During the first 24 hours after birth, nearly every Israeli newborn is subjected to a painful but routine heel prick or needle stick to screen the blood for disease or rare genetic disorders. In most cases that needle stick is administered without pain relief. But a new review of evidence suggests that breastfeeding can ease the pain of such routine procedures.
"Babies who were breastfed experienced less pain, compared to not giving anything, or just swaddling them or using a placebo of sterile water," said Dr. Prakeshkumar Shah, a neonatologist at Mount Sinai Hospital in Toronto. Shah's team gathered data from 11 studies of more than 1,000 newborns. The trials tested the effectiveness breastfeeding and breast milk compared to sugar water or a pacifier to counter the discomfort of the babies' first needle. Breastfeeding works better than no intervention or a placebo to extinguish the signs of pain, but was about as effective as highly concentrated sugar water, the review found. It's uncertain exactly how breastfeeding dampens pain, but the reviewers suspect that a mother's comforting presence, skin-to-skin contact, diversion of attention and the sweetness of breast milk all work together to soothe infants.
The meta-analysis appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care and draws evidence-based conclusions. The Cochrane review shows that breastfeeding is well tested as a pain-relief alternative, Gray said, and should be suggested to parents as the standard of care for newborns.
Getting breastfeeding to work in a hospital setting is much more labor-intensive than giving a baby a pacifier or swaddling. Most of the data is from healthy full-term newborns, but the findings also suggest that breastfeeding is a pain-relief possibility for premature babies, who often have to undergo many painful procedures in neonatal intensive care units.
"We are looking for a natural, inexpensive, easily available approach to reduce pain in those babies," Shah said.
Repeated painful procedures can cause premature babies to suffer rises in blood pressure and heart rate, as well as lower oxygen levels, Shah said. And under stress, extremely premature newborns have a higher risk for brain hemorrhage, he said.
"Right now quite a lot of hospitals have adopted the practice of giving sugar water to those babies for analgesia. But we don't know what happens to them long term by exposing them to high concentrations of sugar." While the long-term effects aren't clear, Shah said, some short-term studies have found delayed motor skills and lower neurological scores for preemies given sugar water for pain. "I think more research is needed on the effectiveness of breastfeeding and breast milk for those babies. What we are proposing in this review is to do further research on those sick babies admitted to the unit who are exposed to multiple painful procedures."
Veteran breastfeeding education expert Wendy Blumfield comments that she always advises mothers to breastfeed immediately after the ritual circumcision to comfort infants, and because the sugar in the breast milk has an analgesic effect. Huge boosts of sugar water can be hazardous for some babies, and what is more natural than the mother and baby get together after they have both been traumatized?"
The problem with using this simple method of pain relief for hospital procedures, she explains, "is that in most hospitals the mother and baby are separated for those very hours that the neonatal staff carry out these tests. Even where there is rooming-in, there is still that period of separation during the time that the mum and baby are transferred from the delivery room to the postnatal ward/neonatal nursery respectively. There is no reason why those procedures cannot wait until the mother is with the baby so that she can breastfeed at the same time."
NEW TAU MEDICAL SCHOOL DEAN
Prof. Yossi Mekori, a veteran allergy and internal medicine specialist and immunologist at Meir Hospital in Kfar Saba, has been named the next dean of Tel Aviv University's Sackler Faculty of Medicine, replacing Prof. Dov Lichtenberg, who has completed his four-year term. It is the first time that a graduate of the medical faculty has become its dean. Former head of the Israel Society for Allergy and Clinical Immunology and director of the Felsenstein Institute for Medical Research in Petah Tikva, he was also chief scientist of Clalit Health Services and an adviser to the UN's Food and Agriculture Organization. In the past three years, he has served as associate dean of the Sackler faculty.
KEEP SPECIAL KIDS SAFE
Jerusalem's Alyn Hospital - Israel's national pediatric and adolescent rehabilitation center - not only treats disabilities but also tries to prevent them. Thus it has just launched a national campaign to promote safe seating in vehicles of physically handicapped children. Many of its patients were seriously injured in road accidents, and some are paralyzed or otherwise confined to wheelchairs, so when they are transported from place to place, it's important to seat them safely.
The hospital, with help from an advertising agency, prepared posters, magnets, stickers and information booklets on the subject. In an effort funded by philanthropists, a "Safe Travel" van will roam the country to about 200 institutions that care for children with special needs and explain safe seating to parents and institution directors.
Alyn is also meeting with Israel Police and Transport Ministry officials about enforcement of laws regarding the seating of disabled children. More information can be obtained by calling the Alyn information center at (02) 649-4277 or e-mailing firstname.lastname@example.org.