VENIPUNCTURE IS MORE EFFECTIVE AND LESS PAINFUL THAN HEEL LANCING FORBLOOD-TESTS IN NEONATES

Objective. Heel lancing has hitherto been the method of choice for scr eening tests of inborn errors of metabolism in neonates. Eutectic mixt ure of local anesthetic has little, if any, analgesic effect when appl ied to the heel of pre-and full-term infants. Today there seems to be no practical method that effectively alleviates the pain caused by hee l lancing. The aim of this study was to investigate whether other meth ods, such as venipuncture of the dorsal side of the hand, are less pai nful and more efficient than heel lancing in neonates. Methods. One hu ndred twenty healthy, full-term infants who underwent testing for phen ylketonuria (PKU) were included in the study. They were randomized int o three groups: a venipuncture group (VP) (n = 50), a heel-lance group with a small lancet (SL) (n = 50), or a large lancet (LL) (n = 20). P ain reactions were assessed by the Neonatal Facial Coding System (NFCS ). The latency and duration of the first cry as well as the total scre aming time was analyzed. The efficacy of the method was assessed by th e time taken to complete the PKU test and number of times the skin had to be punctured. Results. Nociceptive response. The NFCS scores after the first skin puncture were: VP, 247; SL, 333; and LL, 460. The NFCS scores were significantly lower in the VP than in the groups subjecte d to heel lancing. During the first 60 seconds after skin puncture, 44 % of the infants cried in the VP group, compared with 72% and 85% in t he SL and LL groups, respectively. Efficacy. A successful PKU test wit h only one skin puncture was performed in 86% of the VP group, but in only 19% in the SL group and 40% in the LL group. The total time neede d to obtain the PKU blood sample was 191 seconds (median) in the VP gr oup, 419 seconds in the SL group, and 279 seconds in the LL group. Con clusion. Venipuncture is more effective and less painful than heel lan cing for blood tests in neonates.