[Back-of-the hand venepuncture. An alternative to heel puncture?]

Introduction: Using heel puncture by lancets for the determination of metabolic tests (hypothyroidism and phenylketonuria) using heel puncture is a very painful procedure. Venepuncture can be used as an alternative.

Objectives: To determine whether venepuncture in the dorsal side of the hand is less painful and more efficient than heel puncture in the screening test for inborn errors of metabolism, as well as comparing false positives in the hypothyroidism test.

Material and methods: We tested 607 consecutives newborns in an observational, randomised study (280 with venepuncture, and 327 with heel puncture). Pain response was assessed using the Neonatal/Infant Pain Scale (NIPS), and the delay and duration of the first cry. We measured the number of punctures needed, and the time taken to complete the test, as well as the number of false positives in the hypothyroidism test.

Results: Venepuncture was less painful than heel prick (NIPS 2 vs 5, P<.001), as well as in the delay (crying in 57.8% vs 90.2%, P<.0001) and duration of the cry (58 vs 104 seconds). Venepuncture was also faster (60 vs 120seconds), and required less puncture attempts. There were no differences in cases with TSH greater than 5mU/mL, or greater than or equal to 9 mU/mL.

Conclusions: Venepuncture is associated with less pain, is faster to perform and not is associated with more false positive cases.