Ask an answerable question (PICO)：
Newborn screening is a routine examination conducted for every infant during hospitalization in the postnatal care period. The Ministry of Health and Welfare, Taiwan, aims to identify congenital metabolic disorders early through newborn screening, facilitating the prompt detection, prevention, and treatment of issues in newborns. Therefore, within 24 hours of breastfeeding or 48 hours after birth, blood is collected from both sides of the newborn's heel using a puncture needle. This procedure is carried out in the nursery, with the newborn lying flat on an infant bed, wrapped in a towel with the heel exposed for heel stick blood sampling. The newborn experiences pain during the blood collection, leading to crying. Breastfeeding is a natural, easily accessible, and potentially risk-free measure. Numerous studies have assessed the management of neonatal pain through breastfeeding. Consequently, this has led to an interest in conducting a systematic literature review to explore whether breastfeeding during heel stick blood sampling can reduce the pain and crying experienced by newborns.
The Method and Analysis of Literature Review：
A systematic literature review was conducted, searching databases such as PubMed, Cochrane Library, Airiti Library, and Taiwanese theses and dissertations, up to October 23, 2023. The search utilized the PICO framework (Patient, Intervention, Comparator, and Outcome) to establish keywords in both Chinese and English. Specifically, P included terms such as " infant ", " newborn " , " heel stick " , " heel lance " , " heel prick " , " adopt the heel blood " , and "arterial blood sampling". I included “Breast Feeding”, C included “usual care, routine care”, and O included “pain " or " crying ". This search aimed to identify randomized controlled trial articles exploring whether breastfeeding can reduce the pain and crying induced during heel stick blood sampling in newborns. Four articles were identified that met the specified criteria.
Critical Appraisal：
In accordance with the Oxford Centre for Evidence-Based Medicine (Oxford) hierarchy, all selected articles were categorized as Level 2 evidence. The Critical Appraisal Skills Programme (CASP) was employed to assess the quality of the articles.
Results, Conclusions and Recommendations：
The effectiveness of breastfeeding in reducing newborn pain, based on the results of four studies, is summarized as follows: Three studies included measurements of pain, and among them, two studies demonstrated that breastfeeding is more effective than routine care in alleviating newborn pain. In one study, breastfeeding's effectiveness in reducing pain could not be assessed due to the inability of observers to observe newborn facial expressions, but the results were consistent.
In the measurement of crying behavior across three included studies, results consistently showed that breastfeeding led to shorter crying durations compared to routine care. It is recommended that healthcare professionals provide dedicated spaces for breastfeeding during heel stick blood sampling. Additionally, explaining the blood sampling process to mothers beforehand can increase maternal cooperation and foster parent-infant and nurse-patient relationships. However, due to the limited number of studies, further research is needed in the future to explore this topic more comprehensively.
