Pain management strategies for peripheral arterial puncture/cannulation in neonates: A systematic review and meta-analysis
Bibliographic record
Abstract
Abstract Objectives Arterial puncture/cannulation is considered to be a severely painful procedure. Both non-pharmacological and pharmacological interventions are recommended by professional organizations to alleviate pain in neonates undergoing arterial puncture/cannulation, but these recommendations are not based on systematic review of the literature. The primary objective of this systematic review and meta-analysis was to synthesize the literature on pain management strategies in this setting. Methods Databases were searched for randomized trials evaluating pharmacological and non-pharmacological interventions for pain mitigation for arterial puncture/cannulation from inception to July 2024. The literature search was updated in June 2025 and no additional eligible articles were identified for inclusion. Title and abstract screening, full-text screening, and data extraction were performed in duplicate. The risk of bias was assessed using Cochrane’s risk of bias (RoB) 2.0 tool. The critically important outcome was pain measured using validated tools including unidimensional behaviour and multidimensional (comprising combinations of contextual, behavioural, and/or physiological components) tools. Secondary outcomes included procedure success and adverse events. Pooled effect estimates were standardized mean difference (SMD) and relative risk (RR) with 95% confidence intervals (CI) using random effects models. A GRADE assessment of the overall certainty of the evidence for each outcome was completed. Results Five studies including a total of 358 neonates were included. All assessed pain from arterial puncture rather than cannulation. The interventions evaluated in the included studies were: 1) white noise (50 dB) compared to control (0 dB), 2) expressed breast milk compared to 25% oral dextrose, 3) music, 25% oral dextrose or both, 4) familiar scent compared to unfamiliar scent or control, and 5) 24% oral sucrose compared to no intervention. Expressed breast milk was effective in reducing procedural pain compared to 25% oral dextrose (SMD -0.95 [95% CI -1.64, -0.24]; n = 36). The familiar scent was effective in reducing the duration of cry when compared to unfamiliar scent (MD -22.96 [95% CI -33.20, -12.72]; n = 90) and control (MD -25.22 [95% CI -35.22, -15.22]; n = 90) respectively. There was low certainty of evidence for all critical outcomes. No statistically significant difference was demonstrated for other comparisons. Conclusion: Expressed breast milk and familiar scent may be effective in reducing pain during arterial puncture based on single studies, however, there is low confidence in the estimates of effect. There is a need for further research on pharmacological interventions for this procedure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.035 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.039 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".