Comparison of the Effect of Maternal Breast Milk Odor, Facilitated Tucking, and Nonnutritive Sucking Applied to Preterm Neonates During Heel Stick on Pain and Physiological Parameters: A Randomized Controlled Trial

Background: Preterm infants in the neonatal intensive care unit (NICU) frequently undergo painful procedures, which can lead to both short-term and long-term complications, including potential mortality. Effective pain management is crucial in this context. Although numerous studies have explored non-pharmacological pain relief methods for preterm infants, no research has simultaneously compared the effects of maternal breast milk odor, facilitated tucking, and nonnutritive sucking. Aim: This study aims to comparatively investigate the efficacy of nonnutritive sucking, facilitated tucking, and maternal breast milk odor in reducing pain in preterm neonates during heel sticks. Methods: A randomized controlled trial was conducted in a tertiary-level NICU with 144 preterm neonates (gestational age 31-36 weeks) requiring heel sticks. The infants were randomly assigned to four groups: control, nonnutritive sucking, facilitated tucking, and maternal breast milk odor. Pain and physiological parameters were assessed through video recordings of the procedures and scored at 1-minute intervals using the Premature Infant Pain Profile and Data Evaluation Form. Data were collected at baseline and at 1, 2, and 3 minutes before, during, and after the heel stick. Results: The study found significant effects of the interventions on physiological parameters and pain (heart rate: F = 7.5, p < 0.001; oxygen saturation: F = 16.39, p < 0.001; respiratory rate: F = 6.56, p < 0.001; pain: F = 61.45, p < 0.001). Facilitated tucking resulted in significantly lower pain scores (6.61 ± 1.44) compared with the control group (14.22 ± 3.61), maternal breast milk odor (12.22 ± 3.08), and nonnutritive sucking (10.41 ± 1.71) (p < 0.001). Conclusions: All interventions demonstrated effectiveness in maintaining physiological stability and alleviating pain. Nevertheless, the intervention identified as most effective in reducing pain was facilitated tucking group.