The Effect of Different Positions of the Premature Babies upon their Pain Responses during Withdrawing Blood Samples.

Abstract

Pain in the newborn is a very complex subject. Before the year 1980, neonatal pain was infrequently recognized, appreciated and treated. The pioneering work of dedicated clinicians and scientists in the last three decades, both in laboratories as well as clinical situations has established that neonates perceive pain, express pain and have the right to proper pain management (Anand and Whithall, 2009). Still, infants continue to be exposed to far too much pain that is preventable and treatable (Suson Ludington, 2005). Because neonates can not verbalize their pain, they depend on others to recognize, assess and manage their pain (Criag, 2002). As pain is a multidimensional phenomenon, a multidimensional measure of pain, combining behavioral and physiological factors with contextual factors such as gestational age and behavioral state, has been found to be superior to other measures (Stevens et al., 2000). The Premature Infant Pain Profile (PIPP) fulfills this requirement and is easy to use (Stevens et al., 1996). Aim of the work: The present study aimed to study the effect of different positions of the premature babies upon their pain responses during withdrawing blood samples. Research Hypothesis The prone position can affect positively the pain responses for preterm neonates than supine position. Research Design Quasi experimental study design was used. Setting This study was conducted at Neonatal Intensive Care Units at the Hospital of Obstetrics and Gynecology affiliated to Ain Shams University Hospital and Menia El-kamh General Hospital in El-sharqia city. Subject A purposive sample included all available preterm neonates (100) in neonatal intensive care units in previous mentioned setting. Following criteria: I- Inclusion criteria: - Gestational age of preterm between (36-37) weeks. - Weight more than 2.200 kg. - Undergoing blood sampling withdrawal.

II- Exclusion criteria: - Free from condition such as:- a- Severe respiratory distress. b- Congenital anomalies. c- Infectious diseases as sepsis or meningitis. d- Jaundice as hyperbilirubinemia. - Not connected with an artificial ventilator or phototherapy.

Tools of data collection Data were collected by using the following two tools: 1- Medical records of preterm neonates. Basic data of preterm neonates during procedures as (Gestational age, sex, weight, length, diagnosis, age… etc). 2- Premature Infant Pain Profile. Pain level assessment scale. The PIPP tool creates a total score from 0-21. While, a score of 0-6 reflecting mild pain, 7 - 12 reflecting moderate pain, and above 12 indicating severe pain.

Operational Design Pilot study: A pilot study was carried out before starting the data collection in 2013 for two weeks, to test the applicability, and the clarity of study tools. It was applied to (10) preterm neonates that withdraw blood samples to evaluate the content validity of the study tools. Field of work: The researcher collected the data two days a week (Sunday and Wednesday) from 8am to 2pm in NICUs. The actual period of data collection started from April, 2013 to the end of September, 2013. Each neonate in the study was assessed the effect of different positions of the premature babies upon their pain responses during withdrawing blood samples through (PIPP) for pain assessment.