Systematic Review Protocol Title: The effectiveness of non-pharmacological pain management in reducing pain from heel stick blood sampling in newborns Network: Mahidol University JBI Evidence Translation Group

The heel stick procedure, in which the plantar surface of the heel is punctured by a lancet to a depth of 2-3 mm, is the most common way of drawing blood from newborn infants 1. Although, the heel stick procedure is short in duration, it can affect behavioral and physiological responses such as facial expression, heart rate, respiratory rate, and oxygen saturation of the infants 2-6. Untreated pain in newborns has adverse physiologic consequences including blood pressure and glucose alteration 7, 8. The short-term effects may include feeding problems, parent-infant interaction dysfunction, and interruption of sleep-wake cycles. Possible long-term effects of repeated heel sticks include impairments of neurodevelopment, learning, and memory 6, 7. A number of non-pharmacological pain management interventions have been used to reduce pain from heel stick in preterm and full term neonates. These include swaddling 3, 4, 9