The Effects of Different Strategies on the Painful Procedure Management, and the Physiological Parameters in Preterm Infants: A Systematic Review


1 Assistant Professor of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Asistant Professor of Pediatrics, Department of Pediatrics, Faculty Of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Fellowship of Neonatology, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Midwifery, Firoozabad Branch, Islamic Azad University, Firoozabad, Iran.


Background: Since preterm infants are subjected to numerous painful and stressful procedures, various strategies reducing the effects during and after painful procedures are required; we aimed to review the effectiveness of the use of different strategies as a primary or adjunctive treatment on the painful procedures, and the physiological parameters in preterm infants.
Materials and Methods: In this systematic review, English databases such as PubMed, Scopus, ISI Web of Science, Cochrane Library and EMBASE were systematically searched without any time limitation up to February 2019. The search keywords were (Aromatherapy OR Olfactory OR Amniotic Fluid OR Milk or odor) AND (Pain OR Venipuncture).
Results: Finally, four articles were included. The first study conducted on four groups indicates that the pain profile score and the crying time slightly differed during and after the heel prick procedure. In the second study, having pricked the heel, the breast milk group in comparison with the formula milk group embodied the lower premature infant pain profile (PIPP) score. According to the third study, both the vanilla and the breast milk odors groups indicated soothing effects on the premature infants during sampling; and only the breast milk odor is the soothing factor affecting the infants after the sampling termination. The fourth study found that the infants, who were exposed to their own mother’s milk odor, when compared with the control group, encompassed the lowest median PIPP score during venipuncture.
Conclusion: Amniotic fluid, the mother’s milk, vanilla and the mother’s odor were determined as reduction and enhancement factors affecting painful procedures and physiological parameters in preterm infants, respectively.