Title:  Effects of Upright Positioning Combined With Swaddling During Routine Newborn Heel Stick Procedures in Term Neonates
Investigators: 
Primary Investigator: Morrow, Carla MSN, RNC, CNS, WHNP,
Co- Investigator: Hidinger, Andrea MSN, RNC, IBCLC,
Co-Investigator:  Debbie Wilkinson-Faulk, PhD, RN, CPNP
Background/Significance:
Neonates can undergo multiple routine heel stick procedures during the initial hospital admission.  Despite various studies examining the role of pharmacologic and non-pharmacologic methods to reduce pain, there are no effective and practical methods of alleviating pain from routine heel sticks. The primary  purpose of our study was to measure the effectiveness of position change combined with swaddling for infants undergoing routine heel stick procedures. Additionally, we sought to compare total collection time among infants in each group.
Objectives:
1.     Measure pain differences using the Neonatal Infant Pain Scale (NIPS) between neonates in standard positioning technique and infants who are swaddled and held upright during routine heel stick procedures
2.      Determine collection time for each group
3.      Compare the number of specimens rejected from the lab.
Experimental Design and Methods:
Term neonates admitted to the well newborn nursery who qualified  for Total Serum Bilirubin (TSB) testing were invited to participate in the study.   All neonates who meet criteria for participation were consented prior to entering the study. Six registered nurses working in the nursery were selected to participate in this pilot study. A total of 39 infants were enrolled into the study. Each infant was randomly assigned to either the control group (n=17) or the experimental group (n=22).  Infants in the control group were placed in standard position while infants assigned to the experimental group were swaddled and held upright during the routine heel stick procedure.  Pain was measured using the NIPS at two designated times for each group (just before the heel stick and at the completion of the heel stick). Total time of collection for each group was measured  using a stop watch. Specimen quality was also be measured based on the number of rejected specimens for each group.
Results:
The mean NIPS score for the control group was 2.5 sd 1.06 compared to 1.3 sd 0 .9  (p=.02) While the total collection time was lower for infants who were swaddled with a mean of  2.17 minutes compared to a mean of 2.47 minutes, this result was not clinically significant (p=.45). None of the specimens in either group were rejected based on specimen quality.
Conclusion:
Nurses are expected to assess and address infant pain needs during painful procedures. We found the technique of swaddling infants while holding them in an upright position was superior when compared to standard position technique during routine heel stick procedures. Therefore, nurses should routinely place infants in this position during routine heel stick procedures. Additionally, we found the overall collection time for this group was less than the group undergoing standard positioning. While this result was not clinically significant future studies with larger sample sizes may aid in determining the overall significance to nursing practice.