Venepuncture is preferable to heel lance for blood sampling in term neonates. Oral glucose and venepuncture reduce blood sampling pain in newborns. Venipuncture is more effective and less painful than heel lancing for blood tests in neonates. Using non-nutritive sucking and oral glucose solution with neonates to relieve pain: a randomised controlled trial. Venipuncture versus heel prick for blood glucose monitoring in neonates.
The analgesic effect of oral sucrose in newborn infants undergoing painful procedures is generally accepted. For blood sampling, some studies have shown that venepuncture (VP) is less painful than heel lance (HL).
                To determine the least painful and most effective method among blood sampling by VP or HL with or without sucrose.
                Randomised, double blind, placebo controlled trial.
                A total of 100 healthy, full term newborn infants being screened for inborn errors of metabolism were randomly allocated to one of four experimental groups (25 infants in each). Intervention and
                Seven specially trained nurses took turns to carry out blood sampling two minutes after administration of oral sucrose or water. Neonatal pain was assessed by the neonatal facial coding system (NFCS), as well as by crying.
                Without sucrose, the NFCS score was higher in the HL group than the VP group during blood sampling (median 58 v 23, p<0.001). Oral sucrose significantly reduced the score of the HL group (58 v 47, p<0.01) and also tended to reduce the score of the VP group (23 v 2, p<0.1). However, the HL with sucrose group still had a higher score than the VP without sucrose group (47 v 23, p<0.01). Crying and the total procedure time showed the same trends as the NFCS score.
                VP is less painful and more effective than HL for blood sampling in newborn infants. Although oral sucrose may have an additive analgesic effect, it is not necessarily required if VP is used for blood sampling. The objectives of this study were to measure pain symptoms in healthy fullterm newborns undergoing routine blood sampling with different methods. The 120 study subjects were randomly allocated to one of four groups with 30 babies in each, namely venepuncture or heel stick, with or without oral glucose administration. Pain was assessed from the duration of crying within the first 3 min, the Premature Infant Pain Profile (PIPP) and changes in heart rate. When the babies received 1 ml 30% glucose prior to skin puncture there was no significant difference between the heel stick and venepuncture group either in mean crying time (12.9 and 11.6 s, respectively) or in PIPP score (3.9 and 3.3). When no glucose was given crying time was 57.3 s in the heel stick group and 26.8 s in the venepuncture group (P = 0.0041) and the mean PIPP scores were 8.4 and 6.0, respectively (P = 0.0458). This study suggests that if oral glucose is given prior to skin puncture the choice of blood sampling method has no impact on the pain symptoms. Heel lancing has hitherto been the method of choice for screening tests of inborn errors of metabolism in neonates. Eutectic mixture of local anesthetic has little, if any, analgesic effect when applied to the heel of pre- and full-term infants. Today there seems to be no practical method that effectively alleviates the pain caused by heel lancing. The aim of this study was to investigate whether other methods, such as venipuncture of the dorsal side of the hand, are less painful and more efficient than heel lancing in neonates.
                One hundred twenty healthy, full-term infants who underwent testing for phenylketonuria (PKU) were included in the study. They were randomized into three groups: a venipuncture group (VP) (n = 50), a heel-lance group with a small lancet (SL) (n = 50), or a large lancet (LL) (n = 20). Pain reactions were assessed by the Neonatal Facial Coding System (NFCS). The latency and duration of the first cry as well as the total screaming time was analyzed. The efficacy of the method was assessed by the time taken to complete the PKU test and number of times the skin had to be punctured.
                Nociceptive response. The NFCS scores after the first skin puncture were: VP, 247; SL, 333; and LL, 460. The NFCS scores were significantly lower in the VP than in the groups subjected to heel lancing. During the first 60 seconds after skin puncture, 44% of the infants cried in the VP group, compared with 72% and 85% in the SL and LL groups, respectively. Efficacy. A successful PKU test with only one skin puncture was performed in 86% of the VP group, but in only 19% in the SL group and 40% in the LL group. The total time needed to obtain the PKU blood sample was 191 seconds (median) in the VP group, 419 seconds in the SL group, and 279 seconds in the LL group.
                Venipuncture is more effective and less painful than heel lancing for blood tests in neonates. To compare the efficacies of non-nutritive sucking and glucose solution as pain-relief interventions for neonates undergoing a venipuncture procedure.
                Neonates may be subjected to painful procedures. The individual efficacies of non-nutritive sucking or oral glucose solution used alone on pain-relief for neonates still remain controversial.
                A randomised, parallel-group controlled trial was designed.
                A total of 105 neonates were randomly assigned to one of the three groups: non-nutritive sucking, glucose solution, or control group. When a neonate underwent a venipuncture during a newborn screening test, his/her pain manifestations were videotaped and subsequently measured using the Neonatal Infant Pain Scale. Both the stability analysis and the analysis of repeated relationships were performed by generalised estimating equations.
                The level of pain was regressed over the study variables (time and group) and covariate (gestational age). Both the non-nutritive sucking and glucose solution groups had significantly lower pain scores than the control group during the venipuncture and recovery phases. Furthermore, non-nutritive sucking seemed to be more effective than glucose solution.
                Nurses can use a pain assessment tool and the pain-relief intervention to improve the quality of neonatal care in clinical practice. This study indicates that either non-nutritive sucking or glucose solution can effectively decrease the level of pain.
                If a painful procedure on neonates is inevitable, simple, convenient and effective pain-relief methods such as non-nutritive sucking or glucose solution can be provided alone. Based on a neonate's condition, nurses can provide 2 ml of 25% glucose solution through a syringe for a breastfeeding infant before an invasive procedure if nipple confusion is the concern. The aim of this study was to determine whether there was a difference in the pain indicators and effectiveness between venipuncture (VP) and heel prick (HP) for blood glucose monitoring in term neonates (recently, venipuncture was shown superior for the Guthrie test).
                66 term neonates undergoing blood glucose monitoring underwent VP or HP. Primary outcome measures included the Neonatal Facial Scoring System (NFCS) score, duration of the first cry, total duration of cry and duration of procedure. Secondary outcome measured was the number of skin punctures needed to obtain blood.
                The NFCS score was not significantly different between the two groups and the duration of the procedure was significantly longer for the VP than the HP group (median 27 s vs. 7 s; p-value is less than 0.001). The differences between the two groups in the duration of the first cry, total duration of cry and number of skin punctures needed to obtain blood were not statistically significant, but these parameters displayed a trend, favouring the HP.
                The HP is still the preferred method of drawing blood in neonates for blood glucose monitoring, as only one drop of blood is required.
Venepuncture, when performed by a skilled phlebotomist, appears to be the method of choice for blood sampling in term neonates. The use of a sweet tasting solution further reduces the pain. 
Further well designed randomised controlled trials should be conducted in settings where several individuals perform the procedures.