Maternal facilitated tucking versus nurse facilitated tucking for alleviation of pain during neonatal heel lancing: A randomised, two-period, cross-over trial

Background and objectives Preterm neonates undergo multiple painful procedures in neonatal intensive care units (NICU). It is difficult for nurses to utilise non-pharmacological pain control measures every time due to low nurse-patient ratio. Mother is a low-cost resource and can be integrated in management of neonatal pain. The current study was planned to compare maternal facilitated-tucking with nurse facilitated-tucking for pain alleviation following heel-lancing in preterm neonates. Methods A Randomised, controlled, two-period, cross-over trial was conducted in a level III NICU of a tertiary care hospital. Participants included preterm neonates (≤35 wk) admitted in NICU. Interventions included: facilitated-tucking provided to preterm neonates during heel-lancing by simulation-trained mothers or nurses. The tucking sequence was randomised (AB/BA sequence). The primary outcome was the premature infant pain profile - revised (PIPP-R) score. The study was registered under Trial registration: CTRI/2023/08/056592. Results Study neonates (n=45) had significantly lower PIPP-R following maternal tucking compared to nurse facilitated tucking: [10.1 (2.9) versus 11.8 (2.8); mean difference (95% CI): -1.7 (-2.8,-0.6); P =0.003]. No period effect and carry-over effects were observed. Pre-post intervention maternal confidence and parenting-self-efficacy scores were significantly higher, and stress levels were significantly lower. Interpretation and conclusions During heel-lancing of preterm neonates in the NICU, tucking performed by simulation trained mothers was associated with a significant reduction in pain compared to tucking performed by nurses.