Multicentre, randomised controlled trial to investigate the effects of parental touch on relieving acute procedural pain in neonates (Petal)

Maria M Cobo, Fiona Moultrie, Annalisa G V Hauck, Daniel Crankshaw, Vaneesha Monk, Caroline Hartley, Ria Evans Fry, Shellie Robinson, Marianne van der Vaart, Luke Baxter, Eleri Adams, Ravi Poorun, Aomesh Bhatt, Rebeccah Slater, Maria M Cobo, Fiona Moultrie, Annalisa G V Hauck, Daniel Crankshaw, Vaneesha Monk, Caroline Hartley, Ria Evans Fry, Shellie Robinson, Marianne van der Vaart, Luke Baxter, Eleri Adams, Ravi Poorun, Aomesh Bhatt, Rebeccah Slater

Abstract

Introduction: Newborn infants routinely undergo minor painful procedures as part of postnatal care, with infants born sick or premature requiring a greater number of procedures. As pain in early life can have long-term neurodevelopmental consequences and lead to parental anxiety and future avoidance of interventions, effective pain management is essential. Non-pharmacological comfort measures such as breastfeeding, swaddling and sweet solutions are inconsistently implemented and are not always practical or effective in reducing the transmission of noxious input to the brain. Stroking of the skin can activate C-tactile fibres and reduce pain, and therefore could provide a simple and safe parent-led intervention for the management of pain. The trial aim is to determine whether parental touch prior to a painful clinical procedure provides effective pain relief in neonates.

Methods and analysis: This is a multicentre randomised controlled trial. A total of 112 neonates born at 35 weeks' gestation or more requiring a blood test in the first week of life will be recruited and randomised to receive parental stroking either preprocedure or postprocedure. We will record brain activity (EEG), cardiac and respiratory dynamics, oxygen saturation and facial expression to provide proxy pain outcome measures. The primary outcome will be the reduction of noxious-evoked brain activity in response to a heel lance. Secondary outcomes will be a reduction in clinical pain scores (Premature Infant Pain Profile-Revised), postprocedural tachycardia and parental anxiety.

Ethics and dissemination: The study has been approved by the London-South East Research Ethics Committee (ref: 21/LO/0523). The results will be widely disseminated through peer-reviewed publications, international conferences and via our partner neonatal charities Bliss and Supporting the Sick Newborn And their Parents (SSNAP). If the parental tactile intervention is effective, recommendations will be submitted via the National Health Service clinical guideline adoption process.

Study status: Commenced September 2021.

Trial registration number: NCT04901611; 14 135 962.

Keywords: neonatology; neurophysiology; pain management.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Trial flowchart. IVH, intraventricular haemorrhage.
Figure 2
Figure 2
Trial procedures. EEG, electroencephalography; PIPP-R, Premature Infant Pain Profile-Revised.

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