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The Effect of Swaddling and Oropharyngeal Colostrum During Endotracheal Suctioning on Procedural Pain and Comfort in Premature Neonates: A Randomized Controlled Trial.

  • 2024-08-27
  • Advances in neonatal care : official journal of the National Association of Neonatal Nurses 24(5)
    • Huriye Karadede
    • Birsen Mutlu
    • Birsen Mutlu

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 16
Population
48 intubated premature neonates (swaddling group n = 16; oropharyngeal colostrum group n = 16; and control group n = 16) at 26 to 37 weeks of gestation
Methods
Randomized controlled experimental study; neonates were swaddled with a white soft cotton cloth or administered 0.4 mL of oropharyngeal colostrum 2 minutes before ES; two observers evaluated pain and comfort by observing video recordings

Background

Endotracheal suctioning (ES) is a painful procedure frequently performed in the neonatal intensive care unit. This procedure negatively affects the comfort level of premature neonates.

Purpose

To determine the effect of 2 nonpharmacologic methods, swaddling and the administration of oropharyngeal colostrum, on the pain and comfort levels of preterm neonates during ES.

Methods

This randomized controlled experimental study comprised 48 intubated premature neonates (swaddling group n = 16; oropharyngeal colostrum group n = 16; and control group n = 16) at 26 to 37 weeks of gestation. The neonates were swaddled with a white soft cotton cloth or administered 0.4 mL of oropharyngeal colostrum 2 minutes before ES, according to the group in which they were included. Two observers evaluated the pain levels (Premature Infant Pain Profile-Revize [PIPP-R]) and comfort (Newborn Comfort Behavior Scale [COMFORTneo]) of the infants by observing video recordings of before, during, and after the procedure.

Findings/results

A significantly lower mean PIPP-R score was found in the swaddling group during ES compared with the control group ( P = .002). The mean COMFORTneo scores of the swaddling and oropharyngeal colostrum groups during ES ( P < .01, P = .002) and the mean PIPP-R and COMFORTneo scores immediately after ES and 5, 10, and 15 minutes later were significantly lower than the control group ( P < .005).

Implications for practice and research

Swaddling was effective both during and after the procedure, while oropharyngeal colostrum was effective only after the procedure in reducing ES-related pain in premature neonates. Swaddling and oropharyngeal colostrum were effective in increasing comfort both during and after the procedure.

Research Insights

  • Colostrum→Improved Comfort After Procedure

    The mean PIPP-R and COMFORTneo scores immediately after ES and 5, 10, and 15 minutes later were significantly lower than the control group (P < .005).

    Effect
    Beneficial
    Effect size
    Small
    Dose
    0.4 mL
  • Colostrum→Improved Comfort During Procedure

    The mean COMFORTneo scores of the swaddling and oropharyngeal colostrum groups during ES (P < .01, P = .002) were significantly lower than the control group.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    0.4 mL
  • Colostrum→Reduced Pain Score

    The mean PIPP-R and COMFORTneo scores immediately after ES and 5, 10, and 15 minutes later were significantly lower than the control group (P < .005).

    Effect
    Beneficial
    Effect size
    Small
    Dose
    0.4 mL
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