant, and nonpharmacologic. Studies were included if they were peer reviewed, were published in the last 5 years (or considered classic), and if they used experimental study designs. RESULTS: The studies identified demonstrate that facilitated tucking reduces the expression of pain in premature infants. As a whole, existing research supports the use of facilitated tucking for infants as early as 23 weeks' gestational age, during painful procedures including: heel stick, endotracheal suctioning, and venipuncture. IMPLICATIONS FOR PRACTICE AND RESEARCH: Pain management interventions are necessary to decrease the potentially unfavorable consequences of early exposure to pain and to promote positive outcomes. Additional research is indicated to discover the effects of nonpharmacologic interventions in neonates with severe illness, congenital abnormalities, and/or assisted breathing.

Development of atraumatic heel-stick procedures by combined treatment with non-nutritive sucking, oral sucrose, and facilitated tucking: a randomised, controlled trial.

BACKGROUND: Preterm infants manifest pain and stress by behavioural agitation and state change. Few studies have explored the effects of combining nonpharmacological interventions, i.e. non-nutritive sucking, oral sucrose, and facilitated tucking, on infants' behaviours across painful procedures. OBJECTIVES: To explore the effects of combined use of three nonpharmacological interventions (non-nutritive sucking, oral sucrose, and facilitated tucking) on infants' pain- and stress-related behaviours during four assessment phases: baseline, intervention, heel stick, and recovery. DESIGN: Prospective, randomised controlled trial. SETTING: Level III neonatal intensive care unit in Taipei. METHOD: A convenience sample of 110 infants (gestational age 27-37 weeks) needing heel sticks was randomly assigned to five combinations of nonpharmacological treatments: (1) routine care, (2) non-nutritive sucking+facilitated tucking, (3) oral sucrose+facilitated tucking, (4) non-nutritive sucking+oral sucrose, and (5) non-nutritive sucking+oral sucrose+facilitated tucking. Outcomes were infants' withdrawal or stress (grimace, limb and trunk extension or squirming) and approach or self-soothing (sucking, sucking search, or mouthing; hand holding or grasping; and hand to mouth, face) behaviours. RESULTS: The frequency of infants' withdrawal behaviours decreased significantly when they received combinations of nonpharmacological interventions before heel stick. Specifically, grimace frequency decreased by 32.2%, 30.6%, 19.7%, and 13.8% in infants receiving oral sucrose+non-nutritive sucking+facilitated tucking, non-nutritive sucking+oral sucrose, oral sucrose+facilitated tucking, and non-nutritive sucking+facilitated tucking, respectively, compared to those receiving routine care across assessment phases. Furthermore, infants' frequency of limb and trunk extension or squirming decreased by 24.0% when they received non-nutritive sucking+oral sucrose+facilitated tucking compared to those receiving routine care. Infants' frequency of approach behaviours did not change significantly across all phases when they received non-nutritive sucking+oral sucrose+facilitated tucking, non-nutritive sucking+oral sucrose, and oral sucrose+facilitated tucking compared to those receiving routine care. CONCLUSIONS: The combined use of nonpharmacological interventions (non-nutritive sucking+oral sucrose+facilitated tucking) effectively reduced the frequencies of infants' withdrawal behaviours, i.e. grimace and limb and trunk extension or squirming. Our results provide evidence supporting clinicians' incorporation of the combined use of facilitated tucking, oral sucrose, and non-nutritive sucking into clinical practice during painful procedures. Heel-stick procedures can be atraumatic when conducted while infants are stable and quiet, appropriately positioned, and stabilised and by offering facilitated tucking, oral sucrose, and non-nutritive sucking before gently sticking the heel and squeezing blood.

The effect of facilitated tucking on procedural pain control among premature babies.

AIMS AND OBJECTIVES: To determine the effectiveness of facilitated tucking in reducing pain when venepuncture is being performed on preterm infants. BACKGROUND: Preterm neonates are exposed to a myriad of invasive, often painful, procedures throughout their stay in the neonatal intensive care unit. A growing volume of evidence shows that pain in preterm infants has both short- and long-term deleterious effects. It is within the power and ethical responsibility of neonatal nurses to help premature babies cope with procedural pain. DESIGN: A quasi-experimental study with two groups: control and treatment group. METHODS: A study was conducted on a cohort of preterm infants (n = 42), divided into control (n = 21) and treatment (n = 21) groups, to determine the effect of facilitated tucking on pain relief during venepuncture on preterm infants in the neonatal intensive care unit. The severity of pain was measured using the Premature Infant Pain Profile score. The primary outcome measure was reduction in the Premature Infant Pain Profile scores. RESULTS: The Premature Infant Pain Profile score for the treatment group was significantly lower (M = 6·62, SD 2·598) than for the control group (6·62 ± 2·60 vs. 8·52 ± 2·99, respectively, t = -2·202, p < 0·05). CONCLUSIONS: Facilitated tucking reduced the Premature Infant Pain Profile scores in preterm infants. RELEVANCE TO CLINICAL PRACTICE: The findings of this study suggest that facilitated tucking is able to alleviate pain; therefore, nurses must be able to carry out facilitated tucking when necessary.

Pain management in newborns.

As a standard of care for preterm/term newborns effective pain management may improve their clinical and neurodevelopmental outcomes. Neonatal pain is assessed using context-specific, validated, and objective pain methods, despite the limitations of currently available tools. Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Nonpharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain or adjunctive therapy. Local/topical anesthetics, opioids, NSAIDs/acetaminophen and other sedative/anesthetic agents can be incorporated into NICU protocols for managing moderate/severe pain or distress in all newborns.

The effect of facilitated tucking during endotracheal suctioning on procedural pain in preterm neonates: a randomized controlled crossover study.

BACKGROUND: Premature infants not only feel and understand the pain, but also respond more intensively compared with term infants. Non-pharmacological methods of pain control are suitable to relieve pain in painful procedures. The facilitated tucking position is considered as a non-pharmacological method of pain control in infants; however, its impact on frequent and repeated procedural pain such as endotracheal suctioning remains to be studied. OBJECTIVES: This paper is the report of a study that examined the impact of facilitated tucking position on behavioral pain during suctioning in premature neonates. DESIGN: This was a clinical trial study with a crossover design. SETTINGS: The study was conducted in a level II Neonatal Intensive Care Unit, located in a teaching hospital, affiliated to Tehran University of Medical Sciences, Tehran, Iran. PARTICIPANTS: Thirty four infants were enrolled in this study based on the following inclusion criteria: age between 29 to 37 weeks of gestational age, birth weight 1200 grams or more, having an endotracheal tube, no congenital anomalies, no seizures diagnosis, no chest tubes, no intracranial hemorrhage higher than degree II, not receiving opiates and sedatives four hours before intervention and not receiving any painful procedure at least half an hour before the intervention. METHODS: The samples were randomly received a sequence of suctioning with/without or suctioning without/with facilitated tucking. Preterm Infant Pain Profile (PIPP) was used to collect the data. SPSS version 16.0 for Windows (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. RESULTS: While 38.2% of infants experienced severe pain during suctioning without intervention, only 8.8% of them experienced severe pain during suctioning with intervention. The results of the paired t-test show that there is a statistically significant difference in the mean scores of pain between non-intervention and intervention cases (p < 0.001), and the mean pain score substantially reduced in cases with intervention. CONCLUSIONS: Given the multiplicity of endotracheal suctioning frequency and the impossibility of frequent use of pharmacological methods of pain relief, the facilitated tucking position can be used as a safe non-pharmacological method for procedural pain management. 

The effect of facilitated tucking position during endotracheal suctioning on physiological responses and coping with stress in premature infants: a randomized controlled crossover study.

OBJECTIVE: Premature infants respond more intensively to pain compared with term infants. Facilitated tucking position as a non-pharmacological method of pain in infants has been suggested; however, its effect on acute procedural pain such as endotracheal suctioning remains to be studied. This study examined the effect of facilitated tucking position during suctioning on physiological responses and coping with stress in premature infants. METHODS: This was a randomized controlled crossover study. Thirty-four premature infants received an order of either suctioning with intervention - suctioning without intervention, or suctioning without intervention - suctioning with intervention. Neonatal Infant Pain Scale (NIPS) was used to collect the data. RESULTS: No statistical significant difference was seen between intervention and non-intervention cases in terms of the average time duration to reach the pain score to one or zero, and also, in the average of changes in oxygen saturation. However, changes in heart rate were less in intervention cases. CONCLUSION: The effect of facilitated tucking position on coping with stress was not found in this study. This non-pharmacological strategy can be suggested because of its effect on reducing changes in heart rate during painful procedure. It is suggested to replicate the study with larger number of samples.