Facilitated Tucking on Pain in Pre-Term Newborns During Venipuncture
A Randomized Controlled Cross-Over Trial
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Abstract
IMPORTANCE The preterm infant is more vulnerable to painful experiences during early life, resulting in long-term developmental and psychological problems. Venipuncture is a common invasive procedure in neonatal care and can elicit significant pain in preterm infants. Pain management, such as facilitated tucking (FT), becomes a vital component of neonatal care.
AIMS The purpose of this study was to evaluate the effectiveness of FT in preterm neonates during the venipuncture procedure.
METHODS A randomized controlled crossover study was conducted in perinatology units at hospitals in East Java, Indonesia, from 23 October to 20 November 2019. Preterm neonates requiring venipuncture were included. Each participant received facilitated tucking (FT) and non-facilitated tucking (NFT) in alternating order, with a minimum 24-hour washout period between interventions. Infant characteristics were obtained from medical records, and pain responses were assessed one minute after venipuncture using the Neonatal Infant Pain Scale (NIPS). Data was analyzed using SPSS, with the Wilcoxon test used to compare pain scores between intervention conditions (p < 0.05)).
FINDINGS Eighteen preterm infants were included, with gestational ages of 30–34 weeks (median 32 weeks) and birth weights of 840–2358 g (median 1610 g). The FT condition resulted in significantly lower pain scores than the NFT condition (median NIPS 5 [IQR 5] vs. 6 [IQR 0]; p = 0.009; r = 0.62).
CONCLUSION Facilitated tucking (FT) is effective intervention for relieving pain during the venipuncture procedure among preterm neonates.
RELEVANCE TO CLINICAL PRACTICE Facilitated tucking (FT) should be integrated into standard neonatal nursing protocols for procedural pain relief during venipuncture.
ETHICS APPROVAL AND FUNDING This study was obtained from the ethical committee of DR. Saiful Anwar Hospital by ethical clearance number 400/184/K.3/302/2019.and no specific funding.
Keywords:
facilitated tacking nurse pain management preterm-infant venipunctureReferences
Alinejad-Naeini, M., Mohagheghi, P., Peyrovi, H., & Mehran, A. (2014). The effect of facilitated tucking during endotracheal suctioning on procedural pain in preterm neonates: a randomized controlled crossover study. Global Journal of Health Science, 6(4), 278–284. https://doi.org/10.5539/gjhs.v6n4p278
Assefa, E., Dinkiye, M., Geleta, T., Wondwosen, M., & Zewdu, D. (2022). The practice of procedural pain assessment and management in neonatal intensive care unit in Ethiopia : Cross-sectional stud, 5(2), 1–7. https://doi.org/10.1002/hsr2.533
Axelin, A., Salanterä, S., & Lehtonen, L. (2006). “Facilitated tucking by parents” in pain management of preterm infants-a randomized crossover trial. Early Human Development, 82(4), 241–247. https://doi.org/10.1016/j.earlhumdev.2005.09.012
Bayat, M. (2021). 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. Journal of Pediaric Nursing, 56, 19–26. https://doi.org/10.1016/j.pedn.2020.07.001
Bellieni, C. V, Tei, M., Cornacchione, S., Lucia, S. Di, Nardi, V., & Verrotti, A. (2018). Pain perception in NICU : a pilot questionnaire. The Journal of Maternal-Fetal & Neonatal Medicine, 31(14), 1921–1923. https://doi.org/10.1080/14767058.2017.1332038
Cai, Q., Luo, W., Zhou, Y., Yin, Y., Zhu, K., Shi, H., & Liao, Y. (2023). Efficacy and safety of non-pharmacological interventions for endotracheal suctioning pain in preterm infants: A systematic review. Nursing Open, 10(2), 424–434. https://doi.org/10.1002/nop2.1364
Campbell-Yeo, M., Eriksson, M., & Benoit, B. (2022). Assessment and Management of Pain in Preterm Infants: A Practice Update. Children, 9(2), 1–18. https://doi.org/10.3390/children9020244
Cignacco, A. E. L., & Sellam, G. (2015). Oral Sucrose and “ Facilitated Tucking ” for Repeated Pain Relief in Preterms : A Randomized Controlled Trial. Pediatrics, 129(2), 299–308. https://doi.org/10.1542/peds.2011-1879
Davari, S., Borimnejad, L., Khosravi, S., & Haghani, H. (2018). The effect of the facilitated tucking position on pain intensity during heel stick blood sampling in premature infants: a surprising result Samaneh. The Journal of Maternal-Fetal & Neonatal Medicine, 32(20), 3427–3430. https://doi.org/10.1080/14767058.2018.1465550
Hartley, K. A., Miller, C. S., & Gephart, S. M. (2015). Facilitated tucking to reduce pain in neonates: Evidence for best practice. Advances in Neonatal Care, 15(3), 201–208. https://doi.org/10.1097/ANC.0000000000000193
Hatfield, L. A., Murphy, N., Karp, K., & Polomano, R. C. (2019). A Systematic Review of Behavioral and Environmental Interventions for Procedural Pain Management in Preterm Infants. Journal of Pediatric Nursing, 44, 22–30. https://doi.org/10.1016/j.pedn.2018.10.004
Hill, S., Engle, S., Jorgensen, J., Kralik, A., & Whitman, K. (2005). Effects of facilitated tucking during routine care of infants born preterm. Pediatric Physical Therapy, 17(2), 158–163. https://doi.org/10.1097/01.PEP.0000163097.38957.EC
Kent, A. L., Wright, I. M. R., Abdel-Latif, M. E., Bowen, J., Bajuk, B., & Vincent, T. (2012). Mortality and adverse neurologic outcomes are greater in preterm male infants. Pediatrics, 129(1), 124–131. https://doi.org/10.1542/peds.2011-1578
Kucukoglu, S., Kurt, S., & Aytekin, A. (2015). The effect of the facilitated tucking position in reducing vaccination-induced pain in newborns. Italian Journal of Pediatrics, 41(1), 1–7. https://doi.org/10.1186/s13052-015-0168-9
Lavoie, P. M., Stritzke, A., Ting, J., & Jabr, M. (2015). Randomized Controlled Trial of the Use of Oral Glucose with or without Gentle Facilitated Tucking of Infants during Neonatal Echocardiography. PLoS ONE, 10(10), 1–11. https://doi.org/10.1371/journal.pone.0141015
Lee, A. C., Blencowe, H., & Lawn, J. E. (2019). Small babies, big numbers: global estimates of preterm birth. The Lancet Global Health, 7(1), e2–e3. https://doi.org/10.1016/S2214-109X(18)30484-4
Lopez, O., Subramanian, P., Rahmat, N., Theam, L. C., Chinna, K., & Rosli, R. (2015). The effect of facilitated tucking on procedural pain control among premature babies. Journal of Clinical Nursing, 24(1–2), 183–191. https://doi.org/10.1111/jocn.12657
Migliori, C., Braga, M., Siragusa, V., Villa, M. C., & Luzi, L. (2023). The impact of gender medicine on neonatology : the disadvantage of being male : a narrative review. Italian Journal of Pediatrics, 45, 1–6. https://doi.org/10.1186/s13052-023-01447-2
Obiedat, H., & Al-maaitah, E. I. (2020). Critique of the Use of Neonatal Infant Pain Scale ( NIPS ) Neonatal and Pediatric Medicine. 6(1), 1–5.
Oktaviani, E., Rustina, Y., & Efendi, D. (2018). Facilitated Tucking Effective To Pain Relief on the Preterm Infants in Perinatal Unit in Jakarta. Jurnal Keperawatan Indonesia, 21(1), 9–16. https://doi.org/10.7454/jki.v21i1.539
Pekyiğit, A., & Açıkgöz, A. (2023). Effects of White Noise and Facilitated Tucking During Heel Stick Sampling on the Pain Response of Healthy Term Newborns: A Randomized Controlled Study. The Journal of Pediatric Research, 10(1), 43–54. https://doi.org/10.4274/jpr.galenos.2022.67799
Ranjbar, A., Bernstein, C., Shariat, M., & Ranjbar, H. (2020). Comparison of facilitated tucking and oral dextrose in reducing the pain of heel stick in preterm infants: A randomized clinical trial. BMC Pediatrics, 20(1), 1–9. https://doi.org/10.1186/s12887-020-2020-7
Simons, S. H. P., van Dijk, M., Anand, K. S., Roofthooft, D., van Lingen, R. A., & Tibboel, D. (2003). Do We Still Hurt Newborn Babies? Archives of Pediatrics & Adolescent Medicine, 157(11), 1058. https://doi.org/10.1001/archpedi.157.11.1058
Subedi, R., Bhatta, M., Chaudhary, R., & Karn, B. K. (2024). Effectiveness of facilitated tucking on reducing pain during heel stick in neonates : a randomized controlled experimental study. Annals of Medicine & Surgery, 86 (9), 5211–5217. https://doi.org/10.1097/MS9.0000000000002321
Sundaram, B., Shrivastava, S., Pandian, J. S., & Singh, V. P. (2013). Facilitated tucking on pain in pre-term newborns during neonatal intensive care: A single blinded randomized controlled cross-over pilot trial. Journal of Pediatric Rehabilitation Medicine, 6(1), 19–27. https://doi.org/10.3233/PRM-130233
UNICEF-WHO. (2023). Low birthweight - UNICEF DATA. In UNICEF Data: Monitoring the Situation of Children and Women. Retrieved March 3, 2026 from https://data.unicef.org/topic/nutrition/low-birthweight/
Yang, L., Fu, H., & Zhang, L. (2023). A systematic review of improved positions and supporting devices for premature infants in the NICU. Heliyon, 9(3), 1–13. https://doi.org/10.1016/j.heliyon.2023.e14388
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