Five ways to make blood draws less painful for a preemie

Yes, a painless or at least less painful blood draw is possible, and the sooner you start, the greater benefit you’ll see.

Preemies are easily sensitized to pain in the NICU. Studies show painful procedures (heel sticks, blood draws, lumbar punctures, etc.) as a newborn can prime the nervous system, so subsequently painful experiences are felt more acutely (think of it like turning up the volume on the pain signals).

There are five interventions that can reduce the burden on your baby’s nervous system and help him (and you) feel better:

  • Kangaroo care. Holding your baby close to you is very comforting. Your baby will know your smell and touch, even if he can’t yet see. ¬†Mom or dad’s familiar touch is comforting and who doesn’t feel better with a cuddle?
  • Swaddling. This helps a baby stay organized. Pain is a trauma makes the nervous system disorganized, which can have consequences on nervous system development. Keeping your baby as organized as possible during the event (or regrouping as soon as possible afterwards) will help their nervous system get back on track the fastest.
  • Sugar. Yes, glucose – a 30% solution, which is almost 3X more sugar than Coke (I was surprised to find out that Coke is only 11% sugar!). Apparently we are hardwired from before birth to love sugar (it makes out brain churn out endorphins, the chemicals that make us feel good).
  • A pacifier. They are called that for a reason. Non-nutritive sucking (medical term for using a pacifier) also helps the nervous system reorganize.
  • EMLA, which is a combination of two topical anesthetics (numbing creams). There is more experience with EMLA in kids than preemies in the NICU; however, in one NICU study EMLA did not perform anywhere near as well as sugar in a head-to-head comparison against venipuncture (blood draws). EMLA also has to be applied 60 minutes before the procedure and needs to be sealed under an occlusive dressing. Finally, repeated applications in a premature baby can lead to increased methemoglobin levels (an altered form of hemoglobin, the actual molecule that carries oxygen – high methemoglobin levels also happen with carbon monoxide poisoning).

What to do? Hold your baby when ever possible and don’t be shy about asking for glucose or a pacifier. If it is a procedure where you can’t do kangaroo care, make sure your baby gets¬†swaddled as long as that won’t interfere with performing the procedure and sugar (swaddling and sugar was routine at our NICU for eye exams). Even during a lumbar puncture your baby may be able to suck on a sugar coated pacifier. If your baby is on a ventilator or for whatever other reason can’t take a sugar solution, ask about EMLA.

And don’t forget about EMLA once you get home. The fact is, you can’t keep giving your baby a mega-dose of glucose every time they need an eye exam or needle stick. After several years of physically restraining Victor for all his blood draws (and driving to different labs so he wouldn’t freak out in the car, “Surprise, a new office with needles!”), I remembered the EMLA. Now we have the most pleasant experience, although it still doesn’t prevent him for asking for M&Ms or a toy!

Parting pointer: keep EMLA in a kit to take if you ever need to go to the emergency room, especially if it isn’t a kid friendly ER. When I head in with Oliver at 2 a.m. to the ER knowing blood work is almost a guarantee, I put the EMLA on before we leave, so by the time we get there, his arms are good and ready.

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Remember, this blog is not direct medical advice. All prescription medications should be used only under the supervision of a physician.

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5 Responses to Five ways to make blood draws less painful for a preemie

  1. Pingback: Tweets that mention Five ways to make blood draws less painful for a preemie | The Preemie Primer Guide from Dr. Jen Gunter -- Topsy.com

  2. tanniah says:

    I found hydration was a huge deal when my child was very young. One time, after multiple attempts, including by the head of the dept at that children’s hospital (and the baby, and my mom both hysterical crying), I nursed the bugger, and pop, the vein showed and they got a draw immediately. THEN they mentioned that hydration sometimes helped.

  3. Thanks for another great post!

    I just wanted to clarify a bit more about the “sugar” — in the NICU we actually use 24% sucrose solutions (not glucose 30%) — there are currently two products comerically available to the hospital (Toot-Sweet by Hawaii Medical/Natus and Sweet-Ease by Children’s Medical Ventures/Philips) — and there are even recipes to make your own using table sugar too. There are two very important issues with the use of sucrose solutions… #1 — It needs to be absorbed by the oral mucosa, not ingested…so the practice of squirting a bit in to the mouth is not the best, it works best if a pacifier is dipped in to the solution… and #2 It should be given at least 2 minutes before the procedure (and then can be repeated during and after depending on hospital protocols and weight).

    As for EMLA — it is great, but the time required does make its less than ideal for use in emergent situations. As a NNP I love using it for lumbar punctures and PICC lines. Unfortunately, it does not work for heel sticks but Sucrose, holding, and pacifiers are very effective for those.

  4. Jennifer Gunter says:

    Kathi,

    Thanks so much for posting. Glucose and sucrose are very similar in many ways. Sucrose is table sugar and is a disaccharide made up of two monosaccharides – glucose and fructose. Glucose is the natural form (beet sugar etc.) and sucrose is the man made combination of glucose plus fructose. Sucrose is a little bit sweeter than glucose (if sucrose has a sweetness of 1.0 then glucose has a sweetness of 0.74) but they a have the exact same calorie composition: 4 cal/g. Because sucrose is sweeter, a 24% concentration is the same as a 30% of glucose. I used glucose in the posting because that is the product tested in the article I quoted in the head-to-head comparison with EMLA. So both glucose and sucrose are sugar, and both need to be absorbed by the oral mucosa for rapid to get the desired endorphin release (as you mentioned, traditional digestion is just too slow).

    Parents, just ask for sugar! Sorry for any confusion.

    Jennifer

  5. Pingback: Five Ways To Make Blood Draws Less Painful For A Premature | Pacifier Reviews

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