Efeitos da contenção facilitada e do enrolamento na redução da dor no recém-nascido prematuro: ensaio clínico cruzado

Abstract

The Neonatal Intensive Care Unit (NICU) is the ideal environment for the premature infant’s survival and hospitalization, but it has characteristics that put their extrauterine development at risk, such as the many painful procedures. Among these procedures, venous puncture is one of the most frequent performed by nursing. In the face of a painful stimulus, the newborn (NB) can manifest changes in physiological and behavioral parameters, being needed pain relief interventions. The aim of this study is to analyze the efficacy of the effects of facilitated tucking and swaddling to reduce pain in premature newborns during arterial blood sampling. This is a randomized crossover clinical trial with 15 participants, aging from 32 to 36 weeks and 6 days. They were subjected to experimental condition (facilitated tucking) and control condition (swaddling) during arterial blood sampling. In order to assess it was used the following instruments; infant characterization, pain scale (named PIPP-R) and analysis of synchronous-active theory. The study was authorized by the Research Ethics Committee, as number: 4.503.258 and registered at ReBec nº: 8v9x7f9. For data analysis, it was used the chi-square or Fisher's Exact Test, Tukey or Dunnett Test, Wilcoxon-Mann-Whitney Test and Correspondence Analysis. Results: It showed that there was a predominance of the female gender, also that the average weight in the first sampling was 1596 g, all preterm infants had Apgar greater than or equal to seven in the 5th minute of life. Regarding the procedure for arterial blood sampling, it was found that in both conditions the collection process took less than 60 seconds, and the choice was the brachial artery. Regarding physiological parameters (heart rate, respiratory rate and oxygen saturation); and pain assessment by the PIPP-R scale it didn´t have statistically significant difference between the conditions under this study. The findings regarding the synchronous-active theory, through correspondence analysis showed an early organizational pattern of the preterm infants who were submitted to facilitated tucking. It is concluded that both interventions facilitated tucking and swaddling are successful non-pharmacological strategies to manage pain in preterm infants who are submitted to arterial blood sampling. However, the experimental condition showed better results for pain scale and in the pattern of developmental organization.