Venepuncture versus heel lance for blood sampling in term neonates

Venepuncture, when performed by a skilled phlebotomist, appears to be less painful than heel lance for blood sampling in term neonates. The use of a sweet tasting solution further reduces the pain.

The quality of evidence is downgraded by study limitations (unclear allocation concealment).

Summary

A Cochrane review included 6 studies with a total of 478 term neonates. A composite outcome of Infant Pain Scale (NIPS), Neonatal Facial Action Coding System (NFCS) and/or Premature Infant Pain Profile (PIPP) score was reported in 288 infants, who did not receive a sweet tasting solution. Meta-analysis showed a significant reduction in the venepuncture (VP) versus the heel lance group (SMD -0.76, 95% CI -1.00 to -0.52). When a sweet tasting solution was provided the SMD remained significant favouring the VP group (SMD - 0.38, 95% CI -0.69 to -0.07). The typical RD for requiring more than one skin puncture for venepuncture versus heel lance (reported in 4 studies; n = 254) was -0.34 (95% CI -0.43 to -0.25; I2 = 97%) favouring VP group. The NNT to avoid one repeat skin puncture was 3 (95% CI 2 to 4). Cry characteristics favoured the VP group but the differences were reduced by the provision of sweet tasting solutions prior to either procedure.

Clinical comments

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Ədəbiyyat

1. Shah VS, Ohlsson A. Venepuncture versus heel lance for blood sampling in term neonates. Cochrane Database Syst Rev 2011;(10):CD001452.