European Journal of Pediatrics

, Volume 171, Issue 6, pp 927–933 | Cite as

Stress response and procedural pain in the preterm newborn: the role of pharmacological and non-pharmacological treatments

  • Eloisa GittoEmail author
  • Salvatore Pellegrino
  • Maria Manfrida
  • Salvatore Aversa
  • Giuseppe Trimarchi
  • Ignazio Barberi
  • Russel J. Reiter
Original Article


Repeated invasive procedures occur routinely in neonates who require intensive care, causing pain at a time when it is developmentally unexpected. Multiple lines of evidence suggest that repeated and prolonged pain exposure alters their subsequent pain processing, long-term development, and behaviour. Primary outcome of this study was to evaluate the reduction of procedural pain induced by “heel-lances” in preterm newborns with three different treatment [administration of fentanyl (FE, 1–2 μg/kg), facilitated tucking (FT), sensorial saturation (SS)]. Secondary outcome was the measurement of the levels of cytokines as markers of stress correlated to pain. A prospective randomized controlled trial (RCT) comparing three different pharmacological or non-pharmacological treatments was performed involving 150 preterm newborn (gestational age 27–32 weeks). No other analgesic treatment was performed during the study. CRIES score was used to evaluate the procedural pain. The results showed that the reduction in the pain score was greater in FE and SS groups than FS group. The differences were statistically significant (p < 0.01). The levels of IL-6, IL-8, and TNF-α were higher in the FT individuals than in the FE or SS-treated infants at 1 day (p < 0.01), at 3 days (p < 0.01), and at 7 days (p < 0.01) of life. Conclusions: The findings of this study suggest that FE and SS provide a superior analgesia in preterm neonates during procedural pain. In particular, sensorial saturation seems to be an important non-pharmacological alternative treatment to prevent and reduce the procedural pain in preterm newborn.


Preterm Stress response Interleukins Procedural pain 


Conflict of interest statement

The authors declare that they have no conflict of interest. Authors have no a financial relationship with the organization that sponsored the research.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Eloisa Gitto
    • 1
    Email author
  • Salvatore Pellegrino
    • 2
  • Maria Manfrida
    • 1
  • Salvatore Aversa
    • 1
  • Giuseppe Trimarchi
    • 3
  • Ignazio Barberi
    • 1
  • Russel J. Reiter
    • 4
  1. 1.Neonatal Intensive Care Unit, Department of PediatricsUniversity of MessinaMessinaItaly
  2. 2.Ph.D. Fellowship in Clinical and Bio-molecular Hepato-Gastroenterology of Paediatric and Adult AgeUniversity Hospital “G. Martino”MessinaItaly
  3. 3.Department of StatisticsUniversity of MessinaMessinaItaly
  4. 4.Department of Cellular and Structural BiologyThe University of Texas Health Science CenterSan AntonioUSA

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